With a 14-state measles outbreak shining a spotlight on immunization safeguards, North Carolina is earning praise for its accomplishments. “NC ranks third highest in nation for measles vaccination,” one newspaper trumpeted.

In actuality, there could be hundreds or thousands of children in North Carolina who are unvaccinated -- no one knows. Here’s why:

• Public health officials don’t verify whether the state’s 98,000 home-schooled students receive mandatory immunizations; 371 of those children are in Jackson County. A local pediatrician, Dr. Penny O’Neill, confirms some (not all; not a majority; less than 10 percent) of children who come through her practice are unvaccinated. Some of those are not home-schooled children; she has seen unvaccinated children who are enrolled in area daycares.

• North Carolina law requires immunization records be on-site in the state’s 61,000 home schools, ostensibly so officials can confirm students have received their vaccinations. But, there’s zero enforcement – no site inspections are made by any state agency. There are 238 home schools in Jackson County.

• State officials don’t document exemptions for medical or religious reasons lawfully obtained by parents of home-schooled children. These records do not exist, according to the Division of Non-Public Education and the N.C. Department of Health and Human Services.

Public, private and charter schools play by a different set of rules. They do track students with exemptions. These are the numbers for Jackson County’s charter and public schools: Summit Charter has 10 exempted students; Smoky Mountain High School, fewer than 10; Fairview Elementary, seven; Cullowhee Valley, five; Scotts Creek, six; Blue Ridge, two; Smokey Mountain Elementary, one; School of Alternatives, none.

Measles is a highly contagious respiratory disease that begins with a fever, cough and runny nose and evolves into a red rash. It can result in severe complications such as pneumonia and deafness, according to the Centers for Disease Control and Prevention.

The vaccines work by providing “herd immunity:” large numbers of vaccinated people protect the smaller numbers who are not vaccinated. The magic stops when too many people are unvaccinated, according to the Centers for Disease Control and Prevention. Medical experts place the herd-immunity number between 92 percent and 95 percent. Children need to receive two doses of the measles, mumps, and rubella (MMR) vaccine.

CDC spokesman Richard Quartarone said last week that North Carolina’s failure to monitor home-schooled children for proper immunization is not unusual. Practices vary from state to state, he said.

Some parents are refusing to vaccinate based on a discredited medical study that linked vaccination to autism. “I’m getting people with a high school education telling me they’ve studied this,” O’Neill said. “I don’t call NASA and make recommendations on rocket fuel, and they don’t have the knowledge and background to make good decisions.”

Some pediatricians refuse to treat unvaccinated patients. O’Neill and her colleagues continue to accept them. She said the children need medical care, and it’s an opportunity to try to educate their parents. The pediatric practice takes precautions to minimize risk to other children.