These 248 Maryland schools are most vulnerable to measles outbreaks

Maryland has one of the highest measles vaccination rates in the country, but 248 of the state’s schools enroll enough unvaccinated kindergartners to give the disease a potential foothold, according to the most recent data available from the Maryland Department of Health.

Public and private school vaccination rates from November 2025 show that more than 1 in 5 of the 1,154 schools that enroll kindergartners had too few students vaccinated against measles to achieve what public health officials consider herd immunity, the threshold at which the virus is unlikely to spread. Infectious-disease experts say that’s concerning as Maryland sets a modern record for cases amid a wave of national outbreaks, including the largest in neighboring Pennsylvania.

Maryland public health officials have reported 55 measles cases this year compared to five or fewer every year for the past decade. They’ve declined to say how many of those cases were in children. There are no known outbreaks in schools, and parents of vaccinated children have little to worry about: The measles vaccine is considered safe and one of the most effective at staving off infections.

At highest risk are unvaccinated children who attend school with many others whose families can’t or won’t get them immunized, whether for religious or medical reasons.

“Maryland looks good compared to a lot of states, but there are some of these pockets and gaps that are more concerning,” said Shaun Truelove, an infectious-disease epidemiologist at the Johns Hopkins University who has studied school vaccination rates.

Private schools were more likely than public schools to report measles vaccination rates below 95%, the bar for herd immunity. Most counties in the state reported at least one school below that threshold. It’s not clear whether that number has increased in recent years, because of changes in the way the state collects and reports school vaccination rates.

Children typically get two doses of the shot that protects against measles, mumps and rubella — once at a year old and once between ages 4 and 6. The vaccine provides lifelong protection.

Maryland law requires children to be vaccinated by the time they start kindergarten at any school, public or private. There are exceptions for children who can’t be vaccinated for medical reasons, which require a pediatrician’s signature, and for those whose parents object for religious reasons.

Federal data show that more families are seeking both types of exemptions nationally and locally. That becomes worrisome when vaccination rates in a school drop below 95%, but particularly risky below 90%, said Truelove. Federal data suggests the chance of an outbreak rises substantially when fewer than 90% of people are vaccinated.

Nearly 80 Maryland schools had measles vaccination rates under 90%, according to a Banner analysis of state data from last school year, the most recent available. Schools report vaccination rates each November to their local health departments, which in turn report them to the state. The state does not verify the accuracy of school vaccination rates.

Private schools, including some operated by religious organizations, tend to be smaller, and the difference between hitting 95% and falling below could be a handful of students in some schools. Christian Kendzierski, a spokesperson for the Archdiocese of Baltimore, said its Catholic schools have higher vaccination rates today than they reported to health officials last fall.

Gboyinde Onijala, a spokesperson for Baltimore County Public Schools, disputed the state-reported rates for several schools in the system, but she declined to specify which ones or share the rates the system considered accurate.

Two decades after measles was first declared eradicated from the United States, five people have died of measles in Pennsylvania this year, according to the state’s health department. The state, which shares a border with Maryland, has reported by far the highest number of measles cases this year, data from the Johns Hopkins Bloomberg School of Public Health shows.

Maryland cases began spiking this summer, with state health officials reporting 14 cases in one day in August among unvaccinated households in St. Mary’s, Carroll and Cecil counties.

The disease causes fevers and a telltale red rash and is extremely contagious, infecting people hours after someone infected coughs and leaves the area. Up to a third of infected young children suffer complications, including severe ones such as pneumonia, brain swelling and immune system damage, according to the Centers for Disease Control and Prevention.

Nearly every state with higher measles vaccination rates than Maryland has stricter rules for obtaining religious exemptions or has banned them outright. Michigan, for example, requires an in-person appointment at a health department to obtain a religious exemption. In Maryland, religious exemptions require only a parent signature on a single form. Legislators have attempted in years past to restrict or eliminate religious exemptions, but those efforts were unsuccessful.

Some parents use the religious exemption form because they lack health insurance or struggle to access medical care, said Courtney Pate, Baltimore City Public Schools’ director of the health services.

Every morning, she gets a list of city public school children who haven’t been vaccinated. When she sees a pattern, staff members work to get the students to a vaccination clinic. When a parent signs an exemption, staff may ask whether the issue is difficulty getting vaccinated or a true rejection of vaccinations.

“I think all of us in public health are very concerned that diseases that were eradicated are going to return,” she said. Healthcare providers might never have seen a case of measles or mumps before and may not recognize them immediately when a patient has one of these diseases.

Dr. Esther Liu, chair of pediatrics at the University of Maryland Baltimore Washington Medical Center, said vaccine hesitancy has been rising since the late 1990s and early 2000s, fueled by misinformation on social media. More recently, Trump administration officials have made unfounded claims linking vaccines to autism and promoted other misinformation.

“Now we’re seeing more in the general population just refusing to vaccinate,” Liu said.

She said measles is so contagious that when someone in a household or group is exposed, they can spread it to most unvaccinated people around them, including infants who aren’t old enough to be vaccinated.

“As a pediatrician, and now an old one, I remember in training this being the worst part, when I took care of kids who were perfectly fine in the morning and dead by midnight,” Liu said.

She explains to patients and their families that vaccines aren’t 100% safe, though complications such as severe allergic reactions and seizures are rare. Liu said vaccines are far safer than diseases such as measles.

Maryland officials and lawmakers have taken steps to encourage vaccinations, including the combination measles, mumps and rubella vaccine, and promoted programs to pay for them.

The Vax Act, passed earlier this year by the state legislature, gives the health secretary authority to tie Maryland’s guidance to major medical associations rather than the federal health agencies that have long advised the public.

Maryland requires insurers it regulates to cover the two recommended doses of the MMR vaccine, and pharmacists can administer recommended vaccines to those aged 3 and older without a prescription. Local health departments also offer vaccines at no cost to those who are uninsured and underinsured, with special clinics this time of year for routine vaccines and seasonal ones for flu and COVID.

The state’s public schools have a powerful financial incentive to make sure that students are vaccinated if their parents don’t sign a religious or medical exemption.

Every Sept. 30, each public school must take a count of students that determines its funding. Schools receive between $10,000 and $30,000 per student. But only students who are vaccinated or who have an exemption can be counted.

In 2022, that led the principal at Hampstead Hill Academy in Baltimore to pay for vaccinations out of his own budget when he was confronted with children who had no way of getting to a free vaccination clinic and also didn’t have health insurance.

In Anne Arundel County last year, schools had 38 students who weren’t vaccinated and didn’t have exemptions, so the county received no funding for them in the current year’s budget, according to Bob Mosier, a spokesperson for the school system.

As of last week, about 52 kindergartners weren’t vaccinated and didn’t have an exemption, Mosier said. About 118 kindergartners have a religious exemption, he said.

While the number of exemptions in Maryland is troubling to many experts, Dr. William Moss, a Johns Hopkins pediatrician and infectious-disease expert, said it’s unlikely they’ll continue to rise indefinitely.

“Enough people in this state have confidence in vaccines,” he said. “The deaths in Pennsylvania may scare some people.”

About the Education Hub

This reporting is part of The Banner’s Education Hub, community-funded journalism that provides parents with resources they need to make decisions about how their children learn. Read more.