LEONARDTOWN — St. Mary’s County’s measles outbreak has reached 35 confirmed cases, every one of them in an unvaccinated person, and the county’s top health official says the true spread is almost certainly wider than that number shows.
Health Officer Dr. Meena Brewster gave the count, current as of Oct. 21, to the Commissioners of St. Mary’s County, sitting as the Board of Health, on Tuesday, Oct. 27. She said a couple of additional cases were waiting to be added in the health department’s next weekly update, and that “local situational awareness” points to more illness consistent with measles that never makes it into the confirmed tally.
That matters for anyone who is not protected. Measles lingers in the air for a couple of hours after an infected person leaves a room, Brewster said, so people who have never had two doses of the measles, mumps and rubella (MMR) vaccine can be exposed without ever knowing they shared a space with a sick person. Her message to residents was direct: get vaccinated if you haven’t been, and if you develop symptoms and aren’t immune, stay home and call your doctor or the hospital before showing up in person.
Three months into the outbreak
Measles has been a public health problem in the county since late July. The first Southern Maryland cases were confirmed in July, and on Aug. 24 the Maryland Department of Health declared outbreaks in St. Mary’s, Carroll and Cecil counties. At that point St. Mary’s had 13 of the state’s 27 recent cases. The county count has nearly tripled since.
Brewster said three Maryland counties still have active outbreak designations, and Virginia and Pennsylvania have both seen large outbreaks, with Pennsylvania’s still growing. Nationally, the U.S. has already logged more measles cases this year than in decades.
The St. Mary’s County Health Department’s measles page lists its activation status as “Full (Red),” meaning the department has fully activated its incident command system. The case counter there shows 35 confirmed cases reported as of Oct. 22 and carries the same warning Brewster gave the board: the official number may not capture all of the measles activity in the county.
Why kindergarten numbers don’t tell the whole story
One commissioner asked how much vaccine refusal has grown over the past five years. Brewster said she did not have a national figure, and that the county has no single measure of immunity across its whole population.
The best local indicator, she said, is the vaccination rate of children entering public school kindergarten, which has stayed high, at roughly 95% to 96% year after year. But that covers only one slice of the county. It leaves out children who don’t attend public schools and every adult. Maryland’s vaccine registry, where providers and pharmacies now record doses, has only a handful of good years of data, so it says little about older residents.
Brewster said vaccine declinations have risen in recent years and that some groups continue to refuse vaccines altogether, which leaves the community open to spread whenever the virus arrives. Maryland has historically enjoyed high measles immunity because of school-entry vaccine requirements, she said.
More than 1,200 doses since July
Since July, more than 1,200 doses of measles vaccine have been given to county residents by local doctors, pharmacies and the health department, Brewster said. Health workers have also given post-exposure treatment to people who were recently exposed but had not yet gotten sick, which can prevent infection or make it milder.
Asked whether the county had enough vaccine to cover everyone, Brewster said she did not have an exact dose count but described inventory as strong relative to demand. The health department keeps a small supply, the state has provided free doses, and pharmacies and medical practices have contracts that let them restock quickly.
The response also includes:
- A vaccination outreach team going into homes and neighborhoods every day.
- Daily vaccine, testing and post-exposure treatment at all health department clinics, including the school-based health centers and the main clinic in Leonardtown.
- Weekly alerts to local clinicians through the health alert network.
- A partnership with the Department of Emergency Services to check protective equipment and expand respirator fit testing for first responders, including volunteer EMS crews.
The health department’s Measles Community Call Center, open since July, takes questions at 240-735-8288. Residents can schedule an MMR shot through the SMCHD Health Clinic at 301-475-4330; the department offers the vaccine to all county residents regardless of ability to pay, according to its website.
Who should get a shot now
One dose of MMR is 93% effective at preventing measles, and two doses raise that to 97%, Brewster said, calling it one of the most effective vaccines available. Because the county is in outbreak status, an accelerated schedule applies.
The biggest change is for babies. Normally the first MMR dose comes at 12 to 15 months, but during an outbreak, infants 6 to 11 months old are recommended to get an early “dose zero.” It doesn’t replace the two routine doses, which children still get after their first birthday. Young children are among the most vulnerable to measles complications, Brewster said.
Adults who received only one dose, which is common depending on when they were born, are eligible for a second dose in an outbreak community like St. Mary’s. People who have had a confirmed case of measles are generally considered immune, though Brewster noted that some people who believe they had measles actually had something else. The health department’s page breaks recommendations down by age and vaccine history, and notes that pregnant people and those who are severely immunocompromised should not receive MMR.
Brewster stressed that measles is not just a bad cold. While some people have a mild illness, others, especially young children, pregnant people and the immunocompromised, can suffer pneumonia, brain swelling, hearing loss or organ damage. Some people develop brain inflammation years after what seemed like a mild case, and measles-related deaths have occurred, she said.
Flu arriving early
Measles is not the only virus on the health department’s radar. Brewster said influenza activity is rising in Maryland earlier than usual this season, though hospitalizations remain low. She urged anyone who has not had a 2026-27 flu shot to get one now rather than wait. COVID-19 activity is low but typically climbs as people move indoors, and an updated seasonal COVID-19 vaccine is available. RSV activity remains very low.
The health department updates its confirmed measles count weekly on its website, and Brewster said the next update, including the additional pending cases, was expected later in the week.
