LOS ANGELES (AP) — Seventy people have been infected in a measles outbreak that led California public health officials to urge those who haven't been vaccinated against the disease, including children too young to be immunized, should avoid Disney parks where the spread originated. 
 
 FILE - This Nov. 20, 2009 photo shows Sleeping Beauty's Castle in winter dress with the iconic "Partners" statue featuring images of Walt Disney and Mickey Mouse in the foreground, at Disneyland in Anaheim,... (Associated Press) 
 
 New infections linked to the theme parks emerged Wednesday in the outbreak that has spread to five U.S. states and Mexico, though the vast majority — 62 — occurred in California. 
 
 Because measles is highly contagious, people who have not received the measles-mumps-rubella, or MMR, vaccine are susceptible and should avoid visiting Disney "for the time being," state epidemiologist Gil Chavez said. 
 
 The same holds true for crowded places with a high concentration of international travelers, such as airports, Chavez said. People who are vaccinated don't need to take such precautions, he said. 
 
 Disneyland Resorts spokeswoman Suzi Brown said officials agreed with the advice that "it's absolutely safe to visit if you're vaccinated." 
 
 The people who have been infected range in age from 7 months to 70 years old. The vast majority were not vaccinated, and a quarter had to be hospitalized. 
 
 Among those sickened were five Disney employees. Three have since returned to work. The company previously said park employees who may have been in contact with those infected were asked to show proof of vaccination or have a blood test to show immunity against measles. Those with pending results were put on paid leave. Vaccinations are also being offered to all employees. 
 
 Measles has hit California hard recently. The state typically sees four to 60 measles cases a year. 
 
 "We are off to a bad start in 2015," Chavez said. 
 
 Since the outbreak, two dozen unvaccinated students at an Orange County high school were sent home for three weeks after an infected pupil showed up. 
 
 Measles is a highly contagious respiratory illness that can spread by air through coughing or sneezing. Symptoms include fever followed by cough, runny nose and a blotchy rash. Though the virus has been eradicated in the U.S. since 2000, it can still enter the country through an infected traveler. 
 
 While health officials said they likely may never find "patient zero" or the trigger of the outbreak, they believe it was either a resident from a country where measles is widespread or a Californian who went abroad and brought home the virus. 
 
 People at highest risk are those who are unvaccinated, pregnant women, infants under 6 months old, and those with weakened immune systems. 
 
 ___ 
 
 Contact Alicia Chang at http://twitter.com/SciWriAlicia ||||| We think of Disneyland as the most magical place on earth. Now, it’s also known as ground zero for a measles outbreak. USA TODAY’s Carly Mallenbaum talks about how the measles have spread from California to neighboring states. (USA NOW, USA TODAY) 
 
 Miami Children's Hospital pediatrician Amanda Porro prepares to administer a measles vaccination to Sophie Barquin, 4, as her mother, Gabrielle, holds her Jan. 28. A recent outbreak of measles has some doctors encouraging vaccination as the best way to prevent measles and its spread. (Photo: Joe Raedle, Getty Images) 
 
 A resort such as Disneyland, where visitors mix with people from all over the world before flying home, is the perfect place to start a nationwide measles epidemic, public health experts say. 
 
 Yet a Disneyland measles outbreak that has spread to eight states and Mexico could also help turn around a trend in which more parents have opted out of vaccinating their children. 
 
 A growing number of parents in recent years have skipped their children's vaccines because of a discredited belief that vaccines are linked to autism. That has led to pockets of unvaccinated children, says Mark Schleiss, a pediatric infectious disease physician at the University of Minnesota. 
 
 "We could be on the threshold of a watershed event, where we see large outbreaks in many cities," Schleiss says. "But perhaps this will also be watershed event to refocus attention on the safety of vaccines." 
 
 According to the Centers for Disease Control and Prevention, 84 people in 14 states were diagnosed with measles from Jan. 1 through 28. Most were infected either at Disneyland or by someone who went there. 
 
