For a solid month, Ashley Matzie took her newborn almost nowhere. Not to the grocery store, or to the park or even for a walk on her block in Camas, Washington, just east of Vancouver.
What if someone came over to admire the baby? What if that someone had measles or was carrying the virus on their body or clothes?
As dozens of measles cases broke out in Clark County, totaling 73 by late March and prompting a visit from the U.S. surgeon general, Matzie and her partner took every precaution. As soon as he walked in the door from work, he changed his clothes and washed his hands.
"For someone as little as him," Matzie said of 3-month-old Paxton, "that illness can be deadly."
Measles outbreaks in this state and elsewhere have alarmed parents, doctors and public officials about a highly contagious disease that had been deemed eliminated in 2000. Rockland County, New York, this past week declared a state of emergency after confirming more than 150 cases there, barred unvaccinated children from public places and said those in violation could be charged with a misdemeanor.
Clark County, the center of this state's outbreak, now waning, has not gone to that extreme. But the cases have shaken up the county in all sorts of ways -- from challenging health-care workers to contain an unusually contagious virus, to stirring tensions between parents who vaccinate their children and those who don't, to sharply curtailing how families and schools conduct themselves.
Parents of children like Paxton -- too young to receive the measles, mumps and rubella (MMR) vaccine, typically given when a child is about 1 year old -- have felt trapped inside their homes -- "terrified," according to Dr. Luke Voytas of Evergreen Pediatric Clinic in Vancouver.
Schools with confirmed measles cases sent home hundreds of students who couldn't prove they were vaccinated, and canceled or postponed events.
"There were a lot of tears," said Angie Waudby, president of the parent teacher organization at Burton Elementary School in Vancouver. Disappointment ran especially high when the annual school dance, a highlight of the year, had to be put off.
Waudby couldn't even get into the school for weeks to check her PTO mailbox. The school's doors were locked, and only those with proof of vaccination could get in. "Who really carries that with them?" she said. Not her. Her immunization records were buried somewhere at her parents' house.
"C'mon, just immunize your kid so this doesn't spread," she said was the prevailing sentiment among frustrated parents.
Tensions have run both ways. Parents who fear more from vaccines than the diseases they prevent -- despite widespread reassurance from doctors and scientists -- resent the backlash for a choice they feel is theirs alone to make.
One Clark County parent declined to be named for this article because she worried her unvaccinated young children would be shunned.
Another, Katie Williams, said the day care where she takes her unvaccinated 2-year-old daughter treats the family like "outcasts."
"They're literally afraid of my child," she said, adding staffers call to have the girl picked up when she has a runny nose or the slightest fever.
The toddler has a heart condition that prompted her cardiologist to warn that vaccines with a live virus, like the MMR, could be dangerous, Williams said. But the 29-year-old, a telecommunication sales manager, has refrained from giving her daughter other immunizations as well.
Williams said she might eventually give her daughter some vaccines, but not all. She therefore worries about proposed immunization mandates in Olympia, which would remove the current right to philosophical exemptions for students attending public schools.
"My family can't afford private school," she said.
About 15 percent of Clark County kindergartners were not immunized for measles, and roughly 23 percent were not up to date on all vaccines in 2017, according to state Department of Health statistics. That's considerably higher than in the state as a whole, where the figures are 9 and 14 percent, respectively.
Located within the greater Portland area, Clark County's "crunchiness" and interest in holistic living has something to do with it, surmised pediatrician Voytas. So does a rugged individualism that resists being told what to do, compounded by wariness toward authorities among local immigrants from former Soviet republics, where immunization campaigns were conducted by a coercive state.
The measles outbreak changed the risk-benefit analysis for many parents, according to Voytas -- especially those who are not dead-set against vaccines but are spacing them out over a longer stretch of time than the schedule recommended by the Centers for Disease Control and Prevention (CDC).
"Before, measles was so theoretical. Nobody had ever seen it," the pediatrician said. "All of a sudden, it became tangible."
In January and February, Evergreen Pediatric immunized three times more children -- 750 -- than it did during the same period last year.
"Putting my child in danger"
Matzie, a 29-year-old tax preparer, is choosing to vaccinate her child on a delayed schedule. She's concerned simultaneous shots will overwhelm babies with side effects.
She doesn't, however, believe in a once-suggested connection between the MMR vaccine and autism, widely debunked, leading the scientific journal Lancet to retract the paper that once claimed a link. Living in fear for months has made her especially eager to give her child the vaccine when the time comes.
