COLUMBUS — Whenever a parent seems hesitant about immunizations, Dr. Paul Spearman doesn't argue or scold.
"All of them want to do what's best for their kids," said Spearman, the director of Infectious Diseases at Cincinnati Children's Hospital Medical Center. "If you start from that, you can build some trust. If you get angry or say, 'You don't know what you're talking about,' that's not the right approach."
Such conversations are taking on heightened importance as public-health advocates work to keep Ohio from joining the list of states with reported cases of measles.
From Jan. 1 through April 4, the U.S. Centers for Disease Control and Prevention counted 465 individual cases in 19 states — including neighboring Michigan and Kentucky — for the second-largest tally since the federal government declared measles eliminated in 2000.
According to the CDC, the percentage of Ohio toddlers who have received the recommended doses of vaccine for measles, mumps and rubella has declined in recent years. National Immunization Survey data showed 95.6 percent of 19- to 35-month-old Ohio children had the vaccine in 2014. But by 2017, the percentage had dropped to 88.3 percent.
Public-health experts say measles is highly contagious and demands a coverage rate of at least 90 to 95 percent for "herd immunity," the term for broad resistance among the general public.
"We're working closely with our local health departments to promote immunization in their communities," said J.C. Benton, a spokesman for the Ohio Department of Health. "And our state epidemiologist is constantly communicating with her counterparts."
Benton said the department will soon boost the presence of immunization information on its website and through social media messaging.
While all states require vaccines for students, exemption laws vary and Ohio is among the 17 states that allow parents to object to immunizations for reasons of conscience, including religious convictions or other personal beliefs.
A bill introduced last month by state Rep. Don Manning, a Mahoning County Republican, would require that school notifications about immunization requirements also include information on permitted exemptions. Manning said he's not "anti-vaccine" but wants families to know their right to opt out for medical or other reasons.
"I'm not going to say that I think the schools are intentionally misleading anyone," Manning said Wednesday. "But if you're going to quote the law, quote both sides."
Luke Jacobs, population health director at Columbus Public Health, said communities need to focus on boosting immunization rates and view the measles outbreak as another reason "to open up conversations on vaccine hesitancy."
The measles virus is dangerous and easily spreads virally through coughing and sneezing. The CDC says measles is so contagious that if one person has it, up to 90 percent of the people close to that person who are not immune also will become infected.
"The good news is, there is vaccine readily available," Jacobs said. "And it works."
Health experts say exemptions are more likely to increase when families mistakenly believe that immunizations are linked to health problems or disorders such as autism, a claim that has long been debunked.
Sometimes, Spearman said, parents are just suspicious.
That was the case with a mother who declined immunizations for her child during one recent office visit. Spearman spent time talking over her concerns and she said she'd think about it.
"The approach we take is that vaccines are safe and they're part of normal health care," he said. "When she came back she said, 'OK. Let's do this.'''