 That means the USA had more cases of measles in January than it usually has in an entire year, says Anne Schuchat, assistant surgeon general. About 15% of measles patients have been hospitalized. 
 
 “This has the potential to get really huge. We don't know how big this will get.” Dr. Claire McCarthy, Boston Children's Hospital. 
 
 Most of the infected people had not been fully vaccinated, she says. 
 
 "This is a wake-up call to make sure that we keep measles from regaining a foothold in our country," Schuchat says. 
 
 Last year was a particularly bad year for measles, driven both by huge outbreaks in Asia as well as rising rates of unvaccinated children. Doctors diagnosed 644 people with the virus, according to the CDC. Although health officials don't know who started the Disneyland outbreak, they have said it was probably a foreign visitor. 
 
 Q&A: About the measles vaccine 
 
 Measles infects 20 million people around the world each year, killing 145,000, Schuchat says. 
 
 Yet the disease didn't get much attention until it arrived at Disneyland, says Paul Offit, director of the Vaccine Education Center at Children's Hospital of Philadelphia, who says he has been doing non-stop news interviews about measles this week. 
 
 "You really feel much more anger with this outbreak," Offit says. "What is the difference? I really think it's Disneyland." 
 
 Offit says some people are frustrated that parents who chose not to vaccinate are ruining their vacations or just ruining the idea of a happy, carefree place that's normally untouched by reality. California health officials have warned unvaccinated people not to go to Disneyland and not to take babies too young to have had their first shots. 
 
 Jane Szalkowski holds her 6-month old granddaughter, Livia Simon, who is under a measles quarantine as a precaution in Oakland. The baby visited a doctor's office this month where a child with measles was diagnosed. (Photo: Dave Simon, AP) 
 
 California schools have sent dozens of unvaccinated students home from school to protect them and stop the spread of measles. That may educate people about how dangerous and disruptive measles can be, Offit says. 
 
 "People for years have desperately tried to make sure that parents understand what is at stake when you don't vaccinate," Offit says. "Unfortunately, the only thing that really educates people is fear of the disease." 
 
 Some examples of the disruption: Arizona has diagnosed only seven cases of measles, but those infected people have exposed as many as 1,000 others, including babies too young to have had their first measles shot, according to the Arizona Department of Health Services. Doctors recommend that unvaccinated people exposed to measles be quarantined for three weeks, the measles incubation period. 
 
 The CDC recommends that children receive a first measles shot around age 1 and a second at ages 4 to 6 before beginning kindergarten. 
 
 The Arizona measles cases began with one unvaccinated family of four from Pinal County that went to Disneyland, according to state health officials. Back at home, one of the children went to two urgent-care centers for medical attention, exposing 18 children, 13 of whom were unvaccinated. That family also exposed a woman from Maricopa County, who then exposed as many as 195 children at a child care center. A man who caught measles from the family then exposed others. 
 
 Although the routine spread of measles was eliminated in the USA in 2000, a low rate of vaccination in some communities has allowed the virus — one of the most contagious — to make a comeback, says Walter Orenstein, a professor and associate director of the Emory Vaccine Center in Atlanta. Measles vaccination rates range from a low of 81% of kindergarten students in Colorado to a high of nearly 100% in Mississippi. 
 
 The current generation of parents has no experience with measles, Orenstein points out. A growing number have skipped or delayed children's vaccines because of debunked myths about vaccines causing autism, Orenstein says. 
 
 "People don't see these diseases, they don't fear these diseases, and they don't know how serious these diseases can be," he says. 
 
 A boy with measles in 1963. (Photo: http://phil.cdc.gov) 
 
 Measles is a tenacious virus that lingers in the air and can infect people two hours after a sick person has left the room. People with measles are contagious even in the early days of the infection, when they have symptoms similar to those of a cold and the telltale red rash has not appeared, Orenstein says. On average, one measles patient can infect as many as 18 susceptible people — those who are unvaccinated and who have never had measles. 
 
