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Measles outbreaks continue to pop up across the United States, with the number of confirmed cases of the once-eradicated disease now exceeding 700 in 22 states - but so far, only one person in Colorado has become ill with the highly contagious virus.

In January, a Denver resident was placed in isolation and treated for the respiratory illness after being diagnosed following a trip abroad, leading local health officials to issue a public warning about possible exposure to others.

It's the only confirmed case of measles in Colorado this year, but health experts said the state's notoriously low vaccination rate makes communities here vulnerable to a possible outbreak.

"We've seen it happen over and over in communities where the vaccination rate is low," said Dr. Jessica Cataldi, a pediatrician at Children's Hospital Colorado and vaccine researcher.

Only 88.7 percent of the state's kindergarteners received the measles, mumps and rubella vaccine during the 2017-18 school year, making it one of the lowest rates in the nation, according to the Centers for Disease Control and Prevention.

While the childhood immunization rate in Colorado has improved, the issue has become a flashpoint in the General Assembly as a Democratic lawmaker pushes a bill that would make it harder for parents to opt their children out of vaccinations - a measure that is drawing opposition from Gov. Jared Polis.

The issue comes as the CDC said on Monday that the U.S. is experiencing the largest number of measles diagnoses since the virus was declared eliminated in 2000.

Despite the low immunization rate, there have only been 11 cases of the virus in Colorado in the past 19 years, according to data from the state Department of Public Health and Environment.

The reason for the low numbers is because measles is not as common as a cold. But that "doesn't mean we are safe from that possibility," Cataldi said of a potential outbreak. She is one of the health care experts to respond after the governor said Friday that he didn't support the current bill.

"Measles is actually the most contagious infectious disease that we know of," Cataldi said.

Measles is a virus with symptoms that include high fever, cough, runny nose, watery eyes and a rash. Up to 90 percent of the individuals close to a person with the virus can become infected if they aren't immune, according to the CDC.

The CDC recommends all children get both doses of the MMR - or measles, mumps, and rubella - vaccine, beginning with the first one at 12 to 15 months of age. The second dose can be given at 4 to 6 years.

In Colorado, state law requires students to be vaccinated against certain diseases, including measles. But they can be exempted for medical, religious or personal-belief reasons.

For a population to be protected from a measles outbreak, health experts said, a community needs at least a 95 percent vaccination rate. So with only 88.7 percent of kindergarteners in the state with the MMR vaccine, Colorado misses the threshold needed for "herd immunity."

However, the risk can vary depending on the vaccination rate in a particular community, such as a town or school or daycare.

For example, in Denver, the MMR immunization rate for kindergarteners is 90.2 percent. But in Boulder County, the rate is 81.58 percent. Jackson County - which only has 10 students - has the state's lowest rate, at 20 percent. And Kiowa County, which has 30 kindergarteners, has a 100 percent immunization rate, according to data from the state health department.

Measles can spread to Colorado as people travel in and out of the state, especially if they visit an area that has seen an increase in cases, including domestically and abroad.

"Measles is likely to pass through Colorado at any time," said Dr. Seth Foldy, director of epidemiology, informatics and preparedness with Denver Public Health.

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How vulnerable is Colorado to a measles outbreak due to its low vaccination rate? Experts weigh in.

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Measles outbreaks continue to pop up across the United States, with the number of confirmed cases of the once-eradicated disease now exceeding 700 in 22 states - but so far, only one person in Colorado has become ill with the highly contagious virus.

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Journalist Lottie Daley believes it's 'selfish to demand children be vaccinated'

But mother Stephanie Nimmo said it's a parent's responsibility to protect kids

She was left deaf in her right ear as a result of not being vaccinated as a child

Debate became so heated that host Phillip Schofield forced to intervene

A mother on This Morning was accused of 'child abuse' after revealing she refuses to vaccinate her children during a heated debate on the topic.

Journalist Lottie Daley, who has three children, believes her child had a bad reaction to being immunised.

The debate came after it was reported the number of people receiving MMR vaccinations has dropped for the fourth year in a row, despite the number of cases trebling in 2018.

There were 259 measles cases in 2017, which rose to 966 in 2018, while uptakes of both jabs at the age of five has fallen in England for four years in a row from 88.6 per cent up to 87.2 per cent in 2017-2018.

Health secretary Matt Hancock said he wouldn't rule out the option of banning children from school if they were unvaccinated.

But Lottie claims it's against a child's human rights to deny them an education if their parent decides not to vaccinate them.

