Washington is under a state of emergency after a statewide measles outbreak — with 35 confirmed cases and nine suspected cases. The outbreak has officially found its way to King County.

Seattle public health officials determined on Jan. 23 that a local man in his 50s did in fact contract the illness characterized by a blotchy red skin rash. Officials said it was unclear where the man acquired the infection. He had recently traveled to Vancouver, Wash., where the state outbreak is presumed to have begun.

Gov. Jay Inslee declared a state of emergency Friday, Jan. 25, in response to the growing number of confirmed measles cases in the state.

“Measles is a highly contagious infectious disease that can be fatal in small children,” Inslee noted in his proclamation on Jan. 25. “The existence of 26 confirmed cases in the state of Washington creates an extreme public health risk that may quickly spread to other counties.”

Inslee’s announcement directs state departments to use state resources and assist areas impacted by the spread, and it means use of the Emergency Management Assistance Compact — a mutual aid agreement among states — is made available.

The Centers for Disease Control reports that there were 349 individual cases of measles confirmed in 26 states and the District of Columbia in 2018, making it the second-greatest number of annual cases reported since measles was eliminated in the U.S. in 2000.

How it spreads

Measles is spread when a contagious person breathes, coughs or sneezes and can be contracted just by being in a room where someone with the measles has been, officials from Public Health — Seattle & King County said. The virus is contagious before a person may realize they’ve contracted the measles and can live in airspace for two hours after the infected person has left.

Health departments of both King and Clark counties have posted lists of where those confirmed to be carrying the illness visited while they were presumed to be contagious. Officials are pressing everyone to verify their immunization status given that it’s highly likely anyone not immune will contract measles when exposed to the virus.

“Diseases that are really contagious can spread easily among pockets of unvaccinated people,” said Danielle Koenig, an immunization health promotion supervisor with the state health department.“Those can make inroads in communities and spread.”

In Vancouver, 24 of those confirmed to be carrying the measles are younger than 10 years and nine others fall between the ages 11 to 18. Only one is older than 18.

Thirty of these students are confirmed to be un-immunized, according to the health department. The remaining four were not verified as of Sunday.

Certain people can’t vaccinate due to medical reasons or allergies, Koenig said. Others who have been vaccinated simply have immune systems that do not respond successfully to the two-dose vaccine.

The most at risk are young children — unable to vaccinate before reaching their first birthday — and pregnant women. But Koenig adds, measles can be serious and even deadly for anyone.

A safeguard, one Washington has struggled to obtain, is “herd immunity.” About 95 percent of people should be vaccinated to reach herd immunity numbers — adding protection to those who can not vaccinate by eliminating the risk that people around the person will contract the illness.

“Those people rely on everyone around them to have their vaccines …When people start choosing not to vaccinate when they could, protection breaks down.” Koenig said.

Unvaccinated cohorts

Health officials said un-immunized groups of students in schools can pose an increased risk of spreading preventable diseases. An examination of data on vaccination exemptions show that King County schools house some clusters.

Eastside Community School in Bellevue, formerly the Three Cedars Waldorf school, had 33.6 percent of students exempt from the measles, mumps and rubella (MMR) vaccinations during the 2017 – 2018 school year. About 42 percent of all vaccination exemptions at the school were for personal reasons, the data shows.

“Our community is very much into natural health, the whole anthroposophical philosophy,” said Ivan Gorne, the chief school administrator at Eastside. “Everything is very much about bringing up the child and helping them to become who they are rather than trying to turn them to something else.”

He said the parents at his school, being independent, are often into a more natural and environmentally respectful lifestyle. “And people sort of gravitate toward a very thoughtful manner in terms of their health care.”

The Bellevue community school is only one of many others with high rates of parents forgoing the MMR vaccine for their students. At the Living Wisdom School of Seattle, a preschool to fifth-grade private institution, 43.5 percent of students are exempt from the MMR vaccination.

At Overcomer Academy, a private school in the Federal Way-Auburn area, 38.8 percent of students opted out of the MMR vaccination. At both institutions, a majority of the exemptions were cited for personal reasons.

Vaccination requirements

Washington law gives parents three avenues to exempt their children from vaccinations before entering school. They can opt out for medical or religious reasons and is one of 18 states that allows parents to exempt their children from vaccinations based on philisophical reasoning, according to the National Conference of State Legislatures.

A form, to be turned into the student’s school, has to be signed off by a health care provider prior to the exemption being granted.

The doctor will typically discuss risks and benefits with parents before they sign the form, Koenig said. And the process is similar for those attending private schools.

Both sides of the Certificate of Exemption form reads ”The diseases vaccines can protect against still exist, and can spread quickly in school and child care settings. Immunizations are one of the best ways to protect people from getting and spreading diseases that may result in serious illness, disability, or death.”

In California, new personal and religious belief exemptions were banned in the state following January 2016. California children are required to have their polio, diphtheria, tetanus, and pertussis (DTaP), measles, mumps and rubella (MMR), hepatitis B and varicella (chickenpox) vaccines before entering kindergarten.

Vaccine exemptions due to medical reasons are still allowed.