She feels torn about parents who choose otherwise. They have that right, Matzie said. At the same time, "their unvaccinated children are putting my child in danger."
Wynne Hurly, another mother of a newborn kept inside for months, said she was surprised recently to learn that a neighbor's child was unvaccinated. Now she finds herself looking at every child and wondering about their vaccination status.
"It's a really icky feeling," she said, seeming to her almost discriminatory, and all the more unsettling because she's a teacher.
The dreaded event happened for new mom Kristin Cheatley in late January: Her 10 1/2 -month-old son, Steel, was exposed to the virus when they walked into a Vancouver clinic. Just minutes before, an infected child had arrived for treatment.
Ironically, Steel had been due to get the MMR vaccine within days. Cheatley had called the pediatrician to ask whether her son could get it early because of an upcoming family trip that involved flying, with all the recycled air and dense configuration of passengers that involves. The measles virus hangs in the air for up to two hours.
Now, Steel had to get another shot -- actually two shots of immunoglobulin, a substance that boosts the immune system and, in the best-case scenario, wards off measles.
"It was horrible," Cheatley said. "He cried and screamed."
It also took a while. Thick and syrupy, immunoglobulin moves slowly through needles. The amount needed varies by weight and age, and sometimes requires four shots.
"We have to go in with five people," said Ryan Cole, a nurse manager instrumental in setting up a special clinic for those exposed, run by the PeaceHealth system in collaboration with the county health department.
The Vancouver clinic has seen mostly babies too young to be vaccinated. One staffer is needed to help hold the child. Four others deliver shots simultaneously to get the pain over as quickly as possible.
In the early days of the outbreak, PeaceHealth staff spent hours planning the clinic. To keep possibly infected children away from others, they created a special entrance. Masks and gloves are kept by the door, used by staffers who greet patients at their cars when they arrive.
Cheatley, 36, lives and works as a real estate agent in Longview, about 45 minutes away, and went to a Kaiser clinic there to get Steel's shots. Even Cheatley and her partner, both immunized, were asked to wear masks.
The ordeal wasn't over. The immune-boosting shots are not foolproof, so health officials, following up on each case, told the family to keep Steel indoors -- for 28 days, seven longer than usual after someone has been exposed, because immunoglobulin prolongs the potential incubation period.
Her normally easygoing son would try to escape by crawling out the door with the dog.
Wary of vaccination
The mother of 11- and 17-year-olds -- the oldest vaccinated, the youngest not -- Lisa Packard said she and her children have been going about their business as usual. They go to stores and the mall.
The 52-year-old Vancouverite said measles is not as scary as health officials and the media have been making out. She's immunized but her older sisters were not. They got measles and survived, she said.
Millions of people every year did the same decades ago, acknowledged Dr. Jason Hanley in a Facebook Live Q&A put on by PeaceHealth, where he serves as an emergency department's medical director. The disease, however, proves fatal for one or two out of a thousand, he said. Especially vulnerable: children under 5, pregnant women and those with immune systems compromised by cancer or other illnesses.
Packard, who thought she had no choice when she immunized her oldest, but realized she did by the time her second was born, is not completely blasé about the outbreaks. She keeps a close eye on her unvaccinated daughter for symptoms, and checks the county health department's running list of exposure sites daily.
If she were to see a site where her daughter recently visited, Packard said, she would keep the girl home so as not to infect others.
She said she's been dropped as a Facebook friend by some people, including relatives, for her stand on vaccination. She's seen online comments like; "If you don't vaccinate your child, you should have CPS at your door."
She feels disrespected, and it doesn't change her mind. "I'm a special-education teacher. I think autistic kids are amazing," she said, alluding to fears some still have about the MMR. "I just don't want my child to be dead."
A lot of stories about vaccine injuries circulate among so-called anti-vaxxers, and she doesn't trust the government or pharmaceutical companies to tell the truth.
She's not close-minded, she added. She'd like to see more scientific studies.
It's possible they could persuade her to immunize, though likely not until her daughter is 12. A naturopath she knows said that's when children's immune systems are fully developed.
Voytas, the pediatrician, calls that idea "completely false," saying immune systems are strong even in infants and toddlers, which is why a 12-month-old develops almost complete resistance to the measles after vaccination.
Outbreak or no outbreak, Packard said, "I'm still doing a wait and see."