James Mu had braced for the decision that got here in late January.
A affected person from his rural Northern California county had measles, a illness so uncommon there that many physicians have by no means handled a case.
Whereas California has a number of the strictest vaccine legal guidelines within the nation, conservative Shasta County’s method throughout the covid pandemic stood in stark distinction with the state’s steering. Its native leaders opposed masking and vaccine mandates, and they ousted the county public well being officer, who had sought to implement these state insurance policies and different security measures.
A possible measles outbreak had “all the time been in my thoughts,” mentioned Mu, an outspoken household doctor who was amongst native docs to signal a 2022 letter opposing covid vaccine mandates. However Mu, the county’s present public well being officer, mentioned that when his division recognized the primary native measles case, it acted decisively: “We forgot about worry.”
They went to work, he and his workforce mentioned, to painstakingly retrace the steps of 9 individuals sickened with measles, contacting greater than 600 individuals who could have been uncovered at Costco, a sushi restaurant, sporting occasions, a college, or a healthcare clinic. Simply one of many 9 contracted measles from a type of areas, whereas the others have been characterised by the general public well being division as “shut contacts.”
Two and a half months later, the Shasta County public well being division had declared the measles outbreak over. Infectious illness consultants say the speedy response executed within the principally rural, vaccine-hesitant county presents a playbook for public well being officers throughout the nation who’re struggling to maintain the extremely contagious virus from spreading.
“To me, the story of Shasta is one in every of hope,” mentioned Peter Chin-Hong, an infectious illness specialist on the College of California-San Francisco.
After greater than a 12 months of ongoing circumstances, measles has sickened greater than 4,000 individuals within the U.S., in accordance with the Facilities for Illness Management and Prevention. For the primary time in 20 years, the U.S. is poised to lose its measles elimination standing, a designation signaling that outbreaks are uncommon and quickly contained.
Utah had confirmed 673 measles circumstances as of late Could whereas South Carolina had seen not less than 997, in accordance with their state well being departments. California had confirmed 74 circumstances.
Crucial Speedy Response
In late January, when Shasta County recognized the primary case, Mu gathered with greater than a dozen communicable-disease nurses, epidemiologists, and emergency and group relations staffers for an “preliminary risk evaluation assembly.”
Measles is an airborne pathogen that may linger in a room for 2 hours after an contaminated individual leaves, so on-call nurses and responders confronted a frightening job determining precisely when the affected person was infectious and the place they’d been.
“All the pieces is about pace — pace in figuring out the individual and discovering the websites the place measles have been occurring,” Chin-Hong mentioned. “In the event you maintain it down to a couple circumstances, it’s a lot simpler. In the event you wait just a bit bit longer, these individuals would have been involved with much more individuals.”
Roughly 9 in 10 unvaccinated individuals uncovered to the virus turn into contaminated. All 9 of Shasta County’s confirmed circumstances have been individuals who have been unvaccinated or had unknown vaccination standing, in accordance with the county’s public well being division. Earlier than the division referred to as households who could have been uncovered, county nurses typically enlisted faculty principals, church workers, clinic managers, or others to make first contact, mentioned Daniel Walker, the county’s supervising epidemiologist.
Erika Piper, the pinnacle of Redding Christian Faculty in Palo Cedro, talked to high school households cautious of requests by public well being officers — and authorities usually — to supply immunization data or different private info. She mentioned she additionally had robust however respectful conversations with households to make sure uncovered, unvaccinated youngsters stayed residence from faculty, so their group might abide by public well being steering calling for 21 days of isolation.
“I might say to them: ‘That’s completely positive. You might have a selection. You’ve made your selection. However there are nonetheless penalties to the alternatives we make,’” Piper mentioned, referring to households who had opted to not vaccinate their kids. “‘And so you possibly can both be a keen helper and a associate with me on this, and we will make it work and get by it, or you possibly can battle me on it. However both approach, you possibly can’t be in class.’”
She allowed work to be despatched residence to quarantined college students and personally took every day attendance on the faculty to assist guarantee well being pointers have been met.
The California Division of Public Well being assisted with case investigation by making calls to uncovered individuals on the county’s request and deployed a covid-era cellphone system, CalCONNECT, that automates symptom monitoring for uncovered contacts.
Shasta officers warned individuals to not be cautious of calls from contract tracers utilizing a 279 space code, worrying they’d dismiss them as scams.
Delicate Conversations
In Shasta County, the measles vaccination fee is just under the 95% threshold for community-level safety, however in pockets of the group the charges are decrease and range broadly, in accordance with state information. And in these susceptible locations, an outbreak can unfold.
For instance, greater than 1 / 4 of Shasta colleges had charges beneath 95% in 2024-25, in accordance with the newest state information accessible. A number of have been beneath 90%. Though Redding Christian Faculty reported a kindergarten measles vaccination fee at or above 95% in 2024-25, it was 87.8% three years earlier.
When it got here to speaking to individuals who had been uncovered to measles, Sharayne Loomis, a supervising public well being nurse on Shasta’s communicable-disease workforce, described the division’s method as “assembly individuals the place they’re.” That included nonjudgmental conversations that supported residents no matter their stance on vaccination, Loomis mentioned.
Mu mentioned the identical philosophy prolonged throughout the county’s well being businesses, however he publicly cautioned in opposition to “measles events,” gatherings the place unvaccinated kids are deliberately uncovered to construct immunity. And he spoke in opposition to receiving excessive doses of vitamin A with out medical supervision. Vitamin A has circulated as a measles remedy in vaccine-skeptical communities and was endorsed final 12 months by Well being and Human Companies Secretary Robert F. Kennedy Jr., although the CDC web site says that vitamin A “doesn’t forestall measles and isn’t an alternative choice to vaccination.”
Some group members mentioned Mu’s division might have been extra proactive earlier than the outbreak, imploring him to emphasise the significance of vaccination in public messaging.
“Clearly, when the scenario was recognized to be coming into our communities, that might have been a time to advise for vaccines,” Steve Kahn informed county supervisors at their February board assembly. “I believe he was negligent in that.”
For years, public well being has been a political flash level for the area. The Board of Supervisors fired the earlier public well being officer, Karen Ramstrom, in Could 2022 after pushback from residents upset along with her enforcement of state covid guidelines.
In an effort to succeed in vaccine-hesitant Californians, state officers have been working in a coalition referred to as Public Well being for All Californians Collectively and thru an effort nicknamed Mission Stethoscope that makes use of social media monitoring and different analysis to tailor messaging to skeptical viewers.
Erica Pan, director of the California Division of Public Well being, mentioned the state is getting ready for measles to probably surge when it hosts World Cup soccer matches beginning in June, in addition to with elevated summer season journey.
However in the case of mitigating an outbreak in a group, public well being officers say, residents — particularly these skeptical of vaccines — want to listen to from the individuals they know.
“Belief is essential for us,” Mu mentioned. “It’s essential in getting individuals to observe our steering, particularly throughout an outbreak.”