In mid-February, a measles outbreak started at the Manatee Bay Elementary School in Broward County in South Florida. There are now at least nine cases in the county and one additional one in Polk County in Central Florida.

Several public health researchers say Florida's current response to the outbreak goes against well-established public health guidance. Florida's surgeon general, Dr. Joseph Ladapo, has so far not urged parents of unvaccinated children at the school with the outbreak to get their children vaccinated, or to quarantine them. In a Feb. 20 letter, Ladapo left it up to parents to decide whether to send their kids to school.

"I'm flummoxed about this," says Dr. Ali Khan, dean of public health at the University of Nebraska. "I've never heard of a surgeon general who didn't at least advocate for best public health practice."

Khan says flouting science-based guidance is dangerous. "If you're undermining confidence in public health, including vaccination and public health measures, you are putting an increasing number of people at risk of these diseases that we no longer see anymore," he says.

Measles is a highly infectious disease, says Dr. Marcus Plescia, chief medical officer for the Association of State and Territorial Health Officials. "I mean, you can walk by somebody and catch measles if they have it. It's one of the most infectious diseases that we know about."

And when people who are not vaccinated or don't have prior immunity get exposed to it, up to 9 out of 10 will get measles, according to CDC.

State data shows that around 8% of kindergartners in Broward County are not vaccinated for measles.

"If you've been vaccinated, if your children are vaccinated, you don't have to worry about it. [The risk] is really for a small proportion of people whose children are not vaccinated," Plescia says, "But 8% is [still] a lot of children, and the risk is that we could see many of those children getting sick."

Measles has been around for a very long time – it's been studied for well over a century. And there are clear steps to take to contain an outbreak, says Dr. Scott Rivkees, a public health professor at Brown University: "If you have an outbreak, try to get [unvaccinated] people vaccinated within three days of exposure," he says.

And because people can spread the virus even if they don't have symptoms, he says, people who are not vaccinated that have been exposed need to quarantine for 21 days.

Rivkees is the former surgeon general in Florida. And that's the advice Florida would be getting, if he was still in the role.

But Rivkees left in 2021 and Florida Governor Ron DeSantis appointed Ladapo to the role. Ladapo was part of a group that pushed unproven COVID treatments before he took the post. And as surgeon general, he refused to wear masks and discouraged people from getting COVID vaccines.

Rivkees is concerned that skepticism over vaccines for COVID may be spreading to another potentially deadly disease.

"We have seen an incredible attack on vaccines over the past couple of years," he says. "[Now] we're seeing parents who are not getting their children vaccinated, parents who believe that getting the vaccine, for example, will actually cause measles, when it doesn't."

And when it comes to measles, that vaccine reluctance could lead to unnecessary suffering and even risk of death. While measles is rare in the U.S. because of high vaccination rates, it can be serious.

A mild case of measles can involve getting a rash, diarrhea and dehydration. In some cases, it can turn into pneumonia. In rare cases it can lead to brain swelling, which can cause kids to lose their sight or hearing.

In late 2022, there was an outbreak in Columbus, Ohio, where 85 people got sick from measles – and 40% of them ended up in the hospital.

It can also be deadly. Before the vaccine, the U.S. was seeing 500 deaths from measles each year.

Measles was declared eliminated from the U.S. in the year 2000. There are still cases, but those usually come when people travel to other countries and bring it back. The U.S. should be able to keep that "elimination" status — so long as each measles outbreak gets contained within a year, according to CDC.

So far this year, there have been at least 35 cases in 15 states. Those numbers will likely continue to grow, especially in parts of the country with low vaccination rates. And experts say that, when state and local authorities flout longstanding public health advice, it could lead to more disease in more communities.

"This is a very, very serious disease and it's completely vaccine preventable," says Khan.

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