 For every 1,000 cases of measles, two to three people die, Orenstein says. Children can develop pneumonia, deafness or encephalitis, an inflammation of the lining of the brain. 
 
 During a measles outbreak from 1989 to 1991, more than 55,000 Americans were infected, more than 11,000 were hospitalized and 166 died, according to the CDC. 
 
 Children with measles are miserable even if they don't develop serious complications, Offit says. The disease can last up to two weeks, causing fevers of 103 to 105 degrees, ear infections, diarrhea and loss of appetite that can lead to dehydration. Children can become so sensitive to light that they need to lie in bed in a darkened room. 
 
 One way doctors diagnose measles, Offit say, is by noting a child's degree of misery. "Children with measles are inconsolable," he says. 
 
 Controlling a measles outbreak is expensive and time-consuming. Each case in a measles outbreak in 2008 cost taxpayers more than $10,000 as public health staff traced each patient's contacts, quarantined patients and administered vaccines. 
 
 Offit says he's seen a big change in news coverage of the Disneyland measles outbreak. Ten or 15 years ago, he says, reporters often gave credence to parents claiming that vaccines caused their children to develop autism. Since then, studies have debunked any link between autism and childhood immunizations — a fact Offit sees reflected in coverage now. 
 
 The Disneyland outbreak "gives us a chance to have important conversations about what vaccines do and what they protect us from," says Claire McCarthy, a pediatrician at Boston Children's Hospital. "These other measles outbreaks haven't seemed quite real to people. Disneyland has made it real." 
 
 About 25% of measles patients have been sick enough to be hospitalized, according to California health officials. McCarthy says she fears many more will be hospitalized before the outbreak is under control. 
 
 "This has the potential to get really huge," McCarthy says. "We don't know how big this will get." 
 
 Pediatrician Bob Sears, author of The Vaccine Book, says he thinks more families will vaccinate against measles as a result of the outbreak. But he doubts skeptical parents will be more likely to follow the CDC schedule for other vaccinations. 
 
 "Because measles has been so rare in the past 20 years, parents had the luxury to forgo the vaccine without risking disease," Sears says. "When an outbreak occurs, that sense of security goes away." 
 
 Although Sears recommends that parents vaccinate children against measles at age 1, the same age recommended by the CDC, he has popularized an alternative vaccine schedule that stretches out the length of time between shots because some parents worry about too many shots at once. Critics say that leaves children vulnerable to dangerous diseases for an unnecessarily long time. 
 
 "Parent should have the freedom to consider the pros and cons of the (measles) vaccine and make an educated decision for their child," Sears says. 
 
 Schleiss points out that parents who choose not to vaccinate may find themselves taking three weeks off work or hiring a babysitter when their unvaccinated children are excluded from class. 
 
 "That comes with the territory when you choose not to vaccinate," he says. 
 
 Read or Share this story: http://usat.ly/1CE2Zlp ||||| An outbreak of measles that started in California's Disneyland probably came from overseas, carried either by a foreign tourist or by an American coming back with the virus, a top federal health official said Thursday. 
 
 The virus has now infected 94 people in eight states, and 67 can be clearly linked to Disneyland, California health officials report. Because measles is so contagious, more cases can be expected. 
 
 "We don't know exactly how this outbreak started but we do think it was likely a person infected with measles overseas," Dr. Anne Schuchat of the Centers for Disease Control and Prevention told reporters. 
 
 "We assume that someone got infected with measles overseas, visited Disneyland park, and spread the disease to others." 
 
 “ This is a wake-up call to make sure that we keep measles from regaining a foothold in our country.” 
 
 There's been on ongoing outbreak of measles in the Philippines, but no imported U.S. cases have been linked to the Philippines this year, Schuchat said. Genetic tests of the virus affecting Americans are similar to strains seen in Indonesia, Qatar, Azerbaijan and Dubai. 
 
