CORRECTION: Originally, this story misspelled Linda Shutz's name.
Idaho's top disease expert is holding her breath and crossing her fingers.
It's almost spring break.
That means airplanes coming and going, kindergartners seeing Disneyland for the first time, and Idaho students returning from vacations in states where there have been measles cases - which is to say, almost every state surrounding Idaho.
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"We have been very concerned over the past several months. ... That's getting darn close," said state epidemiologist Christine Hahn. "Every week, we've had kids with rashes evaluated for measles."
So far, Idaho isn't part of an outbreak that began late last year.
The last time anyone in Idaho tested positive for the measles was in 2001; it was an adult who had just returned from Korea.
That disease didn't spread, Hahn and other experts say, because there were enough other people vaccinated.
One morning in late February, the Central District Health Department - serving Ada, Boise, Elmore and Valley counties - set aside some measles/mumps/rubella injections and held a special clinic, offering the shots to adults for $38.
Jason Kindelberger, a Boise police officer who works as a resource officer in schools, was among the first through the door. The Boise Police Department didn't require him to go, he said. But with the recent measles and mumps outbreaks, he tried to dig up his childhood vaccination records to make sure he was immune. He couldn't find them anywhere.
"Working at a school, there's other people at risk," he said. "I don't want to be a problem, and I want to protect my kids," which is what he calls the students at his schools.
WHY THE FEAR OF MEASLES?
In the 1950s, hundreds of people in the U.S. died each year from measles. Most children caught it. But in the late 1960s, the current measles vaccine went into widespread use. Deaths fell from 408 in 1962 to 24 in 1972. The U.S. eliminated measles from the country in 2000 - something experts attribute to successful vaccination efforts. There were dozens of cases in the early 21st century, but outbreaks and deaths were rare.
Measles is a nasty bug that can cause a full-body rash, fever, pneumonia and in rare cases brain swelling. One or two children die among every 1,000 who get sick. And it's highly contagious. It lingers in the air, and an infected person can spread the virus up to four days before realizing they're infected.
A flu patient typically will infect one other person. A measles patient will infect 12 to 18.
Despite this, many parents in Idaho are opting out of measles/mumps/rubella vaccinations for their children. Or they're delaying them, making them less effective.
The reason they balk usually isn't religious or because of underlying health problems. It's fear.
This frustrates Idaho doctors and public health officials - because the parents who dismiss their advice are doing what they believe is best for their child.
The only way to develop immunity to measles, mumps, tetanus, whooping cough, chickenpox and other vaccine-preventable illnesses is to be vaccinated or to contract, and recover from, the disease.
A MOTHER'S GUILT
Boisean Linda Shutz is one of the parents who bypasses vaccines. For her, it's about grief and second-guessing her decisions as a new mother.
Shutz brought her first-born to the doctor for his two-month checkup in March 2003. He got a round of vaccinations (not including measles/mumps/rubella, according to records). The next morning at 10:30 a.m., she found him lifeless.
A federal report noted symptoms of cardiac arrest, coma and apnea, or not breathing. It listed in the baby's history "periods of apnea" but no major medical conditions. It said an autopsy listed an "undetermined" cause of death.
Since then, Shutz has refused vaccinations for her three daughters, now 18 months to 8 years old.
"I'm not for or against" vaccinations, Shutz said. "To me, the immune system was built the way it is for a reason. ... I honestly believe they'll be just fine."
Shutz carries guilt that she didn't question vaccines before her son died. She's also "completely and utterly disgusted" by doctors who she says did not warn her of potential complications, and who now tell her it's implausible that her son's death was related to a vaccine.
Asked whether she's concerned about her daughters catching and passing on a disease to someone else, Shutz said: "I owe nothing to the herd. I owe nothing to anybody else in America. All I owe is a duty to my child (to) prepare them for a life."
Tragic losses such as Shutz's trouble John Rusche, a retired pediatrician from Lewiston who is now the Idaho House minority leader. Rusche worries that people hear of vaccinations followed by something horrible, assume that one caused the other and make decisions based on emotion instead of statistics.
"The illnesses really do happen. And anecdotes, single stories from single individuals, make bad medicine, bad public health policy," he said. "When you look at the data over a large population, you can determine what the risks are, and the risks are greater without a vaccination."
Shutz disagrees, saying she started researching vaccines after her son's death. Reading about the financial side of the pharmaceutical industry made her distrustful of recommendations from the CDC, she said.
Other parents have a different perspective.
"I have two children with autism, and I firmly believe that parents should immunize their children," said Katie Romans, of Boise.
Her daughters are now 22 and 19 years old. She is aware of the anti-vaccination theory linking the measles/mumps/rubella vaccine to autism, based on a 1998 paper in The Lancet medical journal. The journal has since retracted the article after finding "several elements ... incorrect," and the lead author was stripped of his medical license.
"I know that autism is not caused by immunizations, and even if it was, I'd rather have my children alive with autism rather than dead from a preventable disease," Romans said.
