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RENEE MONTAGNE, HOST:
And I'm Renee Montagne. The U.S. is in the midst of the largest measles outbreak in over a decade and, much of it, in Amish country. Of the roughly 500 cases documented so far this year, 348 were in Ohio where the disease has spread quickly among the largely unvaccinated Amish communities in the center of the state. From member station WCPN, Sarah Jane Tribble, reports.
SARAH JANE TRIBBLE, BYLINE: The Amish countryside looks like it has for 100 years. There are picturesque pastures with cows, sheep and big red barns dotting the landscape. But something important has changed here. This shop behind me, usually bustling with workers building the frames of houses, has been converted into a makeshift clinic where a County Health Department nurse, Jacqueline Fletcher, is giving the measles vaccine.
(SOUNDBITE OF HEALTH CLINIC)
JACQUELINE FLETCHER: And you must be Lydia?
TRIBBLE: Fletcher started the emergence clinics in April. She says it all began when an Amish woman walked to a communal call box in the late afternoon and dialed the Knox County Health Department. The woman told them that she and a family down the road had the measles.
FLETCHER: So the very next morning, we were out to collect samples, collect nasal swabs and also draw blood. And it was just textbook measles.
TRIBBLE: Fletcher has been a nurse in Knox County for nearly three decades. She had never seen the illness, but she knew the symptoms.
FLETCHER: The rash - they had the conjunctivitis in the eyes. The eyes are red. They don't want the light. They sit in a darkened room, wear dark glasses. I mean, they were just miserable - high temperatures - 103, 104 temps. So this was the measles.
TRIBBLE: That afternoon, the samples went the state health department. And the next day, Fletcher was on a call with the U.S. Centers for Disease Control and Prevention.
FLETCHER: I remember the first conversation we had with the CDC. The fellow said you have to get ahead of this.
TRIBBLE: The county opened the clinics, and Fletcher also organized door-to-door vaccinations. Yet the highly contagious viral disease is still spreading in these grassy hills. The workday has ended, and it's suddenly busy at Fletcher's clinic. Amish families form a line out the door, and buggies continue to roll into a nearby parking lot.
TRIBBLE: Most of the children are barefoot, not needing to wear shoes until they work out of the home. The girls wear dark-colored homemade dresses and white bonnets - the boys, pressed trousers and button-up shirts. Inside the clinic, most are calm. But the younger ones are scared.
Ervin Kauffman watches over his six children as they squeeze into a small back office for their second MMR - mumps, measles and rubella - shot since the outbreak began. None had received shots before.
ERVIN KAUFFMAN: I guess there was no scare to us before. I guess we were too relaxed. That's the reason. I mean, I don't have any objections against it, you know? It's just - I never was a fear for. You know, fear from the measles and stuff like that, so.
TRIBBLE: Kauffman explains how the outbreak changed behavior in this traditional community. Spring is the Amish wedding season - a time when hundreds come together, often traveling from other states and, sometimes, Canada. Those weddings were postponed.
KAUFFMAN: And they're just now starting with weddings.
TRIBBLE: Church services, typically held in family homes, were also curtailed.
KAUFFMAN: We didn't have church for almost two months because of the measles. So it wouldn't spread them. So we kind of tried to put the clamp on them.
TRIBBLE: Knox County Health Commissioner, Julie Miller, is visiting the clinic to lend support. She has no idea how many are still at risk of contracting the illness.
JULIE MILLER: It's hard to answer that because we still don't know what the number is of who has the potential to be sick.
TRIBBLE: That's because there's simply no official count of how many Amish live in Ohio. Researchers at Ohio State University released a report this year estimating that there are about 33,000 Amish living in the six-county area where the outbreak began. At last count, 8,000 people in those counties have been vaccinated.
Miller fears the measles will continue to spread because there is still resistance to vaccinations. Thirty five-year-old father of 11, Paul Raber, is here getting vaccinated. When asking about getting other vaccines, he laughs and says...
PAUL RABER: I don't know that. I guess we'll have to find out. We might. We might.
TRIBBLE: Meanwhile, the virus is spreading, with more cases being reported in nearby Holmes and Stark counties. For NPR News, I'm Sarah Jane Tribble.
MONTAGNE: And that story is part of a reporting partnership with NPR, WCPN and Kaiser Health News.
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