 Whoever first brought the virus to Disneyland is probably long gone, Schuchat said, and could even be unaware that he or she caused the outbreak. 
 
 "This is a wake-up call to make sure that we keep measles from regaining a foothold in our country," Schuchat said. 
 
 "France went from about 40 cases a year to over 10,000 cases. It is only January and we have already had over 84 cases." 
 
 France reported 10,000 cases of measles in 2000. Like other countries, the numbers vary greatly from one year to another, and in 2011 France reported nearly 15,000 measles cases but that fell to just 272 cases in 2013. 
 
 No matter what the source, doctors and nurses need to be on the lookout for the highly infectious virus, she warned. 
 
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 "We are urging all health care professionals to think measles during medical visits," Schuchat said. Anyone with a fever, especially if there's a rash, should be evaluated for measles. It's the most infectious virus known, with a 90 percent transmission rate among people who are not immunized or otherwise immune to it. Each patient with measles can infect 12 to 18 other people." 
 
 The reason it's spreading is simple. People have failed to get vaccinated, Schuchat said. 
 
 "This is not a problem of the measles vaccine not working. It's a problem of the measles vaccine not being used," she said. "Measles can be a very serious disease and people need to be vaccinated." 
 
 Most Americans have been vaccinated but some cannot get the vaccine for medical reasons — if they have a damaged or compromised immune system, for instance. Babies under a year old are not vaccinated because their bodies don't really respond well to the vaccine and it doesn't protect them. 
 
 But the biggest problem is people who skip vaccines for philosophical reasons, said Schuchat. 
 
 "It is frustrating that some people have opted out of vaccination," she said. "I think we do have some communities with many who have not received vaccines." 
 
 Measles was eliminated in the U.S. in 2000, but a few imported cases come in every year. 
 
 "Measles can come into our country easily through visitors or when Americans travel abroad and bring it back," Schuchat said. 
 
 "Measles is still common around the world and we estimate there are around 20 million cases a year," Schuchat added. Of them, more than 145,000 die every year. "For every 1,000 children who get measles, one to three of them die despite treatment," Schuchat said. And 28 percent of kids who get measles are sick enough to be hospitalized, and can suffer permanent brain damage. 
 
 Last year, a big outbreak was traced to Amish volunteers who went to help after a typhoon in the Philippines and who got infected during a measles outbreak there. It helped make for a record year in the U.S. with 600 cases. 
 
 What CDC wants to avert is something like what happened between 1989 and 1991, when 55,000 people got measles and 123 died. 
 
 Most of the kids made sick in the Disney outbreak had not been vaccinated, Schuchat said. But more adults than usual have been infected. 
 
 “ There’s no harm in getting another MMR vaccine.” 
 
 This might not mean much. The vaccine isn't 100 percent effective and most U.S. kids are vaccinated. That means the vulnerable people are more likely to be adults, just by virtue of the fact that adults travel more and there are more adults than children in the United States. 
 
 Schuchat says it's impossible to predict how bad the outbreak will get and where new cases will emerge. 
 
 "I think people really need to know that you can get measles anywhere. It's invisible and we have importations every year," she said. 
 
 But she says CDC is not especially worried about the upcoming Super Bowl in Arizona on Sunday. Schuchat doubts an unusual number of unvaccinated people will be traveling to the Super Bowl and measles only spreads to people who are not immune. 
 
 But the non-immunized need to take care. 
 
 "You can catch measles just by being in the same room as a person who has measles," she said. 
 
 "If you are not sure whether you have had the measles vaccine or not … contact your doctor or nurse," she advised. 
 
 "There's no harm in getting another MMR vaccine." ||||| Nurses Fatima Guillen, left, and Fran Wendt, right, give Kimberly Magdeleno, 4, a whooping cough booster shot, as she is held by her mother, Claudia Solorio, at a health clinic in Tacoma, Wash., on May 3, 2012. (Photo: Ted S. Warren, AP) 
 
 Vaccines given to infants and young children over the past two decades will prevent 322 million illnesses, 21 million hospitalizations and 732,000 deaths over the course of their lifetimes, according to a new report from the Centers for Disease Control and Prevention. 
 