Her views were opposed by fellow journalist Stephanie Nimmo, who was left completely deaf in her right ear after not being vaccinated against the measles.

'It is against the Nuremberg Code, it is against the Unicef human rights bill for children to deny them and education and also to inject them or medicate them without their consent or without parental consent,' said Lottie, arguing that studies show there were only 10 deaths from measles between 2003 and 2016.

'I think that the majority of mums start vaccinating, they only stop when something goes wrong.'

She then highlighted research from a recent freedom of information request which showed 49 children died from vaccine reactions, and said there is a lot of 'scaremongering' surrounding the issue.

At this point host Phillip Schofield interjected, pointing out Stephanie as 'an example' of someone who wasn't vaccinated and suffered life-changing consequences.

As Stephanie entered the debate, Lottie interjected with: 'You can find examples anywhere, people die from the flu.'

Stephanie responded: 'The whole point is, we've almost been sanitised. A generation ago, children were dying of measles, children were in iron lungs with polio, and because of the vaccination programme, we're not exposed to those deaths.

'With vaccination rates decreasing, I think we're going to see the number of deaths increasing but there's also the damages that these illnesses cause.

'I was left dead in my right ear; that's a difficult thing, it's not life-threatening, but there are also children and young people who are unable to have the vaccine, they're immune-suppressed, and are put at risk by unvaccinated children.'

Stephanie then spoke of her youngest daughter Daisy, who was born with a rare genetic disease and was unable to be vaccinated.

'She was therefore at risk of contracting measles, mumps, rubella and dying very painfully of those because she had a weakened immune system,' she said.

'I am contacted daily by friends whose children had treatment for cancer whose immune systems are wiped out and therefore they cannot have a vaccination.'

Co-host Holly Willoughby then suggested that the issue is more about protecting a community over an individual, and that many viewers may think it's selfish to not vaccinate their child and thereby put other people at risk.

But Lottie firmly disagreed, claiming she thinks it's selfish for children to be vaccinated when 'we do not know the ethicacy and the safety long term'.

She went on: 'There's never been a trial that puts unvaccinated and vaccinated and health outcomes, there's never [been one].'

Asked about their stance on the health secretary's proposal, despite the fact that schools cannot refuse admission or exclude a pupil on the basis of their vaccinations, Stephanie said: 'If a parent wants to send an unvaccinated child to school, I think the schools are within their rights to ask for a medical certificate that gives evidence as to why that child is not vaccinated.

'We are protecting the whole community. For us to have herd immunity, 95 per cent of the population needs to be vaccinated.'

But Lottie continued to interject, saying: 'How can my child without any disease whatsoever give a disease, yet an MMR vaccinated child with an attenuated live virus which sheds for 30 days is far more of a danger than my healthy, as far as I know, child.'

But viewers were generally pro-vaccination, with one going so far as accusing Lottie of 'child abuse' for denying her children the jab.

They tweeted: 'This woman is guilty of chid abuse not giving a child a vaccination, it should be law, not an offer to immunize your child. I'd ask the parents if they were immunized! Bad bad parenting, seeking the advice of Dr Google (sic).'

Another commented: '"It's against human rights to medicate children without their consent." Because my eight-month-old understands why she needs medication.'

'I don't understand why anyone wouldn't vaccinate their child,' wrote another.

But others were more sympathetic to Lottie's plight, point out that there are risks involved with vaccinations.

One tweeted: 'Actually Lottie is trying her best - vaccines are dangerous and harmful - aluminium and aborted detal cell lines have never been tested as safe to inject into babies - our kids have been the experiment. Yes they pick parents like Lottie to come on not actual scientists.'

Another supporting Lottie's point about scaremongering, while This Morning's Dr Raj Singh pointed out on social media that vaccines have 'intended benefits and expected harms'.

He went on: 'You're assuming no one is looking at evaluating vaccine risk, which is not true. Also, association isn't the same as causation, which all researchers know.'

When should babies have their first jabs?

Information supplied by the NHS.

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Mum says not educating unvaccinated kids is 'against human rights'

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Journalist Lottie Daley believes it's 'selfish to demand children be vaccinated' But mother Stephanie Nimmo said it's a parent's responsibility to protect kids She was left deaf in her right ear as a result of not being vaccinated as a child Debate became so heated that host Phillip Schofield forced to intervene A mother on This Morning was accused of 'child abuse' after revealing she refuses to vaccinate her children during a heated debate on the topic.

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(Reuters) - Adults in the United States who were vaccinated against measles decades ago may need a new dose depending on when they received the shot and their exposure risk, according to public health experts battling the nation's largest outbreak since the virus was deemed eliminated in 2000.