CAUSE AND EFFECT
Rusche stopped seeing patients in 1996. "I would explain how vaccines worked, and why you use them, and why it was important," Rusche said.
Some of those parents would later show up with a child sick from vaccine-preventable diseases, and with associated lung and brain problems, he said.
"I have seen kids with measles pneumonia, measles meningitis and have seen kids die from chickenpox," Rusche said, and "babies in the hospital turning blue for two weeks" from whooping cough.
Health care providers and officials aren't just worried about children and adults who don't have their shots. They worry about infants too young to be vaccinated and others who are unvaccinated for medical reasons.
One local parent worries the anti-vaccination movement could put her newborn at risk.
"I am absolutely terrified for my 3-month-old son, who has hardly received any vaccinations," said Ashley Hammond, a social worker and mother of two small children. The MMR vaccine "is still many months away for him, yet mumps is here in Idaho."
A mumps outbreak began at the University of Idaho last fall. It has spread to other states and to Boise. Mumps symptoms include fever, a sore and swollen jaw, and muscle aches. While usually mild, mumps can cause brain swelling, hearing loss and other long-term problems.
Pertussis (whooping cough) also is on the rise and has killed babies in Idaho in recent years. Pertussis causes severe, violent, prolonged coughing fits and can cause babies to stop breathing. Serious complications include pneumonia, seizures and brain swelling, especially in babies.
Rubella can cause a rash, fever and joint stiffness. It is especially dangerous for pregnant women, because it can cause birth defects.
"These anti-vaxxers are putting sick children, children too young to be vaccinated, immunocompromised individuals, and the elderly all at risk because of misinformation about vaccine effectiveness and ingredients," Hammond said.
Shutz says that's a mischaracterization of parents who refuse vaccines.
"We research car seats, but nobody stops to think about vaccines. And if I say anything, then it's, 'Oh, she's the crazy conspiracy lady.' No, that's not it," she said.
Hahn and others note that vaccines aren't 100 percent effective - a thoroughly vaccinated "herd" protects those who get ineffective vaccines or who can't get vaccines for medical reasons - and they do have potential side effects. Serious but very rare side effects such as allergic reactions usually happen within minutes, while others, such as a sore arm, are an annoyance, doctors said.
The federal system that tracks self-reported "adverse events" after vaccines has records of deaths and disabilities in Idaho over the past few decades, but no causal link is established. For example, one postvaccination death was a suicide.
HOW IDAHO RATES
Many Idaho kindergartners are going to school without the recommended vaccines, because Idaho gives parents the right to decide whether to vaccinate their children. Idaho is tied with Vermont for second-highest rate of kindergarten students with non-medical exemptions: About 6.1 percent enrolled in kindergarten had such exemptions in the last school year, according to the CDC.
And the rate in Idaho is growing, up half a percentage point from the 2012-2013 school year.
The Treasure Valley overall has a higher rate of students with complete vaccinations than do other pockets of the state. But many schools in Idaho have double-digit exemption rates.
Idaho's charter schools, generally, have a high rate of exemptions.
In Blaine County, schools with a total of 564 students in 2013 reported an average "complete" vaccination record of about 50 percent. The schools didn't have complete records for the other students, so it's unclear whether they are vaccinated.
To put that into context, the CDC says that to achieve "herd immunity" against contagious diseases, at least 75 percent to greater than 95 percent of people in a community should be vaccinated. Some airborne bugs, such as measles, are so quick to spread that "herd immunity" is at the higher end of that range.
VACCINES OFFERED AT SCHOOLS
The Central District Health Department started a targeted vaccine outreach effort on Feb. 1.
Some schools opt for just flu vaccines, while others allow Central District Health to offer all of them.
"This helps to eliminate the barriers of cost, transportation and time. However, schools may decide whether they want assistance with this, and the schools are responsible for enforcing vaccine requirements," said Christine Myron, spokeswoman for the health district Health. "We are currently focusing our effort on private/religious schools. But we would definitely offer assistance to public and charter schools if they are interested."
Marianne Case, a Boise insurance claims manager, was one of the adults who got an MMR shot from the local health department.
Case was planning a March trip to Disneyland with her family, including an 11-year-old daughter who has been vaccinated. The vacation meant measles was top-of-mind for Case, as Disneyland was the origin of the Western-U.S. measles outbreak.
A "firm believer in immunization," Case didn't know for sure whether her vaccine history was complete. So she sought the MMR shot for "peace of mind."
Case said she'd consulted a health care worker and was told that even if she had been vaccinated as a child, the extra shot wouldn't hurt her.
The importance of vaccines is a message that the state's epidemiologist wants to convey - especially to parents who are on the fence about vaccinating their children.
Hahn said she hopes all parents will consult a doctor they trust and base their decision on that medical advice.
"I hope that one thing Ebola taught us is that these diseases that sound so far away ... are only a plane ride away," Hahn said. "These vaccines are safe, they're lifelong."
Audrey Dutton: 377-6448, Twitter: @IDS_Audrey