TOMS RIVER — In response to a measles outbreak in Lakewood, the Ocean County Health Department is encouraging and supporting the exclusion of unvaccinated children from schools, preschools and daycare programs, according to a letter issued Friday by a health officer.

The recommendation is "an effort to curtail the spread of disease in the community," Ocean County Health Officer Daniel E. Regenye wrote in the letter, which was given to the Press by a local education official.

State statute permits the New Jersey Commissioner of Education, the Department of Health, or the commissioner's designee, to exclude non-vaccinated children from schools, preschools and childcare centers during a disease outbreak.

On Friday, the Ocean County Health Department issued guidance that it "highly encourages" and "supports" the exclusion of unvaccinated children at this time.

The rule means schools and daycares can stop children who are not vaccinated, even those with religious and medical vaccine exemptions, from attending during the current outbreak.

As of Thursday, there were six confirmed cases of measles in Ocean County and seven suspected cases under investigation, according to the county's health department.

About one in four people who contract measles will be hospitalized as a result, according to the county health department. The highly contagious disease spreads predominantly through coughs and sneezes.

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Symptoms usually begin seven to 14 days after contracting the virus and often involve a high fever, cough, runny nose, and red and watery eyes. Three to five days days after the onset of initial symptoms, an infected person typically gets the characteristic red measles rash across the body, according to the county health department.

In some cases, the virus can leave behind permanent impacts. About one in 10 children who contract measles will suffer permanent hearing loss and as many as one in 20 children with the virus will get pneumonia, which is the leading cause of measles-related death in young children, according to the Centers for Disease Control. In rare cases, measles infection can cause a fatal disease of the central nervous system, according to the CDC.

Most people who contract measles were never vaccinated, according to the CDC.

The outbreak in Lakewood has been tied to a person who contracted the virus while traveling internationally, health officials said.

"The Ocean County Health Department encourages everyone to review their vaccination status for all vaccine preventable disease and get vaccinated if appropriate," Regenye wrote in the Friday letter.

Health officials said people who visited the following places on certain dates could have been exposed:

the office of Dr. Eli Eilenberg, 150 James St., Lakewood, on Oct. 31 between 11:15 a.m. and 2:45 p.m.

Four Corners Bagel & Cafe, 150 James St., Lakewood, on Oct. 31 between 12:30 p.m. and 3 p.m.

Previously health officials said others could have been exposed if they visited the following locations between Oct. 13 and Oct. 31: Schul Satmar, 405 Forest Ave.; Eat a Pita, 116 Clifton Ave.; CHEMED Health Center, 1771 Madison Ave.; NPGS grocers, 231 Main St.; and Pizza Plus, 241 4th St. Lakewood.

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Amanda Oglesby: @OglesbyAPP; 732-557-5701; aoglesby@gannettnj.com