 Vaccines also will have saved $295 billion in direct costs, such as medical expenses, and a total of more than $1.3 trillion in societal costs over that time, because children who were spared from sometimes-devastating illnesses will be able to contribute to society, the report shows. These calculations may underestimate the full impact of vaccines, the study notes, because authors considered only the early 14 routine childhood immunizations typically required for school entry. Authors didn't include flu shots or adolescent vaccines given at ages 11 or 12. 
 
 The CDC released the report at a time when many parents are uncertain about the benefits of vaccines, leading some to skip or delay routine childhood shots. Authors of the new report based their estimates on CDC annual immunization surveys and published reports showing the known efficacy of vaccines, as well as complication rates from infectious diseases. 
 
 Before the measles vaccine became available in 1963, the virus infected about 500,000 Americans a year, causing 500 deaths and 48,000 hospitalizations. In recent years, the number of diagnoses fell to around 60 to 65, mostly in isolated travelers arriving in the USA. 
 
 Doubts about vaccines safety – and fading memories of vaccine-preventable diseases — have contributed to a resurgence of nearly forgotten diseases such as measles, which was officially declared eradicated in the USA in 2000. Numerous studies have debunked the notion that vaccines cause autism or other chronic diseases, says William Schaffner, an infectious disease specialist and professor at the Vanderbilt University School of Medicine in Nashville. 
 
 "We have roomfuls of evidence" showing that vaccines are some of the safest medications available, Schaffner says, "but rumors and conspiracy theories still spread. Young parents today haven't seen these disease, and they don't respect and fear them." 
 
 The CDC reports that 129 people in the USA have developed measles this year, in 13 outbreaks largely sparked by unvaccinated travelers who become infected while abroad, then spread the disease to their communities. Most measles patients were either unvaccinated or didn't know whether they had been vaccinated. Among the unvaccinated measles cases, 68% had a "personal belief" exemption from school vaccination requirements, the CDC's Anne Schuchat says. 
 
 The USA also is fighting outbreaks of whooping cough, which has infected 5,634 people this year. Mumps has sickened 393 this year, more than twice the number of cases in 2013. 
 
 Health officials have battled such outbreaks for the past 20 years through the federal Vaccines for Children program, which provides free immunizations to poor and uninsured kids. About half of children and teens in the USA are eligible for the program, which has a budget of $4 billion a year, according to the CDC. 
 
 Congress created the entitlement program in 1994, responding to a measles outbreak in 1989 to 1991 that sickened 55,000 people and killed more than 100. At the time, measles outbreaks were fueled by viruses circulating among low-income, inner-city residents. 
 
 The picture has completely changed today, Schaffner says. The federal program has eliminated racial and ethnic disparities among vaccines. Today, the bulk of the unvaccinated children come from wealthy, educated families where parents intentionally choose not to immunize them, due to concerns about vaccine safety. These relatively wealthy children can then spread measles after returning from vacations in Europe, which has had large outbreaks for several years, Schaffner says. 
 
 "Borders can't stop measles, but vaccination can," CDC Director Tom Frieden says. 
 
 Containing a measles outbreak can be tricky, given that many younger doctors have never seen a case, says Julia Shaklee Sammons, a hospital epidemiologist at Children's Hospital of Philadelphia. That can allow measles to spread in doctor's offices and hospitals, Sammons wrote in an article in Annals of Internal Medicine published today. 
 
 Sammons described the typical symptoms and course of a measles infection in her article to help remind younger doctors who aren't familiar with the disease. 
 
 The CDC recommends two doses of the measles, mumps, and rubella vaccine for babies starting at age 12 months. Babies who will be traveling internationally can receive one dose as early as 6 months. 
 