Up to 10 percent of the 695 confirmed measles cases in the current outbreak occurred in people who received one or two doses of the vaccine, according to the U.S. Centers for Disease Control and Prevention.

The figure illustrates what can happen when a large number of individuals, even those who have been vaccinated, are exposed to the measles. CDC recommends that people who are living in or traveling to outbreak areas should check their vaccination status and consider getting a new dose.

Dr. Allison Bartlett, an infectious disease expert at the University of Chicago Medicine, said the "continued vulnerability to infection" is why high-risk adults such as healthcare workers are routinely advised to get a second dose of the measles vaccine if they have not had one.

But knowing your vaccination status can be tricky, experts said.

"It's complicated and often futile because it's very difficult to resurrect those old records," said Dr. William Schaffner, an infectious disease expert at Vanderbilt University Medical Center.

People vaccinated in the United States since 1989 would most likely have received two doses of the combined measles, mumps and rubella (MMR) shot under federal guidelines, and that is still considered the standard for protection.

Anyone vaccinated between 1963 and 1989 would likely have received only one dose, with many people immunized in the earlier years receiving an inactivated version of the virus. Americans born before 1957 are considered immune as they would have been exposed to the virus directly in an outbreak.

Merck & Co Inc is the sole U.S. provider of the MMR vaccine. The company said in a statement that it has "taken steps to increase U.S. supply" of the vaccine due to the current outbreak.

HIGHLY CONTAGIOUS

The measles virus is highly contagious and can cause blindness, deafness, brain damage or death. It is currently spreading in outbreaks in many parts of the world.

According to the World Health Organization, 95 percent of a population needs to be vaccinated to provide "herd immunity," a form of indirect protection that prevents infection in people too young or sick to be vaccinated. U.S. public health officials have blamed the current outbreak in part on rising rates of vaccine skepticism that have reduced measles immunity in certain communities.

For travelers to outbreak areas abroad, the CDC recommends adults consider getting another dose of MMR unless they have proof of receiving two prior doses, take a blood test showing immunity, or were born before 1957.

In general, the CDC says two doses of the measles vaccine should provide 97 percent protection; one dose should offer 93 percent protection. However, immunity can wane over time.

This has occurred even in adults with two documented doses of the vaccine, said Dr. Michael Phillips, chief epidemiologist at NYU Langone Health, which serves parts of New York City, a hot spot in the U.S. outbreak.

He said in kids, "the vaccine is really effective," but in some adults, memory T-cells, which recognize and attack germs, do not fight the virus as effectively as they once did.

Rapid blood tests are available that can detect whether a person is immune based on the level of measles antibodies, but the tests are not 100 percent reliable.

Adults who have any doubt about their immunity should get another dose, Schaffner said: "It's safe. There's no downside risk. Just roll up your sleeve."

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U.S. measles outbreak raises questions about immunity in adults

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Adults in the United States who were vaccinated against measles decades ago may need a new dose depending on when they received the shot and their exposure risk, according to public health experts battling the nation's largest outbreak since the virus was deemed eliminated in 2000.

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1. HOW EFFECTIVE IS THE MEASLES VACCINES?
* ACCORDING TO CDC.GOV, TWO DOSES OF THE MEASLES VACCINE IS SAFE AND 97% EFFECTIVE
2. WHAT ARE THE CAUSES AND HOW CAN YOU PREVENT IT?
3. WHAT AGE GROUP IS THE MOST AFFECTED OF THIS DISEASE?
***
4. WHAT WOULD YOU DO IF THE DISEASE MUTATES AND IT BECOMES DIFFICULT TO FIND A CURE?

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In the year 2000, the Centers for Disease Control and Prevention declared measles "eliminated" from the United States. But with measles continuing to spread and at times flourish in many parts of the globe, the U.S. has been unable to remain immune to the disease.

This year, the U.S. has its highest number of measles cases in 25 years. As of this week, the CDC has recorded 704 cases in 22 states.

The re-emergence of measles is linked to parents who have chosen not to vaccinate their children against this highly contagious disease.

But that's not the full explanation. Dr. James Goodson, a senior measles scientist at the CDC, says the U.S. outbreaks are being driven by a surge in measles globally.

The World Health Organization tallied more than 112,000 measles cases in the first quarter of 2019. This is up more than 300% compared to the same period in 2018. Dr. Tedros Adhanom Ghebreyesus, director general of WHO, calls the rise in measles "alarming" and a "global crisis."

