KINGMAN - The recent outbreak of measles that started in California and quickly spread to other states - including Arizona - has local health and school officials working hard to prevent a similar outbreak here.
Currently, there are no cases of measles in Mohave County, according to the Mohave County Department of Public Health. That includes the student populations at both Kingman Unified School District and Kingman Academy of Learning.
"We haven't seen any symptoms of measles in the schools and we don't want to," said Sharla Smith, district health supervisor for KUSD. "We're very diligent about vaccinations and our immunization rates are very good here.
"Every child's shot record has been gone through and parents have been notified if more shots are needed."
KUSD, which has about 6,900 students in 12 schools, has an immunization exemption rate of almost 3 percent, said Smith. Most parents are seeking medical or non-medical exemptions for vaccinations other than measles, said Smith, and most students have at least one of the two required measles vaccinations, giving them some immunity.
The school nurses located at each of the district's facilities are the front line for preventing disease outbreaks, said Smith. They are required to scrutinize each student's immunization record and make sure the necessary shots have been given, especially the extra set of shots that are must-haves for kindergarteners.
"Our role is to educate parents about immunizations," said Smith. "And we're trying to get that word out. State law tells us what immunizations the children must have, and I take my nurses for training so they know how to implement that. I check the whole district and have a spreadsheet, and each school nurse takes care of what needs to be done."
The concern about measles ramped up throughout the nation in December, when an infected guest spread the illness to visitors at Disneyland, who then exposed many others. Most were unvaccinated, according to state health officials. Disease investigators for weeks raced to track down potential contacts and quarantine them.
California had the largest share with 92 cases, and Arizona came in second with seven cases. The other cases were in Colorado, Nebraska, Oregon, Utah and Washington. The seven Arizona residents are no longer infectious, said health officials.
But up to 1,000 people - including 200 children - in three Arizona counties have potentially been exposed to the disease because of the outbreak. Officials have asked them to stay home so they don't further spread it until a 21-day period passes with no symptoms.
"We are not out of the danger zone yet," said Kore Redden, acting director of the Pinal County Department of Public Health, with five of the diagnosed cases. "We still have the potential of having additional confirmed cases."
Measles is contagious for four days before a person develops a rash and for another four days after, Redden said. The seven diagnosed with measles have passed that period. In Maricopa County, two people who also fell ill with measles have passed the contagious period.
Public health experts say success at containing the outbreak will largely depend on how many unvaccinated people get the measles shot.
"This was a wake-up call," said Dr. James Cherry, a pediatric infectious disease expert at the University of California, Los Angeles. "It could continue to smolder" if not enough people get vaccinated.
"There are zero cases of measles in Mohave County right now, although we've had a number of suspected cases reported that weren't really measles," said Christine Bronston, public health nursing manager for the Mohave County Health Department.
"It's likely we could see some measles cases here, especially with the number of residents who are choosing not to vaccinate."
Bronston said she has heard numerous concerns from parents about why children shouldn't be vaccinated, but the bottom line is that the only way to prevent an outbreak of measles is to get the immunization. Not only does it protect the children, but also those who aren't able to be vaccinated for medical reasons and depend on communal vaccination.
Susan Chan, district administrator for Kingman Academy of Learning, said vaccinations are important for the 1,440 students attending KAOL's four schools. The district's immunization exemption rate is about 5 percent, and it has not had any cases of measles to date, said Chan. All shot records have been checked and double-checked.
"It is extremely important that we do everything possible to protect all of our children from this disease," said Chan. "We want all of our students to be safe in all aspects of their school attendance, and this includes health-related situations.
"I am concerned about the measles cases that have been discovered in Arizona. There are so many children who are not immunized that this could become a very large problem, especially if school-aged children begin contracting the disease. These results could be very damaging to our population."
Federal health officials said it's too early to predict whether this will be a particularly severe year compared with 2014, which saw more measles cases than any year since 1994.
Homegrown measles has not occurred in the United States since 2000 due to an aggressive vaccination campaign. But outbreaks have hit in recent years with nearly all cases linked to travelers who caught the virus overseas where measles still rages and spread it in this country among pockets of unvaccinated people.
In the Disneyland outbreak, public health officials have yet to identify the "index case" - the first person who contracted measles and spread it. But they believe it's someone who imported the virus from abroad and spread it during a visit to the theme park days before Christmas.
Since then, parents who refuse vaccines for their children on religious or philosophical grounds have been on the defensive against a tide of doctors and public-health officials urging people to get the measles-mumps-rubella, or MMR, vaccine.
Last week, California lawmakers sought to eliminate personal belief exemptions by proposing legislation that would require all school children to be vaccinated unless a child's health is in danger. If passed, California would join Mississippi and West Virginia with strict vaccine rules.
According to the Arizona Department of Health Services, before the creation of a measles vaccine, nearly all children got measles by the time they were 15 years old. Each year in the U.S., about 450 people died because of measles, 48,000 were hospitalized, 7,000 had seizures, and about 1,000 suffered permanent brain damage or deafness.
Until last year, there were only about 50 measles cases reported annually in the U.S., mainly due to high rates of vaccination. But the numbers shot up in 2014, with about 645 confirmed cases, the most since 1994. And 2015 already has racked up at least 121 cases in 17 states.
In Arizona, cases of measles are rarely found, with only one case confirmed every few years, typically when someone from the U.S. becomes infected while traveling overseas or someone from another country travels to the U.S. while infected with measles.
The Associated Press contributed to this story.