This is the first in our 2025 “Health Matters” series focused on health topics in South Snohomish County and sponsored by the Verdant Health Commission.

As news of the country’s measles outbreak spread in early March, Edmonds resident Kaylee Allen revised the sign she had printed for her front door.

Allen, who was pregnant with her first child, had designed a red stop sign to caution all visitors. They should enter the home only when free of illness – and if vaccinated for COVID-19, flu and whooping cough. She hadn’t initially thought to include measles, but the hundreds of Texas cases changed her mind.

“I’ve been very clear with the loved ones in our lives that we need to keep our newborn safe,” Allen said. “Measles coming into the mix right at the home stretch here has been a brand-new curveball.”

This week, the Snohomish County Public Health Department reported another local measles case, this time from an infant who had traveled abroad. The latest case brings the Washington state tally to three so far this year. That’s likely not the end of the local threat, though, as a disease that was considered eliminated in the United States is making a comeback.

“This isn’t going away,” said Dr. James Lewis, Snohomish County’s health officer. “We’re going to continue to see measles outbreaks, unfortunately.”

Vaccination rates have declined nationwide, paving the way for the highly-contagious measles to quickly gain a foothold in communities that no longer experience herd immunity. In Snohomish County, 92.4% of kindergarten students reported measles vaccination in the last school year, down from 94.2% in the 2019-20 school year, according to state public health data. Multiple schools in the Edmonds School District have also fallen below the threshold required to halt measles spread, according to data reported in the 2023-24 school year.

“We’re not where we need to be,” Lewis said. “Every school needs to have at least 95% vaccination to have herd immunity since measles is one of the most contagious infections we know about.”

Who is at risk?

Since the measles vaccine is highly protective, the primary concern is for people who are unvaccinated, Lewis said.

Before the measles vaccine became available in 1963, about 3 million to 4 million people in the U.S. got infected each year, and most children had measles before they were 15, according to the Centers for Disease Control and Prevention. Each year, about 400 to 500 people died, nearly 50,000 were hospitalized and hundreds more experienced brain swelling.

The current two-dose measles, mumps and rubella (MMR) vaccine is about 97% effective at preventing measles if someone is exposed. Even one dose of the MMR vaccine, which offers about 93% protection, is sufficient for most adults, the CDC notes.

For community members wondering about their immunity status, it’s important to find a record, Lewis said: “You want concrete evidence of immune status, not just ‘My mom was pro-vaccine and got me vaccines when I was a kid.’”

A health provider can help individuals make decisions regarding a booster, which is not harmful even if someone already has immunity, Lewis said. For example, people who received the vaccine between 1963 and 1967 may require an additional dose since a vaccine offered during that period was less effective.

Protecting the most vulnerable

At Seattle Children’s Hospital, providers are fielding inquiries from concerned parents, especially among those who are too young to be vaccinated.

“The recent outbreaks are certainly concerning,” said Dr. Caitlin McGrath, a Seattle Children’s pediatrician who specializes in infectious disease. “We’re so fortunate to have a vaccine that’s highly effective and safe.”

Yet despite that, the Puget Sound region has seen declining vaccination rates, she said, pointing to a King County press release noting just 87% of 2-year-olds in that county are up to date on the MMR vaccine. Communities with a lower rate of overall immunity can experience measles spread from a single case, she noted.

Children generally receive the first measles vaccine at age 12 months to 15 months, with a booster between ages 4 to 6. In some cases, infants can get vaccinated before that time such as during an outbreak or for international travel – situations that should be discussed with a health care provider, she said.

To protect the youngest infants, it’s important to use known strategies for preventing illness spread, such as avoiding people who are ill and having symptoms, and being aware of what’s happening in the broader community.

Residents reflect on history, check vaccine status

Lynnwood resident Lacey Sutton said the country’s measles outbreak has made her ponder the past. She grew with her grandmother telling her stories of a time without a measles vaccine. During a particularly heartbreaking spring, several babies in her Iowa town died. Her grandmother shared other stories of people who lost their hearing or sight from measles.

“She was really grateful that all of her grandchildren were vaccinated as quickly as possible,” recalled Sutton, now grown with a 14-year-old son of her own. “People are not taking a lot of diseases as seriously as they need to. I’m influenced by the historic cases and how bad it could be.”

Other local residents are responding to the U.S. outbreak by checking their vaccination status. Edmonds resident Brittany Ells recently called her physician’s office to see if she had received measles vaccination as a child.

“I had hoped it would die out in Texas and wouldn’t make its way all over,” she said. “But clearly vaccination rates are dropping and it’s important that I don’t become a spreader.”

Her provider confirmed she had received the vaccine and was fully protected with two doses. Her husband, though, couldn’t find his record. He will likely get a blood test to measure antibodies, and a vaccine if necessary.

“It’s important to maintain immunity in our community to provide a blanket of protection,” Ells said.

That blanket, though, is showing signs of holes.

Edmonds Schools District reports declining vaccination figures

Immunization rates at kindergarten offer an important indicator of community vaccination levels.