Madagascar is grappling with a measles outbreak that's sickened 70,000 people and killed more than a thousand. There are also significant outbreaks in Brazil, India, the Philippines, Ukraine and Venezuela. There have been smaller flare-ups in France, Greece, Israel and Georgia.

"When we see large measles outbreaks in countries that are common destinations for U.S. travelers like we're seeing this year," Goodson says. "that's when we often see the largest number of measles cases in the U.S."

That's because of the nature of the virus. "The only reservoir for the measles virus is people," Goodson says. "So the only way you're going to get measles is if you come in contact with somebody who's infected with measles."

Measles is one of the most highly contagious human diseases known to science. Before a measles vaccine was introduced in the U.S. in the 1960s, the CDC estimates there were 3-to-4 million cases a year in the country

Epidemiologists say that to stop the spread of the virus, 95% of people need to either be vaccinated or immune to measles because they already had the disease. In the year 2000, WHO launched a campaign to attack measles globally with the ambitious target of getting 90% of all children vaccinated before their first birthday. WHO at that point wasn't even talking about "eradicating" measles; the goal was simply to "control" it.

The campaign has slashed the number of measles cases dramatically and brought the estimated number of measles deaths down from roughly half a million a year globally in 2000 to 28,124 in 2018 - but then it took off in the early this year.

"Globally we've made great strides with reducing [measles] incidents by 80 percent since the year 2000," Goodson says. "But we do go through these periods where there are resurgences of measles. It happens and it's related to people not being vaccinated."

Goodson says there are three basic scenarios globally in which measles ends up with fertile ground to spread.
Don't see the graphic above? Click here.
The first: countries that don't have the health care infrastructure to consistently carry out immunization campaigns. Depending on the formulation, the vaccine needs to be refrigerated - transported and stored at between -58 degrees Fahrenheit and 5 F or between -58 F and 46 F. Either temperature range can be a challenge in tropical countries with spotty electricity. The countries with the lowest vaccination rates also tend to rank as some of the least developed in the world: South Sudan, Chad, Haiti, the Democratic Republic of Congo.

The second scenario feeding the spread of measles is civil strife. This applies to places like Syria and Venezuela that used to have strong immunization programs. Those systems fell apart due to war or social collapse. And Goodson says this doesn't just affect that individual country.

"That outbreak in Venezuela has gone on to spread throughout the region of the Americas infecting countries like Brazil, Chile, Peru," he says. "I could go on and on. Most of the countries in the region have now been affected by that outbreak."

The third scenario fueling outbreaks globally is when parents choose not to have their kids vaccinated even though vaccines are widely available. These people don't trust that the vaccines are safe or think there are too many vaccines or don't trust the health-care system in general.

In 2017 the botched rollout of a dengue vaccine in the Philippines (which turned out to make dengue infections worse in people who'd never had dengue previously) ended up causing vaccination rates to drop for other diseases including measles.

Dr. Robin Nandy, UNICEF's chief of immunization, says in some places like Ukraine several of these scenarios are playing out at the same time.

"Ukraine is a complex situation," Nandy says.

From March 2018 to February 2019, Ukraine recorded 72,408 measles cases, the most of any country in the world.

"They've had trust issues," he says about high levels of skepticism toward vaccines in Ukraine. "Also they've had system breakdowns, vaccine shortages that undermine community confidence toward the health service."

In addition, fighting between the government and pro-Russia separatists has caused some parts of the country to be cut off from others, disrupting lots of government services including vaccine delivery.

In 2016 according to WHO only 42% of kids in Ukraine were vaccinated against measles.

"It is not one cause or one determinant that causes low vaccination rates," Nandy says. "Each country is different. The Philippines and Ukraine are very, very different scenarios and there are very different reasons why kids in these countries are not vaccinated."

Nandy says the measles virus is a "super-spreader." It can linger in the air in a room or an airplane for hours waiting to find a new host. If exposed to the virus, 90% of unvaccinated people will end up infected.

But Nandy emphasizes that there's a super-effective vaccine to combat this super-spreader virus. He says the challenge for global health officials is to understand the complex social, economic and structural reasons that are keeping that vaccine from reaching everyone who needs it.

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U.S. Measles Outbreak Is Linked To Global Surge In The Virus

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In the year 2000, the Centers for Disease Control and Prevention declared measles "eliminated" from the United States. But with measles continuing to spread and at times flourish in many parts of the globe, the U.S. has been unable to remain immune to the disease. This year, the U.S.

