Gorrow also lives in a community where she said being anti-vaccine is as acceptable as being vegan or going gluten free. Almost a quarter of kids in Clark County, Wash., a suburb of Portland, Ore., go to school without measles, mumps and rubella immunizations, and Washington Gov. Jay Inslee (D) recently declared a state of emergency amid concern that things could rapidly spin out of control.

Measles outbreaks have sprung up in nine other states this winter, but officials are particularly alarmed about the one in Clark County because of its potential to go very big, very quickly.

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The Pacific Northwest is home to some of the nation’s most vocal and organized anti-vaccination activists. That movement has helped drive down child immunizations in Washington, as well as in neighboring Oregon and Idaho, to some of the lowest rates in the country, with as many as 10.5 percent of kindergartners statewide in Idaho unvaccinated for measles. That is almost double the median rate nationally.

Libertarian-leaning lawmakers, meanwhile, have bowed to public pressure to relax state laws to exempt virtually any child from state vaccination requirements whose parents object. Three states allow only medical exemptions; most others also permit religious exemptions. And 17, including Washington, Oregon and Idaho, allow what they call “philosophical” exemptions, meaning virtually anyone can opt out of the requirements.

All those elements combine into a dangerous mix, spurring concern about the resurgence of a deadly disease that once sent tens of thousands of Americans to hospitals each year and killed an estimated 400 to 500 people, many of them young children.

“You know what keeps me up at night?” said Clark County Public Health Director Alan Melnick. “Measles is exquisitely contagious. If you have an under-vaccinated population, and you introduce a measles case into that population, it will take off like a wildfire.”

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To date, at least 55 people in Washington and neighboring Oregon have gotten sick with the virus, with new cases tallied almost daily. All but five are in Clark County. King County, which includes Seattle, has one case; Multnomah County in Oregon, which includes Portland, has four, including three cases reported Wednesday. Most of those infected are unvaccinated children under 10, health officials said.

Gorrow, who lives in a middle-class bedroom community, says the outbreak has changed nearly every aspect of her life, which is now laser-focused on avoiding contact with children who may carry measles germs.

When she picks up her 3-year-old from preschool, she gently pushes grubby little hands away from the baby. She canceled a family outing to a children’s museum, regular trips to the library, the weekly Costco run and play dates for her daughter.

“I hate to say it but I’m even nervous about having people over — especially people who have small children and I’m not sure where they stand” on vaccinations, said Gorrow, 29, who had her older child vaccinated.

Measles, which remains endemic in many parts of the world, generally returns to the United States when infected travelers bring the disease back to pockets of the country where some parents have chosen not to vaccinate their children. When immunization rates fall below a certain threshold, outbreaks can occur; pregnant women, young children and people with compromised immune systems who can’t get vaccinated are especially at risk. Last year, 349 cases were confirmed across 26 states and the District of Columbia, the second highest total since the disease was declared eliminated from the United States in 2000, according to the Centers for Disease Control and Prevention.

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Since October, an outbreak in New York’s Orthodox Jewish community has sickened 209 people. In the first month of 2019, 10 states, including New York and Washington, have reported cases, all signs of a resurgence of a disease that is entirely preventable with a vaccine that authorities say is safe and effective.

In Washington, with late winter and spring generally the height of measles transmission, health officials say they are scrambling to stop the disease before it can spread further — spending about $200,000 so far tracking down hundreds of unvaccinated people who may have been exposed.

Federal guidelines typically recommend that children get the first vaccine dose at 12 to 15 months of age and the second when they are 4 to 6 years old. (Babies may be vaccinated at age 6 months or older if they are at risk of exposure, for instance if they are traveling to an area with an outbreak.) The combination is 97-99 percent effective in preventing the viral disease.

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Clark County officials are directing hundreds of susceptible families who may have been exposed to the virus at more than three dozen locations — including a Portland Trailblazers basketball game, schools, churches and stores such as Costco and Walmart — to keep their kids home from school for 21 days to avoid exposing others.

They’re encouraging parents to vaccinate their kids if they haven’t already, and are pushing back against rumors and misinformation, including that self-medicating with vitamin A will prevent measles.

