The ongoing measles outbreak in California now stands at 92 cases.
The spread of the highly infectious disease has sparked a debate about people who voluntarily opt out of vaccines or decline to have their children vaccinated.
Many people have no choice. They can't be vaccinated for medical reasons. They rely on the people around them to be vaccinated to prevent the spread of infectious disease.
The Krawitt family in Marin County, Calif., is taking action to try to increase rates of vaccination in their community because 6-year-old Rhett can't be vaccinated.
"I got leukemia when I was 2," Rhett says. "It's a cancer of the blood, and you can die from it."
After three years of chemotherapy, Rhett is in remission. Now there's a new threat: measles. In California, people can legally refuse vaccines for themselves and their children. Marin County has a high rate of these so-called personal belief exemptions. And that worries Rhett's father Carl.
As we first reported on Jan. 26, Carl is pleading with other parents: Please vaccinate your children, because people with compromised immune systems, including his son, can't be vaccinated.
In the past week, Carl Krawitt's efforts have gained national attention, part of a growing debate on the ethics and health consequences of parents refusing to vaccinate.
But public health officials and school districts have to navigate a thorny issue: How do you respect people's personal medical choices with keeping the population safe from preventable disease?
Marin County health officer Dr. Matt Willis says he is "extremely sympathetic" to the Krawitts' situation, but science does not back up their request to keep kids out of school.
"There's little evidence that excluding unvaccinated children from a school where there's no evidence of measles transmission would be an effective public health strategy for limiting the spread of disease," Willis said.
In addition, if he were to exclude unvaccinated children from school, that would mean Rhett and others with a medical exemption from vaccines would have to stay home, too.
"Picking only one child who is allowed to attend school and excluding the others would be inconsistent."
Meanwhile, the Krawitts' school district has been working aggressively this school year to get children who are behind on their vaccines caught up.
Lisa Aliferis, editor of KQED's State of Health blog, broke the story about the Krawitt family's efforts to increase vaccination rates in their community in the midst of a measles outbreak. She continues to report the story as part of a partnership with NPR, KQED and Kaiser Health News.
DAVID GREENE, HOST:
An ongoing measles outbreak in this country has sparked a lot of questions about and finger-pointing towards people who don't get their kids vaccinated. Lisa Aliferis first reported the story for KQED, an NPR Shots blog, about a father whose child has leukemia and can't be vaccinated. We heard from his father on All Things Considered on Friday. Lisa now has more from this family, trying to figure out how to protect their child.
RHETT KRAWITT: Wow, that is so cool.
LISA ALIFERIS, BYLINE: Six-year-old Rhett Krawitt and his big sister Annesley are playing two-square in front of their home in Marin County, just north of San Francisco. Rhett has short, blonde hair and a sweet face, but he has endured much in his young life.
RHETT: Well, I got leukemia when I was 2. It's a type of blood cancer, and you can die from it.
ALIFERIS: After three years of chemotherapy, Rhett is in remission. Now there's a new threat - measles. In California, people can legally refuse vaccines for themselves and their children. Marin County has a high rate of these so-called personal belief exemptions. Since I first told the story last week, Rhett's father, Carl, has been speaking out about his concerns.
CARL KRAWITT: He's been through the fear of losing his life from cancer. And now I've got to explain to him the danger of being exposed to measles.
ALIFERIS: Rhett had been vaccinated against measles, but the chemotherapy wiped out his protection. Once his immune system recovers, he can be vaccinated again. In the meantime, Rhett and anyone else with a weak immune system is dependent on what's called herd immunity. That's when so many people are vaccinated that if a disease is introduced, it can't spread. Now Carl and his wife, Jodi, are taking action. They want all voluntarily unvaccinated kids to stay home from school until the outbreak is under control.
KRAWITT: If your kid gets the measles and gives it to my kid, you know, and my kid dies, are you responsible?
ALIFERIS: During a disease outbreak, who stays out of school is up to Marin County health officer Dr. Matt Willis. He says he's extremely sympathetic to the Krawitts' plea, but it's complicated.
MATT WILLIS: There's little evidence currently that excluding unvaccinated children from schools where there is no evidence of measles transmission would be an effective public health strategy for limiting the spread of disease.
ALIFERIS: Plus, Willis says, excluding unvaccinated children from school would mean Rhett and others with a medical exemption from vaccines would have to stay home, too.
WILLIS: Picking only one child who is unvaccinated to be allowed to attend school and excluding all the others would be inconsistent.
ALIFERIS: Rhett's risk of contracting measles is probably small, says Rhett's oncologist, Dr. Rob Goldsby. But he says that children and adults alike with a compromised immune system - people with cancer or HIV - are at higher risk of complications from measles, complications which can be severe. Goldsby says that when someone is diagnosed with a serious illness, friends and family rally to support the patient.
ROB GOLDSBY: Quite frequently, people say, well, what can I do to help? And one of the things they can do to help is make sure that their kids are immunized because that not only protects their child, but it'll protect the kids that can't undergo the immunization process. It's really, really, really important.
RHETT: One, two, three.
ALIFERIS: Back at the Krawitts' house, Carl says his son missed years of preschool because of his treatment. Now he and his wife want Rhett to have a normal life.
KRAWITT: We've been there. We know what fear is. We know what it's like for somebody to look you in the eye and tell you your kid might die. We've been in that room because of cancer. And I think that we now look at, what can we control?
ALIFERIS: Carl says he doesn't want kids to miss school. But just as many schools forbid nuts to protect children with those allergies, Carl wants the same level of safety for his child.
KRAWITT: I mean, our real ask is please vaccinate your children.
ALIFERIS: For NPR News, I'm Lisa Aliferis in San Francisco.
GREENE: And Lisa's story is part of a partnership with NPR, KQED and Kaiser Health News. Transcript provided by NPR, Copyright NPR.