36TH LEGISLATURE OF THE VIRGIN ISLANDS  
HEALTH, HOSPITALS AND HUMAN SERVICES 
 
 
The Honorable Senator Ray Fonseca 
Chair of Committee  
  
 
 
Testimony Presented By 
The Honorable Justa Encarnacion, RN, BSN, MBA/HCM 
Commissioner of Health 
 
 
 
 
on 
 
 provide an overview and mitigation plan for the following diseases in the territory;  
Hand, Foot, and Mouth, Measles, Covid, and Flu 
 
 
 
  
 
 
 
VIDOH Testimony on HFMD MMR 
COVID & FLU 
April 22, 2025 
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Good day, Honorable Senator Ray Fonseca, Chairperson of the Committee on Health, Hospitals 
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and Human Services, Honorable Senator Hubert Fredericks, Vice Chair; Committee members, and 
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non-committee members present, and the viewing and listening audience. I am Justa Encarnacion, 
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Commissioner of Health for the Virgin Islands Department of Health.  Joining me today are 
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Assistant Commissioner Dr. Nicole Craigwell-Syms, Assistant Commissioner Reuben Molloy, 
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Chief Medical Officer Dr. Tai Hunte-Caesar, Deputy Commissioner of Health Promotion and 
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Disease Prevention, Janis Valmond, PhD, and the Assistant Director of Epidemiology, Dr. Lisa 
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Ekpo.  
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Thank you for the opportunity to provide this committee with an overview of infectious diseases 
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impacting the well-being of the US Virgin Islands community, and the VI Department of Health’s 
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preparedness and response efforts. Specifically, we will address Hand, Foot, and Mouth Disease 
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(HFMD), Measles, COVID-19, and Influenza. 
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Though these diseases differ in severity, they share a common thread: their ability to disrupt 
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community well-being, to pose threats to our most vulnerable populations and to strain our 
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healthcare infrastructure. The VI Department of Health is responding with data-driven 
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surveillance, targeted public health messaging, provider engagement, and interagency 
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coordination to protect our residents and maintain healthcare resilience.  
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Hand, Foot, and Mouth Disease (HFMD) is a common but highly contagious viral illness 
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primarily affecting children under five years old. Symptoms include fever, sore throat, painful 
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mouth sores that may blister, and a rash on the hands and feet. HFMD is spread through droplets 
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with virus particles made after a person sneezes, coughs, or talks, contaminated surfaces, and by 
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VIDOH Testimony on HFMD MMR 
COVID & FLU 
April 22, 2025 
3 | P a g e  
 
 
 
fluid from blisters and stool. There is no specific antiviral treatment, but the illness typically 
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resolves on its own within 7 to 10 days. 
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While HFMD cases occur annually in the USVI, an outbreak occurred in February. As of Friday, 
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April 19, a total of 277 cases of HFMD have been reported – 272 in the St. Thomas-St. John 
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District and 5 in the St. Croix District. In response to the outbreak, the VI Department of Health 
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launched a coordinated public awareness effort to promote proper hygiene practices and help 
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control the rapid spread of HFMD. We issued public health advisories, participated in weekly 
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Government House press briefings, and collaborated with the Departments of Education and 
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Human Services to share critical information with parents and staff. 
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We also hosted our own press conference, featuring St. Croix pediatrician Dr. Anthony Ricketts, 
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who provided guidance to parents on how to care for children with HFMD. 
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To further expand our outreach, the department produced and aired a Public Service 
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Announcement on local radio, conducted interviews, and created an informational video to help 
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parents recognize and manage HFMD symptoms. The video was shared with partner agencies and 
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posted on the VI Department of Health’s YouTube channel to increase accessibility and visibility. 
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Our Epidemiology Division continues to provide phone consultations and in-person visits for 
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direct observation and infection control training to affected daycares and schools. Rather than 
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closures for HFMD, we have recommended enhanced hand hygiene protocols and environmental 
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cleaning efforts for all schools and childcare settings. 
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Now on to Measles: The VI Department of Health has been actively monitoring national measles 
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trends to inform a potential local response and public health messaging.  
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VIDOH Testimony on HFMD MMR 
COVID & FLU 
April 22, 2025 
4 | P a g e  
 
 
 
