As measles spreads nationally, Santa Cruz County faces double threat: Low vaccination rates and new federal cuts

As measles continues to spread across the United States, Santa Cruz County public health officials say they worry that recent surprise federal funding cuts to their immunization programs might hamper efforts to encourage families to get vaccinated. The cuts come at a time when measles immunization rates among kindergarten children in the county are already low and falling.

County Deputy Health Officer Dr. Karissa LeClair Cortez said the county’s health services agency found out last week that several federal grants were being immediately cut by the Trump administration, including COVID-era immunization grants the county had received. The cuts amounted to 89% of the agency’s immunization funding.

The money paid for staff members to visit schools and other places, working to get broader swaths of the population immunized against a number of infectious diseases. Now, clinical positions in charge of doing that work are unfunded, and the future of the county’s vaccination efforts are murky.

“The immunization unit is something that’s not technically mandated by law, but it’s something we do because we believe that it’s important,” LeClair Cortez said. “We really don’t have money to fund staff to do this anymore.”

The cuts come as public health officials were already concerned about the county’s low measles vaccination rate among children.

Statewide data shows that only 91.8% of Santa Cruz County kindergarten students had received a full course of the measles vaccine in the 2023-24 academic year, the lowest rate in the San Francisco Bay Area. LeClair Cortez said that this school year, the rate slipped even further, to 91.1%.

Of Santa Cruz’s neighboring counties, the next-lowest are San Benito and San Mateo counties, whose vaccination rates for kindergartners both sit at 98.5%, higher than the statewide average of about 96.2%. 

Public health officials typically aim for 95% of a population to be vaccinated against the disease, as that is considered the level of vaccination needed to prevent measles from spreading within a community. Santa Cruz County is not meeting that threshold.

While there have been no measles cases recorded in the county this year so far, the county’s low vaccination rate could be a problem, LeClair Cortez said, if the region begins to experience the kinds of measles outbreaks that have happened elsewhere in the U.S. this year. 

“Because of our low vaccination rates, we know that Santa Cruz is at a relatively higher risk of being impacted in a large way if measles comes to the community,” she said. “Because we know that measles is so prevalent on a national level, and there’s a lot of travel that happens, we are anticipating the case in which that will happen.”

A measles outbreak began in Texas in January and quickly spread to other states. As of last Friday, the Centers for Disease Control and Prevention had recorded 483 confirmed measles cases across the country — three-quarters of them among children and teens. That includes at least eight reported cases in California. On Monday, public health officials confirmed the Bay Area’s first measles case, in San Mateo County. 

LeClair Cortez said Santa Cruz County’s lackluster measles vaccination rate isn’t a brand-new phenomenon and has been observed for at least the past decade.

Vaccine hesitancy and misinformation has likely worsened since the COVID pandemic, said LeClair Cortez. Additionally, she said the pandemic made it more difficult for people to access health care, which might have led to fewer people receiving various immunizations than prior to the pandemic, and some residents have remained behind on getting their vaccines.

“Folks not having access to health care and having to play catch-up on their vaccines has probably impacted vaccination rates for other diseases, too,” she said.

LeClair Cortez said one Santa Cruz County-specific factor could play into the poor uptake rate: the high level of homeschooling. She said that about 8.2% of all students in Santa Cruz are homeschooled or in independent studies programs with no in-person learning. California has strict regulations around the immunizations that children need to attend school, but homeschooled students are not held to the same guidelines. “That’s a relatively high rate of folks that we might be missing,” LeClair Cortez said.

Among children who attend local schools, LeClair Cortez said that if 10% of a school’s students are overdue for immunizations or conditionally admitted — admitted with the understanding that they will have to catch up on vaccinations they have not received in order to gain full admission status — county public health workers will visit the school and give guidance, resources and support to try to get the vaccination rates up. However, the coming federal funding cuts will make this effort much more difficult, she said.

LeClair Cortez said the measles vaccine is about 97% effective at preventing someone from getting the disease after two doses of the jab, compared to 93% after one dose. She said that even if a vaccinated person does contract the disease, it’s much less likely they will develop serious illness.

Measles is an extremely contagious viral illness that often starts with relatively nondescript symptoms, such as a mild to moderate fever, cough, runny nose and red or watery eyes. Some cases include gastrointestinal symptoms such as nausea, vomiting and diarrhea. After two to three days, a blotchy rash often appears on the face before spreading down to the chest, back, thighs and feet. The rash usually fades after a week.

The disease is spread through respiratory droplets, which can stay airborne for up to an hour in the airspace where an infected person has coughed or sneezed. The time from infection to developing symptoms is typically nine to 12 days, but can be as long as 21 days. An infected person is likely infectious from four days before to four days after the onset of the rash, and should stay home for that entire period of time.

Last July, a person who traveled to Santa Cruz County was later confirmed to have had measles. No secondary cases were ever detected. LeClair Cortez said the most recent known case in a county resident was in 2019.

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