They're getting ready to pack their bags and head to camp. But as kids prepare to share close quarters, there's something parents should know: The United States is facing its largest measles outbreak in seven years -- and measles spreads fast.
After someone with measles coughs or sneezes, the virus lingers for up to two hours after that person walks away.
"The thing about measles is that it's extremely contagious," said Anne Schuchat, director of the Center for Disease Control and Prevention's National Center for Immunization and Respiratory Diseases. "Somebody could get measles without ever having been in the office at the same time as the first child."
The CDC Thursday announced a series of measles outbreaks between January and April 25 that resulted in 64 measles cases in the United States -- the highest number reported in the same time period since 2001. Officials blame a spike in the number of travelers bringing measles in from Israel and Europe. Once in the United States, measles has been able to take hold because more and more people are choosing not to get vaccinated, Schuchat said.
Eleven of the U.S. residents who contracted measles were between the ages of 5 and 19 years old.
"My suggestion would be that summer camps oblige all foreign students to be immunized," said Dr. William Schaffner, chairman of the department of preventive medicine at Vanderbilt University's School of Medicine in Tennessee.
As for American students spending the summer away from home? "Clearly they ought to have their immunization status completely reviewed," he said.
What to Look For
A rash, high fever, runny nose, cough and red, watery eyes are all symptoms of the measles, according to the CDC.
But for parents and camp counselors, that could look a lot like other problems as well.
Fortunately, Schnaffer said there are other distinguishing symptoms, including a "very, very characteristic" rash that starts on a person's trunk and spreads to the limbs, face and the neck. Upon closer observation, doctors also see tiny white spots on the inside of the infected person's mouth.
"It looks as though somebody had just put some salt on the inside of the cheek," Schaffner said.
Still, most doctors, let alone camp staff, aren't nearly as familiar with measles as previous generations were.
"You have to go to somebody with some gray hair who's seen a case of measles," Schaffner said.
At Camp Lakota in New York's Catskill Mountains, camp director Carol Hager said all campers and staff are required to have the vaccine for measles. Between 300 and 350 campers, ages 5 to 17, will attend Camp Lakota this summer. Although Hager said they have kept their eyes on the virus for years, this year, "we're much more aware of it and we're much more cautious."
Hager said the camp nurses will likely give a talk to staff at orientation about what to look out for when it comes to measles. New York is one of four states in which the CDC said a measles outbreak is ongoing.
Measles can spread to other people as early as four days before someone gets a rash and as late as four days after it becomes apparent, according to the CDC.
One in 10 kids who get measles then get an ear infection, and severe cases can lead to pneumonia.
How to Prevent Getting Measles
Getting vaccinated is the most surefire way to prevent catching the disease, as the CDC reports that the vaccine is 99 percent effective.
While about 96 percent of U.S. kindergarten-age children are vaccinated, there are, increasingly, pockets of people across the country who opt out of vaccines for personal or religious reasons.
Though state laws impose vaccinations requirements on schools, with some options available to opt out, many summer programs make their own choices about whether to require vaccines.
At the National Outdoor Leadership School, director of risk management Drew Leemon said neither staff nor students are required to be vaccinated. He added that NOLS is watching the measles situation.
Leemon said some students, though very few, are not vaccinated for religious reasons. NOLS operates programs for people 14 years old and older in the U.S. and abroad, and is running a trip in Europe for the first time this summer.
"We give a lot more advice to our students who are going abroad," Leemon said. "With them, we tell them that they should have their normal vaccinations up-to-date and we refer them to the CDC for any country-specific inoculations that they might need."
Of those who got measles this year, just one had received the full two doses of vaccine that the CDC recommends getting before age 6. The measles vaccine is administered as MMR, a vaccine that protects people from measles, mumps and rubella.
The CDC also found earlier this week that more than one in four U.S. children are not in compliance with official vaccination recommendations because of missed doses of vaccines or vaccine lapses.
That could be the case for some camp staff as well as campers, as Schaffner said teenagers and young adults may have only received one dose and are therefore not "optimally protected."
Still, it's not too late to prepare for summer because the recommended doses can be taken two weeks apart.
"Get 'em vaccinated," Vanderbilt's Schaffner said. "We have two obligations -- to ourselves and to everyone else that we live with."
Camp director Hager said, "You can't be too careful. We even check everybody that comes to camp before they stay over the first night to make sure they don't have lice."