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People who are unvaccinated need to know that the epidemiology of vaccine-preventable diseases and the risk of vaccine preventable diseases is changing — it's going up," said Karen Holbrook, the county's interim public health officer.

"Even though we don't have any cases in Sonoma County, right now I'm concerned," she said.

In a teleconference with reporters Friday, Kathleen Harriman of the California Department of Public Health said that fewer than 3 percent of kids statewide have not been vaccinated by the time they get to kindergarten. In these cases, the parents have received personal belief exemptions.

Holbrook said in Sonoma County, 6.3 percent of parents request such an exemption. But in the west county, nonvaccination rates are much higher, she said.

In Sebastopol Union and Twin Hills school districts, 40 percent or more of parents request personal belief exemptions, Holbrook said. A new law that took effect Jan. 1 now requires parents to obtain a signed statement from a heath care professional that shows they received medical information about the benefits and risks of vaccines.

"We look forward to the new law that will be in place for the next school year," said Linda Irving, superintendent of Twin Hills. "It will give parents the opportunity to discuss vaccinations more in-depth with regard to personal belief exemptions."

There have been no measles-related deaths, state health officials said Friday. The actual number of measles cases may be higher because there is a lag between the time counties document cases and the time the state reports them.

During the Friday teleconference, state epidemiologist Dr. Gil Chavez said that a significant number of the 15 measles cases involved people who traveled — or were exposed to those who traveled — to other countries with high rates of measles infections.

Three traveled to the Philippines, two to India and two others were exposed to international travelers, Chavez said. He urged Californians who are traveling outside of North and South America to "make sure you're the fully vaccinated." Places such as the Philippines, India and some countries in Europe are especially troublesome, he said.

Health officials said the current outbreak of measles in the Philippines may have been exacerbated by the devastating typhoon that hit the region in November.

Chavez urged parents to make sure their children are vaccinated against the measles virus, noting that seven of the 15 cases involved parents who obtained personal belief exemptions. Five of these cases involved underage children and two were young adults.

State officials said that two of the 15 statewide measles cases involved people who were vaccinated. In general, they said, about one percent of those who receive the measles vaccine "remain susceptible" to the virus.

Holbrook said measles, a viral disease that before the 1960s affected nearly everyone in the United States, was declared eradicated in this country by 2000. Nationally, a low of 37 cases were reported in 2004.

"Since then we've had an increase in cases, imported and contacts to those that bring it into the country," she said, adding that there is also an "upward trend" in cases both in underdeveloped and developed nations.

She said measles is now endemic in many parts of the world including, England, France, Spain and Israel, where many people are choosing not to get vaccinated. Measles spreads quickly because it is a highly contagious disease.

"Approximately 90 percent of people who are susceptible and have contact with an ill infectious person will get measles," she said.

Measles is transmitted through the air in tiny particles that are in the nose and throat, Holbrook said. The virus is expelled into the air through coughing or sneezing and will remain in a room for up to two hours after the infected person has left, she said.

"People are infectious four days before the onset of the classic rash," Holbrook said.

Initial symptoms are similar to those of the flu, including coughing, runny nose and irritated eyes. After that, an infected person can get fever which can reach very high temperatures.

"Then there's the rash that develops, a red blotchy, spotty rash" that usually appears on the face and makes its way down the body to the feet, Holbrook said. The rash can appear along the hairline and behind the ears.

In a few weeks, the rash fades in the same order that it appeared. The degree of illness can vary, Holbrook said.

In the decade before widespread measles vaccination in the United States began, about 3 million to 4 million people were infected each year, with 400 to 500 people dying and 48,000 requiring hospitalization, according to the Centers for Disease Control and Prevention.

Holbrook said that, in general, one in 20 infected people will get pneumonia; one in 1,000 will get acute encephalitis; one in 500 to 1,000 die. Of the deaths, 60 percent of deaths are because of pneumonia. A small percentage of people even after getting over the measles could get late onset subacute panencephalitis, a degenerative central nervous system disease.

"Some of our recent cases (in the state) are definitely linked to this outbreak in the Philippines," Holbrook said.

Sonoma County residents, particularly in areas with low vaccination rates, are vulnerable, she said.

"I want people to be to be aware and to be thinking about and making wise decisions and choices," she said.

You can reach Staff Writer Martin Espinoza at 521-5213 or martin.espinoza@pressdemocrat.com.