Measles is a highly contagious viral infection that begins with a high fever, cough, runny nose, 
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inflamed eyes, and sore throat. Tiny white spots appear inside the mouth within two to three days, 
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followed by a red, blotchy rash on the face that spreads to the body within three to five days. 
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Complications may include ear infection leading to hearing loss, pneumonia, encephalitis, and 
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even death.  
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Symptoms typically appear 7 to 14 days after exposure, and the virus can remain airborne for up 
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to two hours after an infected person leaves the area. One person can infect an average of 10 to 12 
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other people. 
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As of April 19, 2025, the Center for Disease Control and Prevention (CDC) has reported a total of 
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800 confirmed cases of measles in 25 states across the US, with 10 outbreaks in six of the 25 states. 
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Outbreaks are defined as more than three cases. 
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The affected states include Alaska, Arkansas, California, Colorado, Florida, Georgia, Hawaii, 
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Indiana, Kansas, Kentucky, Maryland, Michigan, Minnesota, New Jersey, New Mexico, New 
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York State, Ohio, Oklahoma, Pennsylvania, Rhode Island, Tennessee, Texas, Vermont, and 
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Washington. New York City is also counted as a separate jurisdiction. Three associated deaths 
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have been reported – two children and one adult – and 96% of cases reported are persons who are 
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unvaccinated, or the vaccine status is unknown.  
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We are alarmed by the high rate of transmission and while no cases have been reported in the 
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territory, we feel it is a matter of ‘when,’ not ‘if.’  To put it in perspective, for the entire year of 
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2024, the CDC confirmed a total of 285 measles cases and 16 outbreaks in the US while thus far 
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in 2025 there have been 515 cases.  
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VIDOH Testimony on HFMD MMR 
COVID & FLU 
April 22, 2025 
5 | P a g e  
 
 
 
Our primary concern is the unvaccinated population aged 12 months to six years, with a current 
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vaccination rate of 44.32%. This means over half of this vulnerable group is unvaccinated. Other 
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high-risk segments include unvaccinated pregnant women and individuals with compromised 
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immune systems. 
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The Measles-Mumps-Rubella (MMR) vaccine is safe and proven to be the most effective, 
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providing 97% protection against measles. 
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Children under 6 months of age, pregnant women, and immunocompromised individuals should 
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not receive the MMR vaccine because it contains live, weakened viruses that could be harmful to 
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their immune systems. However, it is recommended that everyone around them – including 
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caregivers and older children – be vaccinated to create a protective barrier. 
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With the growing measles crisis, the arrival of spring break, and the upcoming summer travel 
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season, the Department has been actively emphasizing the importance of staying up to date on 
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MMR vaccination—especially for those traveling internationally or to areas in the U.S. 
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experiencing outbreaks. Parents are urged to vaccinate their children as soon as possible, and adults 
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are also encouraged to get vaccinated if they have not already done so.  
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The MMR vaccine is widely available in the territory at our clinics, through healthcare providers 
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and at some pharmacies. The list of available sites has been posted on our Facebook page, 
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@virginislandsDOH and in on our press release segment of our website. A designated Measels 
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page will be added to our website within the next 24 hours. 
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The current inventory of MMR vaccines in the territory are as follows: 486 doses at the VI 
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Department of Health clinics; 108 doses at local pharmacies, and 1,048 doses at healthcare 
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VIDOH Testimony on HFMD MMR 
COVID & FLU 
April 22, 2025 
6 | P a g e  
 
 
 
providers participating in the Vaccine for Children Program which serves the Medicaid, uninsured 
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and underinsured population. 
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It is crucial to acknowledge that a measles outbreak in the territory would present significant public 
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health risks by overwhelming healthcare resources. The USVI's limited hospital capacity will face 
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challenges in managing measles cases, necessitating an emergency response effort that includes 
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isolating infected patients, safeguarding healthcare workers, and addressing complications. 
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The Department of Health is changing the narrative by shifting public perception from 
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misinformation, complacency, and fear to one rooted in facts, personal responsibility, and vaccine 
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prevention. We're replacing outdated beliefs—such as “measles is just a childhood illness” or 
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“vaccines are risky or unnecessary”—with the truth: the MMR vaccine is safe, effective, and 
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essential to protecting our entire community, and outbreaks are preventable—but only if we remain 
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vigilant and vaccinate. 
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To support this effort, the Department has launched an informational campaign. Similar to our 
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approach with HFMD, we’ve shared key messages through Government House press briefings, 
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our own press conference, and multiple radio interviews. We've also produced a public service 
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announcement (PSA) that will be broadcast at air and seaports, as well as on local radio. A broader 
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social media campaign will soon launch across various platforms. Additionally, we are developing 
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a short video to be distributed to the Departments of Education and Human Services for use with 
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parents and staff in schools across the territory. 
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Additionally, the department’s Immunization Program working with our Maternal Child Health 
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Division is in the process of distributing letters, signed by me, urging parents with an approved 
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VIDOH Testimony on HFMD MMR 
COVID & FLU 
April 22, 2025 
7 | P a g e  
 
