A few weeks after a measles outbreak began in the Pacific Northwest, another case has occurred in Toronto — just a half-day’s drive from this area.

Hancock County health officials say they are looking to educate citizens about measles and vaccines.

The Toronto Star reported Tuesday that Toronto Public Health is investigating a confirmed case of measles in an infant, who was not old enough for the typical measles vaccination and had recently returned from overseas travel.

According to the Centers for Disease Control and Prevention, six measles outbreaks (defined as three or more cases) have been reported so far in 2019 in the United States. The U.S. experienced 17 outbreaks in all of 2018.

From Jan. 1 to Feb. 28, 206 individual cases of measles were confirmed in 11 states. The nearest are Kentucky and Illinois.

Measles is a highly contagious disease that can be fatal. And while a vaccine can prevent the disease, many parents are skeptical of the vaccine.

Tyler Alt, a public health nurse, infectious disease, for Hancock Public Health, said measles can involve a rash, a runny nose and a fever as high as 105 degrees.

A sick person can develop swelling of the brain, which can be deadly, as “you only have so much space,” Alt said.

One in 20 measles patients gets pneumonia, and 1 in 1,000 gets brain swelling that can lead to seizures, deafness or intellectual disability.

Worldwide, measles killed 110,000 people in 2017.

Alt said anyone born before 1957 is considered immune to measles, as they have likely been exposed. Everyone else should have gotten two doses of the shots. Those who received only one dose are not considered fully vaccinated.

Measles is highly contagious, and is spread through the air through droplets from someone coughing and sneezing, or “even just normal breathing,” Alt said.

In 2000, it was declared that measles had been eliminated from the United States. But “people travel,” said Dr. Kevin Johnson, a pediatric hospitalist at Blanchard Valley Hospital. People get on airplanes, and outbreaks have started in the United States after unvaccinated people traveled abroad.

Johnson said people may have let their guard down and become lax about vaccinating, “because you don’t hear about cases, because there weren’t any cases.”

Since the measles, mumps and rubella (MMR) vaccine was introduced in 1963, it has cut the number of outbreaks, Alt said.

The Ohio Department of Health requires children to have received two doses of MMR before starting school. But Shannon Chamberlin, a registered nurse and director of community health services for Hancock Public Health, said in Ohio, a parent can ask for an exemption for either religious or philosophical reasons.

Public health leaders are trying to tighten the rules so a parent would have to get a health care provider or someone at a local health department to sign the exemption, after providing education.

Alt said public health leaders face an “uphill battle against misinformation” — in particular, the misconception that vaccines cause autism.

This week, researchers announced a 10-year study of more than 650,000 children born in Denmark that confirmed — again — that there is no risk of autism from the MMR vaccine.

Johnson said a “quote-unquote study” that claimed to show a link between vaccines and autism was fraudulent. Andrew Wakefield, the lead author, was later stripped of his medical license in the United Kingdom, and the study was withdrawn by the medical journal in which it appeared.

But in the years since, much campaigning against vaccines has taken place.

In February, The Guardian, a British newspaper, reported it found that “Facebook search results for groups and pages with information about vaccines were dominated by anti-vaccination propaganda, and that YouTube’s recommendation algorithm steers viewers from fact-based medical information toward anti-vaccine misinformation.”

Later that month, the same newspaper reported how Pinterest had taken steps to remove such content.

“We’re a place where people come to find inspiration, and there is nothing inspiring about harmful content,” Ifeoma Ozoma, a public policy and social impact manager at Pinterest, told the publication.

Social media makes it possible for those opposed to vaccines, including some prominent actors and politicians, to reach a lot of people quickly.

“It’s easy now to project your personal beliefs onto a lot more people than before,” said Hancock Public Health Commissioner Karim Baroudi.

“There’s a movement out there that’s really fighting vaccination,” and health department staff needs to combat it, Baroudi said.

“A big part of our job is to separate science from fiction. … Don’t argue with science,” Baroudi said.

Baroudi said staff members try to explain science slowly and calmly to people who call. Callers are often very passionate, but he tries to educate them on how they are “putting the whole community at risk,” including people who cannot get immunized.

The infant in Canada is an example. Very young babies cannot get immunized, because it isn’t safe for them. People dealing with certain medical conditions that compromise their immune systems also cannot receive vaccines.

This is why health officials push everyone to get vaccinated who can, because what is known as “herd immunity” protects those who cannot be vaccinated.

If most of the community is vaccinated, “Then those germs aren’t going to spread so rapidly,” Chamberlin said.

Johnson said a small percentage of people, even after getting the vaccine, may still be susceptible to getting sick, but they benefit from herd immunity.

Hancock Public Health refers parents who have questions to the Centers for Disease Control and Prevention website.

Public health nurse Tatum Weber said some parents are hesitant about vaccines because of fears for their children. A common question might be, “What are you putting in them?” Parents don’t want their child to be hurt, or scared, or traumatized by too many injections at once.

“Fear does play a big role,” Weber said.

Alt said it’s safe to get all the recommended vaccinations at once. But if parents want to use a different schedule, Hancock Public Health is willing to work with them.

“There’s all different personal reasons” why someone may want to delay, Chamberlin said. Maybe a parent knows their child tends to get sore, or run a fever, after a vaccination.

Alt noted that soreness, fever and irritability after a vaccine are normal, as the child’s immune system is reacting to the vaccine.

Weber said parents may say they read something online about a serious reaction to a vaccine. Weber said in her own experience, “I’ve seen X number of reactions, none of them severe.”

Johnson encouraged parents to educate themselves.

“We all want what’s best for our children,” he said, and it’s understandable that people have strong emotions and fears about safety.

But “I want people to know that this is a safe vaccine. … There’s much more to be afraid of from the disease,” Johnson said.

Johnson said in more than 20 years as a hospitalist, not all of them locally, he’s never encountered a patient with measles.

But he has treated “dozens and dozens” with mumps, also preventable with the vaccine. Mumps is “a miserable illness” and can lead to encephalitis or sterility, he said.

“I expect to see measles in my career now,” he said. “The statistics suggest that I’ll encounter it.”

Johnson said, “The bottom line is this: Vaccines have been thoroughly studied, are safe, and are extremely effective.”

And, he said, measles “is a completely preventable illness. … And that makes it all the more sad” when it occurs.

Information from the Associated Press was included in this story.

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Twitter: @swarthurs