4 more measles cases in California; 4 who got it abroad were intentionally unvaccinated

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State health officials have confirmed four more cases of measles in Orange County, bringing the statewide total for the year to 36. Meanwhile, KPCC has learned that of the 10 Californians who contracted the disease while traveling abroad, four were intentionally not vaccinated.

The number of measles victims who were not vaccinated grew by one, to 20, according to the California Department of Public Health (CDPH). The total number of people with measles who were intentionally unvaccinated remains at 14, a number KPCC first reported on Tuesday. Twelve of the patients had no vaccination record, so their immunization status could not be verified, the CDPH said.

Since the measles was declared eliminated in  the US in 2000, there have been between 4 and 40 cases in California each year, most of which involve people who traveled to countries where the disease is still present.

By this time last year there were three measles cases in California.

Of the 10 people who have contracted the disease abroad in 2014, five were unvaccinated, according to state epidemiologist Dr. Gil Chavez. Three had gone to the Philippines, where there is a large outbreak, one went to India, and one went to Vietnam, he said. Measles is still endemic in those two countries. 

Four of those unvaccinated travelers were intentionally not vaccinated, said Chavez. Citing confidentiality concerns, the CDPH did not release the ages of the four travelers, or where they went.

RELATED: Surge in measles cases has health officials worried about vaccine refusers

California allows parents to opt out of vaccinating their children by invoking a personal belief exemption.

In at least three California counties, the measles outbreak has been linked with exposure to people who contracted the disease abroad.

In San Diego County, where there are four confirmed cases, three people were infected through exposure to someone who contracted it in the Philippines, according to county spokesman Jose Alvarez.

Of the 10 confirmed cases in Los Angeles County, four were contracted abroad, according to county health department spokesman Allen Solomon. Eight of the county’s measles cases are linked to travel, and the other two are under investigation, he said. Seven L.A. County residents who contracted the disease were unvaccinated, four of them due to personal belief exemptions, Solomon added.

In Contra Costa County, where there are four confirmed cases, two were contracted in the Philippines, and two were not connected to travel, a county official said. Three of those cases were in people who were intentionally unvaccinated, the official added.

None of Riverside County's five confirmed measles cases involved people who had traveled, said the county’s director of disease control, Barbara Cole. All five were unvaccinated, although Cole declined to say whether they had personal belief exemptions.

Symptoms of a typical measles case usually start with a mild to moderate fever, cough, runny nose, red eyes and sore throat, which are often followed several days later by tiny white spots inside the mouth and a red or brown rash on the body that starts in the face and upper neck and moves to the trunk and extremities, according to health officials.

So far this year California has also seen individual measles cases in Alameda, San Mateo, and Santa Clara Counties. Orange County has had a total of 10 cases so far.

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