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A Salt Lake County measles outbreak has been traced to a family in Holladay who recently traveled to Poland to retrieve their missionary daughter.

The virus started with students at Olympus High School and Evergreen Junior High, the unimmunized siblings of a returned missionary who had been assigned to the Poland Warsaw Mission of The Church of Jesus Christ of Latter-day Saints, multiple sources confirm. The missionary was likely vaccinated under LDS Church policy.

Why her siblings weren't isn't clear. Calls to the family on Thursday were not immediately returned.

School and health officials have sought to shield the family's identity, citing state and federal privacy laws and concern for their well-being.

"We are wary of any potential push back they could receive from the community because of the circumstances," said Ben Horsley, a spokesman at Granite School District, the only district affected by the outbreak so far. "Parents have a right under state law to make the best decisions for their child's well-being and education. We as a district fully respect that right."

To attend public school in Utah, children must show proof that they are up to date on their immunizations. But parents can seek exemptions for philosophical and religious reasons, or if a licensed physician determines that a specific vaccine would endanger a student's life or health.

In 2010, 2.8 percent of all school-age children were exempted from the measles vaccine, up from 2 percent in 2006.

"They've gradually gone up, but not at a rate that is cause for alarm," said Rebecca Ward, of the Utah Health Department's Communicable Disease Investigation & Response. "Obviously we'd like to have more people vaccinated, but 97 percent is pretty high. If exemptions started creeping up to 7 to 10 percent we might want to look at that."

Widespread use of the measles, mumps, rubella vaccine led to the eradication of measles in the United States in 2000, according to the U.S. Centers for Disease Control (CDC). Even people who aren't vaccinated benefit from what's known as herd immunity, which slows the spread of the virus.

Cindy Gellner, a pediatrician at Westridge Health Center in West Valley City, said she has never treated a measles patient. About five of her families have opted to forgo or delay immunizations and the outbreak hasn't increased demand for vaccines, she said.

In countries such as Africa and Europe, where vaccination is less popular, the measles virus is not contained and it poses a risk to travelers who aren't inoculated. Measles is a leading cause of death among young children worldwide.

Gregory Armstrong, an epidemiologist at the CDC, said it could always recur in the U.S. as it did in the United Kingdom, where vaccination rates are below 80 percent. Rates there slipped following a study that linked the vaccine to autism. The study was later retracted after its author admitted to falsifying data.

"In the last several years, we've seen large numbers of cases in France, Germany and Switzerland," said Armstrong. "We've had several deaths in those countries, children of varying ages, some of them who were previously healthy. But the kids who pay the biggest price are those who are immuno-compromised and can't be vaccinated."

Any outbreaks in the U.S. are imported and limited in size, Armstrong said.

But even the smallest carry a cost to taxpayers and to families and education professionals whose lives are disrupted by school quarantines.

The Salt Lake Valley Health Department, which is monitoring the disease, hasn't tallied its costs yet.

The U.S. Centers for Disease Control pegs the average cost to investigate one measles case at $150,000; there have been five confirmed cases of the measles in Utah so far.

Schools, too, have taken a hit. "It's been a big use of our time at the district level, but to calculate costs would be difficult," said Horsley.

Staff at four schools spent weekends poring over student records to identify dozens who weren't vaccinated and might have been exposed to the virus. Teachers have had to communicate via e-mail with home-bound students and there have been discussions about web streaming classes, Horsley said.

And there's the direct cost of hiring 40 substitute teachers to fill in for those who had no immediate proof of immunization. Assuming they each worked three days at an average cost of $73, the total bill would be $8,760.

Students confirmed to have the measles have all been cleared by the Salt Lake Valley Health Department to return to school because they are no longer contagious. But most unimmunized kids will remain absent through April 25, which means less instruction time for students and time off work for parents.

Miriam Hyde has children at two exposed schools. Both are up to date on their shots. But because her daughter was exposed to the virus at Olympus High, the teenager had to be cleared by a doctor — and missed some work — before she could return to her part-time job.

"She works around kids," explained Hyde, who also got a booster to protect her aging mother whom she is visiting soon in Florida. She would like to see Utah's school admissions law tightened.

"The blame lies squarely on the shoulders of their parents," not the kids, Hyde stressed. "The rest of us should be protected from nonimmunized people."

Measles on the rise?

The Centers for Disease Control and Prevention report 28 imported cases of the measles nationally in just the first two months of 2011. That's about the total number in any given year, prompting the agency to issue an advisory this month to remind parents to immunize their children before traveling with them overseas.

When to get vaccinated • The normal schedule is two doses; one at 12-15 months of age and a second before entering school at age 3-4. But toddlers traveling overseas may be eligible for a second dose ahead of schedule, the CDC says.

Help with vaccination • Parents are urged to consult with their doctor on vaccination decisions. The federal Vaccine for Children program helps those who are up to 18 years of age, who are uninsured.