I know just how badly you want this to be about vaccine exemption. It's not.

The response to the epidemic has been hampered by the recession, which has left state and local health departments on the front lines of defense weakened by years of sustained budget cuts.

Here in Skagit County, about an hour’s drive north of Seattle — the hardest-hit corner of the state, based on pertussis cases per capita — the local Public Health Department has half the staff it did in 2008. Preventive care programs, intended to keep people healthy, are mostly gone.

The county’s top medical officer, Dr. Howard Leibrand, who is also a full-time emergency room physician, said that in the crushing triage of a combined health crisis and budget crisis, he had gone so far as to urge local physicians to stop testing patients to confirm a whooping cough diagnosis.

If the signs are there, he said — especially a persistent, deep cough and indication of contact with a confirmed victim — doctors should simply treat patients with antibiotics. The pertussis test can cost up to $400 and delay treatment by days. About 14.6 percent of Skagit County residents have no health insurance, according to a state study conducted last year, up from 11.6 percent in 2008.

“There has been half a million dollars spent on testing in this county,” Dr. Leibrand said late last week. “Do you know how much vaccination you can buy for half a million dollars?” And testing, he added, benefits only the epidemiologists, not the patients. “It’s an outrageous way to spend your health care dollar.”

People wanted to get bent outta shape about the anti-vax crowd in 2012, too. They had a bit more of a leg to stand on. Except Washington actually changed their regulations for the better the year before:

Last year, the Washington Legislature passed a law requiring parents to prove that they had consulted a physician before declining vaccinations for their children.

“We had the easiest opt-out law in the nation until last year, so what we also had was the highest percent of parents opting out,” Ms. Selecky said.

And I know you want this to be "a group of religious people that went to South America." Except it was eighteen different strains.

Thirty-one PFGE types were found, with the most common types, CDC013 (n = 51), CDC237 (n = 44), and CDC002 (n = 42), accounting for 57% of them. Eleven MLVA types were observed, mainly comprising type 27 (n = 183, 76%). Seven MLST types were identified, with the majority of the isolates typing as prn2-ptxP3-ptxA1-fim3-1 (n = 157, 65%). Four different prn mutations accounted for the 76% of isolates exhibiting pertactin deficiency.

Listen closely to me, atheist, because you're doing that thing everybody hates us for: proclaiming that proper zealous adherence to dogma will protect our virtue. That's like when people would tell me my kid has a life-threatening peanut allergy because my wife didn't eat enough peanut butter sandwiches when she was pregnant, and then blamed us both for not enrolling her in a peanut allergy study.

You're whistling in the goddamn graveyard and everybody knows it - but worse than that, you're saying parents are to blame for the random misfortunes of their offspring. You know why there's a pertussis outbreak in Kentucky?

However, Thomas Clark, MD, an epidemiologist with the CDC's meningitis and vaccine-preventable disease branch, told the Times that many people sickened in outbreaks in Washington and other states received their childhood vaccinations, but changes in the vaccine in the early 1990s to reduce side effects may have had an impact on how long immunity lasts.

So if you're under 50 you thought you were vaccinated against pertussis forever but it turns out you were actually only vaccinated against pertussis until about 2008. Stop trying to blame people for that. No. this isn't about crossing national borders. No. This isn't about whether or not you ride the bus. This is about the fact that people get fucking sick sometimes and it's a drag. Kinda like how the flu vaccine is sometimes like 40% effective because it's for the wrong strain.

I dated a girl who worked at a hospital. As part of her HR package she had to be tested for every fuckin' thing under the sun. Turns out she picked up tuberculosis when she was in Spain five years previously. Is there a tuberculosis vaccine? yes. Is it given in the US? no. So are we gonna keep all the brown people out now? or give them all a vaccine scar that never goes away? Or just go ahead and treat everyone? 'cuz that's a six month course with a teratogenic that requires monthly liver function checks and utter abstinence of all alcohol.

Or maybe just accept that in a town called Perfect everyone thinks like you, acts like you, behaves like you and vaccines are 100% effective but here in These United States we can't afford to burn people at the stake for getting sick?