 
 
vaccination exemption to vaccinate their children now as measles outbreaks continue to rapidly 
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spread across the US. It emphasizes the efficacy of the MMR vaccine and reminds them that 
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measles can have long-lasting serious implications for an unvaccinated child and may even lead 
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to death. 
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Finally, we are planning vaccination drives for our upcoming USVI Health and Wellness Fair set 
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for the first two weeks of June. 
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Out of an abundance of caution, I have placed the Division of Public Health Preparedness on alert. 
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The team has reviewed our internal Emergency Operations Center plan with all staff to ensure 
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readiness. In addition, we are actively engaging healthcare providers, hospitals, federally qualified 
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health centers, and other key stakeholders to support MMR vaccine promotion and to help develop 
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a coordinated response plan in the event of a measles outbreak. 
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Finally, we briefed the Emergency Management and Homeland Security Council—which includes 
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the Governor, Lieutenant Governor, Cabinet members, semi-autonomous agencies, and other key 
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stakeholders—on the potential impact of a measles outbreak in the territory. 
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COVID-19 is caused by the SARS-CoV-2 virus which led to a global pandemic, with significant 
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morbidity, mortality, and societal disruption. The disease primarily spreads through respiratory 
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droplets, and its severity can range from mild to life-threatening, particularly among vulnerable 
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populations such as the elderly and those with underlying conditions. 
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The COVID-19 pandemic has transitioned from an emergency phase to an endemic phase. 
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Widespread vaccination and natural immunity have contributed to reduced case fatality rates, but 
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VIDOH Testimony on HFMD MMR 
COVID & FLU 
April 22, 2025 
8 | P a g e  
 
 
 
COVID-19 remains a public health concern, especially with the potential for new variants among 
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those who are unvaccinated. 
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Equitable access to COVID-19 vaccines and healthcare in the territory remain public health 
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concerns.  Long term effects that linger weeks, months, or years after a COVID infection is referred 
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to as Long COVID, and this syndrome can result in debilitating conditions.  Management and 
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surveillance of these rates in the territory remain a high priority for the Department. 
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The Department continues to promote public health strategies that include vaccination campaigns, 
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public health messaging on the importance of continued caution, monitoring of new variants, and 
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investment in healthcare infrastructure. The mental health toll of the pandemic also necessitates 
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focused support for affected populations. 
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Influenza (flu) is a viral infection, commonly seasonal although seen continuously in the territory 
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due to the high rates of worldwide travelers, that affects the respiratory system. Its symptoms 
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include fever, cough, sore throat, muscle aches, and fatigue. It can lead to severe complications 
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that include pneumonia, respiratory failure, Guillan Barre disease (neurological complication 
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resulting in muscle weakness), and death, particularly in high-risk populations such as young 
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children, the elderly, and individuals with underlying health conditions.   
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Seasonal flu remains a major public health challenge globally. Influenza viruses undergo frequent 
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genetic changes, leading to annual epidemics. Although vaccines are available and effective in 
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reducing the severity of illness, vaccine coverage remains inconsistent in many populations 
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including the Virgin Islands.   
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VIDOH Testimony on HFMD MMR 
COVID & FLU 
April 22, 2025 
9 | P a g e  
 
 
 
The flu virus’s ability to mutate rapidly complicates vaccine development and efficacy. Public 
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complacency due to the perceived mildness of the disease and challenges in achieving high 
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vaccination rates remain a significant challenge in the territory. 
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The seasonal flu vaccine, which is updated annually, remains the most effective preventive 
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measure.  The Immunization Division engages with campaigns for public health messaging, 
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ensuring vaccine access to the un- and under insured, and preparing healthcare systems for 
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seasonal surges to mitigate the impact of influenza outbreaks.   
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The diseases under consideration—Hand, Foot, and Mouth Disease, Measles, COVID-19, and 
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Influenza— highlight the ongoing challenges in public health and the importance of 
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comprehensive, proactive measures to protect our community.  The Department of Health’s 
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actions to prioritize vaccination, provide education, conduct surveillances is a testament to our 
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preparedness and commitment to mitigate the impact of these diseases and protect the health of all 
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community members.   
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We encourage members of this body and the public to visit our website at doh.vi.gov and click on 
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the “USVI Epidemiology Data Dashboard” for weekly updates on viral activity in the territory, 
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including COVID-19 and influenza. 
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In closing the department is committed to reducing health risks, increasing access to quality 
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equitable healthcare, and enforcing health standards. Thank you for the opportunity to present on 
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this critical issue and for your continued support and collaboration.  We stand ready to take any 
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questions the committee may have. 
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