On January 25, Governor Jay Inslee declared a local public health emergency in all counties of Washington State, where many people (mostly unvaccinated children) have become infected with measles. Officials said 30 of the cases involved people who have not had a measles immunization; the other four are not verified.
"As a pediatrician and parent, I find it frustrating because this is happening among children who are dependent on their parents' decision-making", said Wendy Swanson, a pediatrician and chief of digital innovation at Seattle Children's Hospital.
The specific source of the outbreak is not now known, but the Oregonian reported that low immunization rates in the area meant that it was only a matter of time before a preventable outbreak like this one took hold in the Pacific Northwest. The virus can live for up to two hours wherever an infected person has coughed or sneezed.
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"It's the kids who are too young to be immunized, or who are too sick to be immunized that we worry about", Swanson said. "These costs could have been prevented if we had everybody vaccinated".
Clark County, which includes the Portland bedroom community of Vancouver, Washington, has a measles vaccination rate of 78 percent, well below the 92 to 94 percent rate required for so-called "herd immunity", said Marissa Armstrong, the department's spokeswoman.
"For decades, vaccines were given and compliance was very high, and there are a lot of people, especially in the US, who have no experience with these vaccine-preventable illnesses", Deese said. The measles vaccine is 98 percent effective.
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Here's why the current outbreak in Washington is a ideal example of what can happen when parents do not vaccinate their children for philosophical or religious reasons - and how exactly that can put their own kids, and others, at risk.
Those who are concerned about their potential measles exposure but have no symptoms can call 8-1-1 and speak to a nurse.
In Clark County, however, vaccination rates have been dropping.
People are contagious with measles for up to four days before and up to four days after the rash appears.
The Centers for Disease Control and Prevention recommends that people who have not been immunized but believe they have been exposed to the airborne virus, get the MMR vaccine. Those people stayed home and later got ill, Armstrong said. Serious complications such pneumonia and brain infections can arise from the disease in some cases.
Measles is caused by a virus that presents as fever, cough, runny nose and red eyes, followed by full body rash of tiny red spots, according to the CDC.