 Adults who aren't sure if they've been vaccinated should also get a measles booster before going abroad, especially to the Phillippines, where an ongoing outbreak has sickened 20,000 people, Schuchat says. 
 
 "If you're not sure, get another dose," Schuchat says. 
 
 Read or Share this story: http://usat.ly/1hpNX8X ||||| The vaccination exemption rate among kindergarten students in California — cases in which parents said they did not want their children vaccinated for health, religious or other reasons — was 3.1 percent in the 2013-14 school year, according to the C.D.C. report. Oregon had an exemption rate of 7.1 percent, the nation’s highest, the report found. Health officials said the vaccination rate needed to be above 95 percent in all communities to prevent outbreaks. 
 
 Still, the California figure can be deceiving. Health officials said there were pockets across the state, including wealthy neighborhoods in Los Angeles and Orange Counties and enclaves in Northern California, where the exemption rate jumped into the double digits. California has long been viewed as particularly prone to this kind of outbreak because of its population size and the number of people arriving from overseas. 
 
 “The problem is that there are these pockets with low vaccination rates,” said Dr. Jane Seward, the deputy director of the viral diseases division at the C.D.C. “If a case comes into a population where a lot of people are unvaccinated, that’s where you get the outbreak and where you get the spread.” 
 
 Organizations that have led the campaign of doubts about vaccinations suggested that it was too soon to draw such a conclusion. The groups cautioned parents not to be pressured into having their children receive vaccinations, which the organizations say have been linked to other diseases. Health professionals say those claims are unfounded or vastly overstated. 
 
 “It’s premature to blame the increase in reports of measles on the unvaccinated when we don’t have all the facts yet,” said Barbara Loe Fisher, the president of the National Vaccine Information Center, a group raising concerns about inoculations. “I do know this: Fifty-seven cases of measles coming out of Disneyland in a country with a population of 317 million people is not a lot of cases. We should all take a deep breath and wait to see and get more information.” 
 
 A handful of doctors seem sympathetic to these views. Dr. Jay Gordon, a Santa Monica pediatrician who has cautioned against the way vaccines are used, said he had “given more measles vaccines” than ever before but did not like giving the shot to younger children. 
 
 “I think whatever risk there is — and I can’t prove a risk — is, I think, caused by the timing,” he said, referring to when the shot is administered. “It’s given at a time when kids are more susceptible to environmental impact. Don’t get me wrong; I have no proof that this vaccine causes harm. I just have anecdotal reports from parents who are convinced that their children were harmed by the vaccine.”
– From 1988 to 1990, California was slammed with a measles epidemic that affected at least 16,000 people, per the Western Journal of Medicine. Now public health officials are trying to avoid a similar scenario, encouraging people in the Golden State to a) get vaccinated, and b) stay away from Disney parks where the current outbreak started if they're not. Although a Disneyland spokeswoman tells the AP "it's absolutely safe to visit if you're vaccinated," a state epidemiologist warns that those who haven't received the measles-mumps-rubella (MMR) shot should keep away for "the time being." Seventy people—the "vast majority" of them unvaccinated, notes the AP—have reportedly been infected so far in the outbreak. Measles has officially been eradicated since 2000 in the US; California officials speculate the current outbreak was caused by a foreign visitor or a resident who traveled overseas. The vaccination debate has been renewed, with many health officials lambasting those who refuse to get their shots due to fears about risks. "[These cases] wouldn't have happened otherwise. … There are some pretty dumb people out there," an infectious disease specialist tells the New York Times, while a deputy director at the California Center for Infectious Diseases urges "unvaccinated Californians to consider getting vaccinated against measles." Even Bill Gates, who has lobbied for vaccinations around the globe, tells Wired, "It will take cases like this Disneyland thing to remind people how irresponsible [not being vaccinated] is." The head of the National Vaccine Information Center, however, says it's all overblown. "Fifty-seven cases of measles coming out of Disneyland in a country with a population of 317 million people is not a lot ... . We should all take a deep breath," she says.