Q & A: SCHOOL MANAGEMENT OF MEASLES
Schools play an important role in preventing disease through enforcing school-enrollment immunization requirements and in controlling disease by following Minnesota Department of Health guidance on excluding susceptible children who have been exposed and could potentially transmit the disease to others. This document provides basic guidance to school districts and charter schools regarding school management of measles outbreaks. If you have further questions, see Minnesota Departments of Health (MDH) and Education (MDE) contacts at the end of this resource.
What do schools need to know about measles?
Measles is a highly infectious disease caused by a virus that is easily transmitted in unvaccinated populations. Measles causes severe illness, can lead to hospitalization and, in rare cases, is fatal. Measles spreads through the air when someone who has the disease breathes, coughs, or sneezes. You can get measles just by being in the same room as an infected person.
Although vaccine rates in the state are high overall, several areas of the state have immunization coverage that is very low, which can result in the spread of measles in the community. Most children and adults who received the Measles, Mumps and Rubella (MMR) vaccine or had measles disease are considered protected. The measles vaccine is typically given at 12-15 months of age and a booster shot between 4-6 years of age.
Individuals not sure if they are protected should contact their health care provider.
People who are severely immunocompromised should contact their health care provider for advice during a local outbreak regarding attending school or any community activity.
For more information, see MDH Measles Basics and the Centers for Disease Control and Prevention - CDC Measles.
Can parents refuse vaccines for their children?
Yes. A parent/guardian may refuse one or more vaccines required for enrollment in child care and schools for conscientiously held beliefs or because the child has a medical exemption (Minnesota Statute § 121A.15, Subd. 3(d)). The school immunization law pertains to public and nonpublic schools.
An exemption statement is on the reverse side of the MDH immunization form. A parent must have the statement notarized if claiming the conscientious exemption.
What happens if a child in our school comes down with a case of measles?
If there is case of measles in your school, MDH will contact the school and provide instructions on how to proceed. State and local public health authorities will help in identifying unprotected children whose families will be notified. Public health determines which children to exclude from school attendance and for how long.
What happens when a child who is not protected from measles has been exposed?
MDH, as the state public health authority, strongly recommends an unprotected child be excluded from child care and school for 21 calendar days from the date of last exposure.
Unprotected or susceptible means the child is not vaccinated (no dose of MMR vaccine) and has not had measles disease. Exposure means being in the same space as a child who has measles during the infectious period (4 days before a rash appears to 4 days after a rash appears). An unprotected child who has been exposed should be excluded from child care or school attendance so that, if the child develops an active case of measles, the disease does not spread to others. People can get measles up to 21 days after being exposed.
MDH interviews the family of an unprotected child and educates them about measles and that children should not attend any childcare, school or group congregate settings such as sports practices or camps. Parents can get a letter with the rationale for the child’s exclusion from child care /or school.
For child care, the health department the contacts the child care facility and the families. For schools, the parent reports the exclusion to the school or the public health team may contact the school.
For questions about general school exclusion or to seek exclusion dates, call MDH at 651-201-5414.
What is the school’s responsibility for educating children excluded from school and confined to the home?
Children who are excluded from school due to measles exposure should be considered homebound for student accounting purposes. A child is eligible for homebound instruction if medically confined to the home and not participating in community activities (MARSS Manual, Homebound Indicator, June 2016).
The school must maintain continuity of learning by providing educational services to the students while they are at home. See the United States Department of Education, Readiness and Emergency Management for Schools (REMS) Technical Assistance (TA) Center Supporting Continuity of Teaching and Learning During an Emergency, March 2015. Also see also the United States Department of Education, Office for Civil Rights, Fact Sheet: Addressing the Risk of Measles in Schools while Protecting the Civil Rights of Students with Disabilities, March 2015.
What education services need to be provided to children receiving special education and related service during exclusion from school attendance?
