Quick - can you describe what a measles rash looks like? Do you know the difference between throats swollen from mumps or tonsillitis? If you don't, you're not alone.

Quick - can you describe what a measles rash looks like? Do you know the difference between throats swollen from mumps or tonsillitis?

If you don't, you're not alone.

"We haven't seen these diseases in a long time," said Heidi Steiner, executive director of the Ohio Association of School Nurses. "People don't know what they look like. They don't fear them. We need to provide a picture of what these diseases look like."

Confronted by recent mumps and measles outbreaks, school nurses are joining other health officials in warning parents about the risks of opting out of required vaccinations for their children.

But data show more Ohio parents choosing not to vaccinate their children, often citing religious or philosophical objections.

The Current Outbreak

Nationally, measles cases are at a 20-year high, according to federal health officials.

The recent outbreaks of measles and mumps in central Ohio are prompting local health departments to share details about the diseases and raise awareness about vaccinations. A case of the measles can lead to "pretty serious complications," said Dr. Mary DiOrio, state epidemiologist with the Ohio Department of Health.

Seven people have been hospitalized due to the current measles outbreak, which had infected 356 people as of late June and spread to eight. Watery eyes, fever and rash are the typical symptoms of measles, but about 30 percent of patients experience complications that can include pneumonia, ear infections and diarrhea. The outbreak in Ohio started among a group of unvaccinated people who traveled to the Philippines.

The mumps outbreak in Ohio began in January and had spread to 432 people living in 17 counties, also as of late June.

The outbreaks illustrate the need for vaccines, DiOrio said. Nurses also need to make parents aware that in the event of an outbreak, unvaccinated children will not be allowed to attend school until the incubation period is over, Steiner added. When health officials connected the measles outbreak to the Olentangy Local School District this spring, five unvaccinated students were banned from classes for 25 days, the incubation period of the disease. The district worked with the families so that the children didn't fall behind academically during that time.

Children who receive the recommended two doses of the measles, mumps and rubella (MMR) vaccine are "99 percent-plus protected" against measles, said Dr. Dennis Cunningham, medical director for epidemiology at Nationwide Children's Hospital.

"We should not have any measles," he said.

Protection against mumps is not quite as robust, Cunningham said. The recommended two doses of vaccine protect about 85 percent of the people who receive it, he said. Preventing children from getting the mumps is important because the disease can cause hearing loss and swelling of the brain, he added.

Choosing Not to Vaccinate

But a growing number of Ohio parents are choosing not to vaccinate their children. In the 2012-13 school year, 2,241 of the state's 142,170 incoming kindergarteners - about 1.5 percent - were not vaccinated due to their parents' religious or philosophic beliefs, according to data collected by the Ohio Department of Health. Ten years earlier, 710 of Ohio's incoming 144,484 kindergarteners - or about 0.5 percent - went unvaccinated for the same reasons.

Some parents oppose vaccines because they fear the inoculations can cause autism (a 1998 British study that made the link has been repeatedly discredited) or overload children with too much disease too soon.

For years, Lucy Anguilano never questioned the value of immunizations. The mother of five believed they were a risk-free necessity for children.

But when her youngest daughter, Allie, developed a persistent rash last fall that ultimately covered her body in angry lesions, Anguilano began to wonder about vaccines. She discovered that she disagrees with many medical practitioners about what is "safe" for children.

"To a parent, 'safe' is harmless," said Anguilano of Strongsville. "To the medical industry, 'safe' means the benefits outweigh the risk."

Anguilano has decided the risk is too great for her family. She and her husband, Jeff, plan to refuse all further vaccines for their children. In addition to 1-year-old Allie, they have a 5-year-old and 3-year-old triplets.

Allie developed a rash, then lesions and swelling in her hands, face and lymph nodes last November after receiving immunizations at her 6-month-old checkup. The family saw allergists, dermatologists and other doctors to determine what was causing the symptoms. Allie was prescribed antibiotics, steroids and antiviral medication but nothing cleared up the condition, Anguilano said.

She started researching possible causes and became concerned that Allie had contracted a virus from a vaccine. She repeatedly asked the doctors to test Allie for viral diseases. The doctors refused, she said.

"They all rejected the idea of a vaccine reaction," she said.

In April, Anguilano started taking her daughter to a natural healer who is treating her with herbs and changes in diet. Although Allie appears to be on the mend now, Anguilano still wants to know what caused her daughter months of pain and discomfort.

Parents need to inform themselves about vaccines, said Barbara Loe Fisher, co-founder of the National Vaccine Information Center, based in Sterling, Va. She encourages parents to read the labels on vaccines and provide the pediatrician with a family medical history. Some pre-existing conditions, such as immune disorders, can lead to reactions, she said.

"The doctor needs to know the medical history of the family and the medical history of the individual," Fisher said. "There's a lot we can do to minimize the incidence of adverse events."

What's Next

The medical community is working hard to allay the community's concerns, Cunningham said. Multiple studies have concluded there is no link between autism and vaccines, he said. Autism Speaks, the national autism advocacy group, even encourages parents to vaccinate, he added.

Doctors opt to vaccinate babies and children because they are more susceptible to many diseases, Cunningham said. Today's vaccines contain smaller amounts of virus than earlier versions due to scientific advancements.

"The schedule is actually pretty carefully thought out so we get the right vaccine at the right time," he said.

Cunningham encouraged parents with questions to consult their doctor.

"Come out and say it: 'I want to ask you about this,'" he said. "You do need to have an open communication with your health-care provider."