Washington State law requires up-to-date immunizations for children attending school or child care. There are some ways around this requirement, though. Parents or guardians can seek an exemption from required immunizations for personal/philosophical, religious or medical reasons. The personal/philosophical exemption isn’t allowed for the MMR vaccine, though, which could explain why those figures tend to be higher than overall vaccination rates. For example, the Edmonds School District had an 89% overall vaccination rate for the last school year, but a 93.5% vaccination rate for measles.

Multiple Edmonds School District schools reported kindergarten measles rates of less than 95%, the threshold needed to stop the highly contagious disease from spreading. Some of those schools, such as Chase Lake Elementary and Lynnwood Elementary, fell below 90% for measles vaccination, according to the 2023-24 state data. The vast majority of schools showed a decline from pre-pandemic levels. For example, in the 2019-2020 school year Edmonds Elementary reported 100% measles vaccination at kindergarten. Last year, that figure dropped to 90.2%.

It’s hard to pinpoint exactly why rates are lower at some schools than others, Lewis said, though they could reflect vaccination attitudes in the surrounding communities. Public health officials also cautioned that the data collection might not reflect the on-the-ground reality, since additional students might have been vaccinated after the data was submitted.

Improving access for area students

Throughout the area, there are efforts underway to make vaccines accessible for students and their families. The Childhood Vaccine Program connects families with appointments for students who aren’t up-to-date on required immunizations. That seamless way to get connected with the health care system can be especially beneficial for families who might not have a primary care provider – or face long waits for appointments.

The Edmonds School District has more provider sites than any other area of the county, according to Kelly Barrows-Straughn, the vaccine compliance coordinator with the Snohomish County Health Department. There are at least a dozen clinics in the Lynnwood, Edmonds and Mountlake Terrace areas participating in the program, and some offer additional support such as guidance with Medicaid enrollment. The majority of these clinics are also on bus lines and some have Saturday hours, she noted.

Meanwhile, the Snohomish County Health Department is growing the immunization team, including ordering a new van that will do mobile vaccinations. Making vaccines convenient for people who work during normal clinic hours is key to expanding access, Lewis said.

Pandemic misinformation heightened vaccine hesitancy

But access isn’t the only barrier to vaccination. The pandemic contributed to the overall immunization decline since many people delayed or skipped medical appointments. During that period, misinformation about the COVID-19 vaccine likely spilled over into childhood vaccines overall, public health experts say.

Amid that growing vaccine hesitancy, providers such as Mikaela Guimaraes, an advanced registered nurse practitioner at the Community Health Center, listens carefully to family concerns. In her work in the Edmonds and Everett walk-in clinics, she’ll often explain how the risk of any potential vaccine side effects is far outweighed by the detrimental health impacts of the disease itself. In diverse communities, having providers that are trusted and culturally sensitive matters, as well as providing language and interpretation services, she said.

“You want to find common ground,” she said. “You want to build a relationship with this family. They’re trusting you with their child’s health.”

Sharing personal experiences can help, too. For example, she’ll sometimes describe what it was like to watch a baby with whooping cough struggle to breathe while knowing a vaccine could prevent the spread of this illness.

At Seattle Children’s, providers, too, strive to help families sift through an increasingly complex array of information — and misinformation. Pediatrician McGrath has heard patients comment that measles is a mild illness. That isn’t true, she said, adding that 1 in 5 unvaccinated people will require hospitalization. Similarly, Vitamin A and other home remedies do not prevent or cure measles. Sharing information like that helps people realize how critical vaccination can be, she added.

That’s a sentiment that resonates with local residents like Allen, the one who created the vaccination requirement sign for her front door. While the poster will offer some protection in the short term, she wonders how she’ll navigate the months before her child will be eligible for vaccination.

“My baby won’t get the same community protection I got growing in the ’90s,” she said.

Three ways to confirm immunity to measles

1. You had a birthday before 1957. People born before the introduction of the measles vaccine probably had the illness.

2. You have documented vaccination records.
For children ages 1-3, this would be one dose, so far.
For students ages 4 and up, this would be two doses.
For most adults, this would be one dose. Exceptions include health care providers, international travelers, and students. (An ineffective vaccine was given to less than 1 million people between 1963 and 1967. People born during this time may require a booster).

3. Lab test results: A blood test can show whether you have enough immunity through previous measles infections or vaccination.

How to find a measles shot:

Vaccines are provided at no cost to all kids through age 18, according to the Snohomish County Health Department. For help finding a health care provider, visit Help Me Grow WA.

Check your child’s school:

For more information on school vaccination rates, check out this Washington State Department of Health site, which includes a searchable database by school district and school site.

Kellie Schmitt is an award-winning health reporter based in Edmonds. She covers health policy, public health and children’s health for a variety of publications including the Johns Hopkins University Public Health Magazine, ParentMap, and USC’s Center for Health Journalism. She has a master’s in science writing from Johns Hopkins University.

This series is supported by funding from the Verdant Health Commission. The My Neighborhood News Network maintains full editorial control over content produced as part of this series.