The child’s IEP or 504 Team must determine how to continue providing a free appropriate public education (FAPE), revising the child’s IEP or 504 to reflect the appropriate services provided while at home. The plan should include how the school will continue to provide specialized instruction to ensure progress toward goals and objectives, instruction in the general education curriculum, ensure progress toward graduation requirements, and provide related aids and services such as speech/language services, occupational therapy services, and assistive technology (34 C.F.R. § 300.115, 34 CFR § 104.033). For further questions about the due process protections and/or services to be provided to children receiving special education services, please contact Sara K. Wolf at 651-582-8602 or sara.k.wolf@state.mn.us.
How does the school district/charter school report continued instruction when a child is excluded from school attendance and confined to home?
For Minnesota Automated Reporting Student System (MARSS) reporting and purposes, the student would be reported as Homebound. Students must receive live and interactive instruction in all subject areas, in person or virtually, for at least one hour of direct instruction per day in order to generate general education revenue and continued student enrollment (Minnesota Statute § 126C.05, Subd. 8). For general education students, the district/charter determines how instruction will be provided, however the instruction must be direct. For example, interactive virtual instruction may be sufficient, but simply sending home worksheets and textbooks would not.
To document the homebound status, the school should retain the following documentation for audit purposes as evidence that the child was medically confined to the home and not participating in community activities:
- The child’s immunization record showing the child was not vaccinated for measles and parent’s conscientious exemption statement; and
- The public health agency notification to the parents recommending exclusion from school attendance with the exclusion dates. The parent or the public health agency will provide this letter.
- Or a statement from the child’s health care provider that the child is immunosuppressed and medically confined to the home.
For more information on types of instruction and reporting, see the MARSS Manual, and find these two resources: Reporting for Students Who Receive Instruction Off-Site, April 28, 2016; and Homebound Indicator, June 2016.
Schools are the hub of communities and public health relies on schools to share information with staff, parents and students. What information should school share to reinforce so that exposed children who are not vaccinated stay home?
To ensure consistency and accuracy, use state and local public health publications as your primary resources:
- MDH Measles fact sheets for staff and parents are available in several languages.
- ECHO resources has videos and print materials for parents and community members in several languages.
For more information:
- Minnesota Department of Health: Erika Yoney, State School Health Consultant, erika.yoney@state.mn.us, 651-201-3631.
- Minnesota Department of Education: Ruth Ellen Luehr, Interagency Education Specialist, ruthellen.luehr@state.mn.us, 651-582-8403
- Minnesota Department of Health Disease Prevention/Control line: 651-201-5414 – exclusion questions
- Minnesota Department of Education - Special Education planning: Sara K. Wolf, sara.k.wolf@state.mn.us, 651-582-8602
Future Communication
MDE-ORG is the repository of current key district/charter schools contacts used by MDE and other agencies. While Superintendents are notified of all key issues, we want to directly contact health services leaders – your District-level RN/Licensed School Nurse.
Please check your District School Nurse (public health emergency) contact for accuracy. Your Site Verification Coordinator makes changes to the list.
This information was being sent to all MARSS Coordinators and Regional Coordinators. Please share this message with others in your schools who would benefit from the information.
As you may be aware, several schools have experienced an outbreak of measles. Students who have not been vaccinated are at risk of contracting the disease, furthering the spread. The Minnesota Department of Health is working to stop the spread and in many cases that involves asking a family to keep exposed children home from day care and/or school if they have not been vaccinated. Refer to the attached document for more information and instructions for MARSS reporting.
The Department of Health has provided a list of schools with relatively low vaccination rates. Should any student in these schools contract measles, the Department of Health will ask students who have not been vaccinated to exclude themselves from school for 21 calendar days. We will be following up with those schools with more detail. If you would like more follow up information specific to MARSS reporting, please respond to the email marss@state.mn.us and MDE will schedule a call with you.
Thank you.
Marilynn Loehr
State MARSS Coordinator
651-582-8456 | marilynn.loehr@state.mn.us
Minnesota Department of Education
1500 Highway 36 West, Roseville, MN 55113
education.state.mn.us