Melnick said the county is also spending precious time and resources addressing false ideas being spread by anti-vaccine advocates, who he said posted “ridiculous” misinformation as comments on the county health department’s Facebook page.

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Critics claimed, for instance, that the measles vaccine can cause encephalitis, or brain inflammation, he said. That was documented once in a child who had an immune deficiency and should not have gotten a shot. More commonly, encephalitis is a severe but rare complication of the disease itself. The department has a three-person team countering those assertions and responding to questions.

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“That’s what we’re up against,” he said.

Anti-vaccination activists, for their part, contend that state officials are twisting facts to stoke public fear.

“It shouldn’t be called an outbreak,” Seattle-area mother Bernadette Pajer, a co-founder of the state’s main anti-vaccine group, Informed Choice Washington, said of the measles cases, arguing that the illness has spread only within a small, self-contained group. “I would refer to it as an in-break, within a community.”

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Like many in her group, Pajer considers the risks from measles to be less dangerous than those posed by the vaccine itself — a claim that can be traced back to a retracted and discredited 1998 paper that inspired the modern anti-vaccination movement.

In fact, health officials say the virus is so contagious that if an unvaccinated person walks through a room two hours after someone with measles has left, there’s a 90 percent chance that an unvaccinated person will get the disease. People can spread measles for four days before the rash appears and for four days after.

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Vaccine advocates are also trying to arrange for doctors to meet with parents in small groups or one-on-one, sometimes for hours at a time, to answer their questions.

Martina Clements, 41, a Portland mom who didn’t vaccinate her two children until recently, said the anti-vaccine community uses fear to raise doubts about vaccine safety. But parents who support immunizations can be belittling.

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“On one side, they make you afraid, and the other side they make you feel stupid, and you get stuck in this middle where you feel beat up by both sides,” she said.

Clements eventually changed her mind, deciding to give her kids the shots after a doctor at a vaccine workshop answered her questions for more than two hours, at one point drawing diagrams on a whiteboard to explain cell interaction. He was thoughtful, factual and also “still very warm,” she said.

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Vaccine advocates blame federal public health officials for not mounting a more robust response to those spreading fears about vaccine safety.

Peter J. Hotez, a vaccine scientist and dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston, whose daughter has autism, wrote a book, “Vaccines Did Not Cause Rachel’s Autism,” to counter the anti-vaccine lobby.

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In a Twitter exchange last week, Hotez said the U.S. surgeon general and CDC director could be doing much more to push states to tighten state vaccination requirements. Surgeon General Jerome M. Adams responded by flipping the responsibility back to local and state officials, who he says have greater influence with local communities.

“Their response seemed to say this was not their fight because it’s a state issue, not a federal one,” Hotez said. “But I disagree. I feel that anything adversely affecting the public health of Americans is certainly within” their purview.

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CDC Director Robert Redfield has tweeted about the dangers of the disease and the importance of routine vaccinations. On Friday, Adams also released a YouTube video with information about measles.

In Washington, state lawmakers supporting tougher vaccine requirements are mounting their second effort in the past three years to make it harder for parents to opt out of vaccinations.

The same day Inslee declared a state of emergency, Washington state Rep. Paul Harris, a Republican from Vancouver who represents Clark County, introduced a bill that would prohibit all exemptions from the measles vaccine requirement save for medical and religious reasons.

“It’s about public health,” he said. “People have told me they won’t go to the store or out into the community as much because they have cancer and are getting chemotherapy. So it doesn’t just impact those people who choose not to get vaccinated.”

Anti-vaccine groups are prepared to turn out at a committee hearing scheduled for Friday. Pajer said that her group is arranging experts to testify against it. Among those expected to speak is Robert F. Kennedy Jr., who has argued that there is a government conspiracy about the safety of vaccines.

Despite the expected turnout and the defeat of a similar bill in 2015, Harris said he believes the bill has a chance of passage. The resurgence of a vaccine-preventable disease has scared a lot of people, he said, noting that polls show the vast majority of Americans support vaccinations.

“It’s the right thing to do,” he said. “This is something we can actually control if we choose to.”