Whooping cough cases are at an eight-year high in Pima County, and the Vail area southeast of Tucson continues to suffer the deepest consequences of the ongoing problem.

Forty-one cases of whooping cough have been reported in Tucson-area schools since June, and 63 percent of them have been in the 12,000-student Vail School District, county health data show. Sycamore Elementary School has had the most cases — six students and one staff member since June.

Twenty-four students from Sycamore, which is in outbreak status, are banned from attending their campus through Dec. 18 and are taking classes in a nearby church because they haven’t been vaccinated and are considered vulnerable to the highly contagious respiratory infection.

The voices of those parents electing not to vaccinate their children were noticeably absent from a community meeting at Empire High School in Vail this week. No one exactly knew why, because those parents have been vocal in contacting the Health Department and the school district, and have been defending their actions on Facebook.

Still, neither Pima County Health Department Director Dr. Francisco Garcia nor any of the parents in attendance blamed the parents who don’t vaccinate because of “personal beliefs.” He said there are pockets of such parents not only in Vail but in the Foothills and Marana areas, too.

“We are a close community. Things were a little heated on the Facebook page, but we respect one another,” said Heather York, whose three children attend Civano Community charter school. The school has had four whooping cough cases since June, county data show.

York vaccinates her children and has experienced fear of vaccine-preventable disease in the past, because when her twins were younger they were on a late immunization schedule for medical reasons.

York and other Civano parents were worried about the disease spreading more quickly through Civano because it is a small school. But she sees no point in acrimony with any parents, regardless of their thoughts on vaccinations.

Indeed, kids who are unvaccinated should feel supported at school, said Vail school board member Margaret Burkholder, who is also a parent.

“It’s important to protect the kids,” she said after the meeting. “It doesn’t help to demonize.”

The number of parents who don’t vaccinate their children for personal beliefs is increasing locally and nationally, even though science shows vaccines are the best way to avoid whooping cough, which can be fatal in young children. The last pertussis death in Pima County was of an infant in 2009.

Garcia has had angry calls from parents at schools where outbreaks were declared and whose children were sent home because they are unvaccinated. Garcia stressed the purpose has never been to punish those children but rather to protect them.

Vaccine coverage for Vail sixth-graders was slightly below “herd immunity” for an important booster shot that protects against whooping cough last academic year, county data showed.

Herd immunity refers to a level where the unvaccinated are more protected because they aren’t exposed to disease. To achieve it, vaccination rates need to be 80 percent to 95 percent, depending on the illness. For pertussis, it’s typically 90 percent.

Eighty-seven percent of sixth-graders in the Vail district had received the required Tdap booster vaccine to protect them from pertussis, fewer than county officials want.

Garcia said Mohave and Maricopa counties have had more cases than Pima County this year. Mohave County, which has a high concentration of unvaccinated children, has had 590 cases this year. Pima County has had 90 cases and has a population about five times the size of Mohave County.

When someone is infected with whooping cough, formally known as pertussis, bacteria attach to the tiny, hairlike extensions called cilia that line part of the upper respiratory system. The bacteria release toxins, which damage the cilia and cause swelling that can be fatal, particularly in babies.

Vaccination doesn’t give 100 percent protection, but studies show people who are not vaccinated against whooping cough are 22 times more likely to get it than people who are. Before pertussis vaccines became widely available in the 1940s, about 200,000 U.S. children got sick with it each year and about 9,000 died.

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Nationally, 48,277 cases of whooping cough were reported last year, the most in the U.S. since 1955.

The U.S. Centers for Disease Control and Prevention strongly advocates vaccination, but like Garcia, officials focus not on pointing fingers but on education.

Tucson resident Jessica Contreras said she used to be suspicious of vaccines. But after her newborn daughter contracted whooping cough and nearly died last year, she is now an advocate for the booster vaccine.

Contreras’ daughter, Bryanna Robles, was hooked up to an external lung at the University of Arizona Medical Center-Diamond Children’s last year, and doctors estimated her chances of survival at just 5 percent.

Contreras doesn’t know how Bryanna contracted whooping cough. She did not receive the Tdap booster while she was pregnant because her provider didn’t offer it, though it’s recommended for women in their third trimester.

Bryanna was healthy when she was born at 6 pounds 9 ounces, Contreras said. But when she got sick with a cough at just 3 weeks old, her tiny lungs could not get enough air and she was rushed to the emergency room.

Once babies are hospitalized for whooping cough, the odds are against them. The odds get even worse for babies who are treated with the external heart and lung machine.

Bryanna surprised everyone by pulling through. She spent two weeks on the external lung and heart, and another couple of weeks recovering in the intensive care unit.

The vaccine isn’t perfect — it wears off and is effective about 70 percent to 80 percent of the time, so immunized kids are sometimes the ones who get sick. But their illnesses aren’t usually as severe, said Dr. Sean P. Elliott, medical director of infection prevention at the University of Arizona Health Network.