Before the development of a vaccine to immunize against whooping cough in the 1940s, millions of people suffered from the illness with little means to prevent its spread. In the years that followed, compulsory vaccinations nearly wiped it out over the course of a few decades.

But in the last few years parents have increasingly exploited a loophole in the law by requesting and receiving, on the basis of “personal belief,” their childrens’ exemption from compulsory vaccination laws. Now whooping cough, also known as pertussis, is officially an epidemic, according to a Nov. 26 report by the California Department of Health. This year, the disease — which produces severe coughing spells, fatigue and vomiting — has struck 9,935 people in California.

The common view of professionals in the health field is that the rise in personal belief exemptions is coming from misinformation and lack of education.

“I really do think it has a lot to do with education,” said Dr. Cassandra Jobert, director of the Central California Children’s Institute and Fresno State public health professor. “I also think it has to do with people. On the one hand, it’s education and making sure people understand the facts and the risks if they don’t vaccinate. On the other hand, I think what we’re experiencing are people really wanting to make sure that their rights are protected. Their rights to do what they want to do with their children.”

The California Department of Public Health says that schools and care facilities with higher rates of non-vaccinated children are at greater risk of outbreaks. With rising numbers in personal belief exemptions state-wide, California has had an increase in whooping cough cases. The number reached a 60-year high in 2010 with over 9,000 cases.

“It’s extremely important, especially with pertussis,” said Lucas Sherman, a charge nurse of the immunization program for the Fresno County Department of Public Health. “It’s very important that they get all those vaccines to protect themselves and their fellow students.”

California law states that incoming kindergarten students must enter with all required immunizations. These immunizations cover the 17 vaccine-preventable diseases which include the likes of haemophilus influenzae and polio. Seventh grade students are also required to have the TDAP, which includes added protection against tetanus, diphtheria and whooping cough.

Parents who do not wish to have their children receive these immunizations have a method of avoiding the shots through a personal belief exemption form, a recent trend that has helped in decreasing immunization rates.

“It’s a very complicated issue and it’s because, for parents, their primary concern is their kid,” said Dr. Setareh Tais, a Fresno naturopathic doctor. “It’s where individualized medicine clashes with community medicine.”

The percentage of students with personal belief exemptions has been low, yet trending upwards since 2007, from .56 percent to 1.62 percent of kindergarteners in Fresno County. Seventh graders are, most recently, at an even higher rate at 2.43 percent.

State numbers are higher at 3.15 percent of kindergarteners and 3.26 percent in seventh graders in the 2013 to 2014 year.

And it’s no surprise that the number increases as children get older. Parents sometimes have a bad experience with vaccination or change their overall opinion on them between kindergarten to seventh grade.

Personal medical exemptions and conditional entrants also factor in a percentage of students without all required immunizations. Conditional entrants include students who either have a temporary medical exemption or are in the process of receiving immunizations. That accounts for 4.23 percent of kindergarteners in Fresno County.

There are many reasons, experts say, why parents decide to choose the personal belief exemption. Links of the Measles, Mumps and Rubella vaccine to autism, though debunked, have been a factor in the growing trend of PBEs.

“There’s several things,” said Lisa Roberts, a nurse practitioner at the Fresno State Health Center. “Fear, concerns about safety, concerns about side effects — in really 60 to 70 percent of the concerns — come from these two main issues. There’s some religious objections where some people feel like it’s a violation of God’s will. Philosophical objections, that they aren’t natural. And then sometimes it’s cost or really even access to care.”

Tais, who treats patients who both want alternative means of health care and also patients who seek regular primary care, has had first-hand experiences with parents coming into her practice seeking counseling for the personal belief exemption. She said many concerns come from misinformation.

“I would say that there is a lot of skepticism and worry that vaccines will harm you,” Tais said. “A lot of suspicion that they don’t really work or they give you the actual disease. I do believe that a lot of this is misinformation.”

There are rare occasions that some vaccinations can cause an unwanted reaction. Doctors such as Tais will go through these risks provided by the Centers for Disease Control and Prevention to relieve some worries and to pinpoint exactly what vaccines they are concerned about.

“It’s always valid for a parent to be concerned if that flu shot has a one percent chance of giving their child a fever, of course that’s a valid concern,” Tais said. “I believe that every concern that a parent has about a vaccine is valid, with the exception of autism, just because there has been way too much research showing that that connection has been debunked.”

Providing education is something the government sought to do with a new law which went into effect on Jan. 1. To file for a personal relief exemption, parents receive a standard card in which the school keeps for shot records. Before, parents could just sign the card.

Now, parents must seek a medical professional to receive education and advising to learn more about the information on vaccines and the potential risks of choosing not to vaccinate. However, if the exemption is due to religious reasons, they are not required to obtain the signature.

State officials and medical professionals believe the law will help inform parents on their information and reverse the seven-year trend in rising personal belief exemptions.

“That’s what we hope,” Sherman said. “That was the goal of the state, I believe, and I think it will.”

At the end of the consultation, the parents have the ultimate decision, however. The medical professional only signs that they have provided the education to the parent before they made the decision to exempt their child.

On many occasions, the consultation is not enough to persuade parents.

“For the most part, patients will hear your spiel about vaccines and then they’ll go ahead and say ‘No, I want to be exempt from them,’” Tais said. “It’s so ingrained in that that certain things are really bad that they kind of go with it.”

If the law doesn’t have the desired effect and child immunization rates continue to decline over several years, there are concerns about the effects that could result.

“We’re going to see a resurgence of preventable illnesses, loss of work and some death,” Roberts said. “I think too that, because our vaccine programs have been so good, we don’t really see these diseases, and so parents don’t really realize how severe they can be.”

Vaccinations for children are not offered at the Fresno State Health Center, but students can get vaccinations for themselves and seek advice and consultation on vaccinating their children. Fresno State students with children are advised to be vaccinated to prevent possible outbreaks in schools carrying over to the university.

Medical professionals are concerned that the issue with childhood vaccinations isn’t just an issue with children. If parents are not vaccinated, they too can catch diseases that breakout in children and help create an epidemic just as what has become with pertussis.

“If the children get it and the parents haven’t been vaccinated, absolutely,” Roberts said.