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.
While California has among the strictest vaccine legal guidelines within the nation, conservative Shasta County’s strategy through 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 “always been in my mind,” stated Mu, an outspoken household doctor who was among local doctors to signal a 2022 letter opposing covid vaccine mandates. But Mu, the county’s present public well being officer, stated that when his division recognized the primary native measles case, it acted decisively: “We forgot about fear.”
They went to work, he and his workforce stated, to painstakingly retrace the steps of nine people sickened with measles, contacting greater than 600 individuals who might have been uncovered at Costco, a sushi restaurant, sporting occasions, a college, or a healthcare clinic. Just one of many 9 contracted measles from a kind of areas, whereas the others have been characterised by the general public well being division as “close contacts.”
Two and a half months later, the Shasta County public well being division had declared the measles outbreak over. Infectious illness specialists say the fast response executed within the largely rural, vaccine-hesitant county provides 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 of hope,” stated Peter Chin-Hong, an infectious illness specialist on the University of California-San Francisco.
Downtown Redding, California, the seat of Shasta County. (iStock/Getty Images)
After greater than a yr of ongoing instances, measles has sickened greater than 4,000 people within the U.S., in keeping with the Centers for Disease Control 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 instances as of late May whereas South Carolina had seen at the very least 997, in keeping with their state well being departments. California had confirmed 74 instances.
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Critical Rapid 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 neighborhood relations staffers for an “initial threat assessment meeting.”
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 process determining precisely when the affected person was infectious and the place that they had been.
“Everything is about speed — speed in identifying the person and finding the sites where measles were occurring,” Chin-Hong stated. “If you keep it down to a few cases, it’s much easier. If you wait just a little bit longer, those people would have been in contact with a lot more people.”
Roughly 9 in 10 unvaccinated folks uncovered to the virus develop into contaminated. All 9 of Shasta County’s confirmed instances have been individuals who have been unvaccinated or had unknown vaccination standing, in keeping with the county’s public well being division. Before the division referred to as households who might have been uncovered, county nurses generally enlisted college principals, church workers, clinic managers, or others to make first contact, stated Daniel Walker, the county’s supervising epidemiologist.
Erika Piper, the pinnacle of Redding Christian School in Palo Cedro, talked to high school households cautious of requests by public well being officers — and authorities basically — to offer immunization data or different private info. She stated she additionally had robust however respectful conversations with households to make sure uncovered, unvaccinated children stayed house from college, so their neighborhood might abide by public well being steering calling for 21 days of isolation.
“I would say to them: ‘That’s totally fine. You have a choice. You’ve made your choice. But there are still consequences to the choices we make,’” Piper stated, referring to households who had opted to not vaccinate their youngsters. “‘And so you can either be a willing helper and a partner with me in this, and we can make it work and get through it, or you can battle me on it. But either way, you can’t be in school.’”
She allowed work to be despatched house to quarantined college students and personally took day by day attendance on the college to assist guarantee well being pointers have been met.
The California Department of Public Health assisted with case investigation by making calls to uncovered folks on the county’s request and deployed a covid-era cellphone system, CalCONNECT, that automates symptom monitoring for uncovered contacts.
Shasta officers warned folks 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 charge is just under the 95% threshold for community-level safety, however in pockets of the neighborhood the charges are decrease and differ broadly, in keeping with state data. 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 keeping with the most recent state information obtainable. Several have been beneath 90%. Although Redding Christian School reported a kindergarten measles vaccination charge 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 strategy as “meeting people where they are.” That included nonjudgmental conversations that supported residents no matter their stance on vaccination, Loomis stated.
Mu stated the identical philosophy prolonged throughout the county’s well being businesses, however he publicly cautioned against “measles parties,” gatherings the place unvaccinated youngsters are deliberately uncovered to construct immunity. And he spoke towards 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 yr by Health and Human Services Secretary Robert F. Kennedy Jr., although the CDC web site says that vitamin A “does not prevent measles and is not a substitute for vaccination.”
James Mu, Shasta County’s public well being officer, led the agricultural, conservative California county’s effort to comprise a measles outbreak that started in late January. (Shasta County)
Some neighborhood members stated 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 situation was known to be coming into our communities, that would have been a time to advise for vaccines,” Steve Kahn advised county supervisors at their February board assembly. “I think 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 May 2022 after pushback from residents upset together with her enforcement of state covid guidelines.
In an effort to achieve vaccine-hesitant Californians, state officers have been working in a coalition referred to as Public Health for All Californians Together and thru an effort nicknamed Project Stethoscope that makes use of social media monitoring and different analysis to tailor messaging to skeptical viewers.
Erica Pan, director of the California Department of Public Health, stated 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 time journey.
But on the subject of mitigating an outbreak in a neighborhood, public well being officers say, residents — particularly these skeptical of vaccines — want to listen to from the folks they know.
“Trust is very important for us,” Mu stated. “It is critical in getting people to follow our guidance, especially during an outbreak.”