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ByAliciaChang The Associated Press LOS ANGELES The largest U.S. measles outbreak in recent history isn't the one that started in December at Disneyland. It happened months earlier in Ohio's Amish country, where 383 people fell ill after unvac- cinated Amish missionar- ies traveled to the Philip- pines and returned with the virus. The Ohio episode drew far less attention, even though the number of cases was almost four times that of the Southern California outbreak, because it seemed to pose little threat outside close-knit religious commu- nities. The Disneyland outbreak has already spread well be- yond the theme parks that attract tens of thousands of visitors from around the globe, who could then return home with the vi- rus. Disease investigators for weeks raced to identify measles-stricken patients, track down potential con- tacts and quarantine them if necessary. Public health experts say success at containing the outbreak will largely de- pend on how many unvac- cinated people get the mea- sles shot. "This was a wake-up call," said Dr. James Cherry, a pediatric infectious dis- ease expert at the Univer- sity of California, Los An- geles. "It could continue to smolder" if not enough peo- ple get vaccinated. The California outbreak probably began when an infected person spread the illness to a handful of mostly unvaccinated people, who then exposed many others. In contrast, the Ohio outbreak "stayed con- tained within those com- munities, and outside peo- ple said, 'Well, it doesn't really affect me.' What's different with this one is more people can relate to Disneyland," said Dr. Greg- ory Wallace of the Centers for Disease Control and Prevention. The CDC estimates 105 measles cases — the vast majority from California — have been linked to visits to Disneyland in December or exposure to infected people who went there. The agency said it's too early to predict whether this will be a par- ticularly severe year com- pared with 2014, which saw more measles cases than any year since 1994. The Ohio outbreak ac- counted for more than half of the 644 measles cases re- ported last year. Homegrown measles has not occurred in the United States since 2000 due to an aggressive vaccination campaign. But outbreaks have hit in recent years with nearly all cases linked to travelers who caught the virus overseas where mea- sles still rages and spread it in this country among pockets of unvaccinated people. In the Disneyland out- break, public health offi- cials have yet to identify the "index case" — the first per- son who contracted mea- sles and spread it. But they believe it's someone who imported the virus from abroad and spread it during a visit to one of the theme parks days before Christ- mas. Multistate measles out- breaks have occurred be- fore, but when a "location has name-brand recogni- tion to society, like Disney- land, it's going to get a lot of media attention," said Dr. James Wilson, a pedi- atrician and disease fore- caster at the University of Nevada, Reno. Wilson said California faces a bigger health prob- lem — whooping cough, also known as pertussis, which killed two babies last year. The last time there was a measles death in the U.S. was in 2003. Both measles and whop- ping cough can be pre- vented through vaccina- tions. Since the Disneyland measles outbreak, parents who refuse vaccines for their children on religious or philosophical grounds have been on the defensive against a tide of doctors and public-health officials urg- ing people to get the mea- sles-mumps-rubella, or MMR, vaccine. The issue has stirred sometimes-angry debates and even entered the realm of presidential politics. Measles is extremely contagious and is spread by air through coughing and sneezing. Symptoms include fever, runny nose and telltale rash all over the body. The disease is partic- ularly dangerous to preg- nant women, people with weak immune systems and babies who are too young to receive the shot. OHIO EPISODE Di sn ey la nd m ea sl es o ut br ea k isn't largest in recent memory JAEC.HONG—THEASSOCIATEDPRESSFILE A woman with a Mickey Mouse hat walks toward Sleeping Beauty's Castle at Disneyland, in Anaheim. PLUS10,000onlineimpressionson www.redbluffdailynews.com with an interactive digital rectangle ad* Only$299 total *ShouldstartbyFRIFEB13toguaranteedelivery of 10,000 online impressions Other special rating for print and online advertising during the survey period! Call your Daily NewsAdvertising Representive TODAY for details! Gayla Eckels: geckels@redbluffdailynews.com (530) 737-5044 Suzy Noble: snoble@redbluffdailynews.com (530) 737-5056 Online Survey Now Underway! Now through Wednesday, February 25 FOUR 2 col x 4" full color Display PrintAds in LOCALBUSINESSES! Invite your customers to vote for your business as "Best Of" your category in | NEWS | REDBLUFFDAILYNEWS.COM THURSDAY, FEBRUARY 5, 2015 8 A