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Josh

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Almost two-thirds of the nearly 800 students, faculty and staff members who were quarantined following exposure to the measles virus at two Los Angeles universities have been cleared to resume normal activities.

The quarantine marked one of the most sweeping efforts by authorities to contain the nation's measles outbreak, where cases have reached a 25-year high.

People at California State University, Los Angeles and the University of California, Los Angeles were cleared after providing proof of immunity.

At the Cal State campus, 435 students and employees were cleared by Monday afternoon, with 221 still under quarantine.

Officials said they may have been exposed to an infected student who visited a school library.

At UCLA, 27 people remained quarantined. People at that campus were in classes attended by an infected student.

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Hundreds of Students, Staff Cleared After Quarantine by UCLA, Cal State L.A. for Possible Measles Exposure

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Almost two-thirds of the nearly 800 students, faculty and staff members who were quarantined following exposure to the measles virus at two Los Angeles universities have been cleared to resume normal activities. The quarantine marked one of the most sweeping efforts by authorities to contain the nation's measles outbreak, where cases have reached a 25-year high.

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Josh

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Measles is on the rise again, all around the globe.

Though the number of people affected in the U.S. is still relatively low compared with the countries hardest hit, there are a record number of U.S. measles cases - more than 700, so far, in 2019, according to the CDC - the highest since the disease was eliminated in the U.S. back in 2000.

Measles has been documented in more than a third of states, with large outbreaks in New York and Washington.

And although the majority of people getting the illness now were never vaccinated, the expanding outbreaks have raised new questions about whether some older adults - including many of those born before the mid-1960s - should be revaccinated, along with some younger people uncertain of their immunization status.

According to the Centers for Disease Control and Prevention, people who were vaccinated prior to 1968 with an early version of the vaccine, which was made from an inactivated (killed) virus, " should be revaccinated" with at least one dose of live attenuated measles vaccine.

Today's recommended vaccine is known as MMR and protects against measles, mumps and rubella.

"This recommendation is intended to protect those who may have received killed measles vaccine, which was available in 1963-1967 and was not effective," according to this Q & A on measles from the CDC.

Since few people born in the 1960s are likely to have their vaccination records handy, many may be uncertain as to whether they got the ineffective vaccine or were later vaccinated with the newer version. In addition, women of any age who are considering pregnancy should make sure their MMR vaccinations are up to date, according to the CDC.

If you're uncertain of your immunization status, it's safe, with a few exceptions, to go ahead and get an MMR shot now to minimize your chances of getting measles. And that's the point: As an adult, you're likelier to develop complications from the illness, which can include pneumonia and brain swelling, health officials say.

"There's no downside to getting a dose of measles vaccine," says William Schaffner, a professor at Vanderbilt University and an infectious disease and vaccine expert. "If you're [already] protected, it won't help much, but it won't harm you. And if you happen to be susceptible, it will give you over 90 percent protection."

This advice also applies to people born between 1957 and the early 1960s who may not have been vaccinated against measles at all.

Schaffner says it's not a blanket recommendation - do check with your doctor. But it's reasonable to consider getting the MMR shot, especially if you live in a community where there's an outbreak of measles or if you're traveling out of the country to places where there are outbreaks currently - including Israel, Brazil, Japan, the Philippines and some countries in Europe and Africa.

"If you were born between 1957 and 1963 and you are unsure of your measles immunization status, and you are so inclined, sure! Go ahead and get a dose of MMR," Schaffner says.

Another option if you're unsure of your vaccination status is to get a blood test to determine whether you are immune. But the CDC says this is likely to take two doctor's visits and cost more than a vaccination. So it may be easier to just get the shot.

"There is no harm in getting another dose of MMR vaccine if you may already be immune to measles," states this CDC measles summary.

Meanwhile, most of the eldest Americans - those born before 1957 - are considered to be protected against measles and don't need a booster, because the virus was so widespread in their youth that nearly everyone was exposed.

The CDC does have some exceptions to that rule: Some health care workers born before 1957 (who have a higher chance, amid the current outbreaks, of coming into contact with people who have measles) should consider getting the MMR vaccine.

Still wondering which advice best fits you? Check with your doctor.

So far, even the hundreds of measles cases reported in the U.S. this year pale in comparison with the 1950s, when millions of people each year got measles. The CDC says the longer the current outbreaks continue, the greater the risk the disease will regain its foothold in the United States.

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Measles Shots Aren't Just For Kids: Many Adults Could Use A Booster Too

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Measles is on the rise again, all around the globe. Though the number of people affected in the U.S. is still relatively low compared with the countries hardest hit, there are a record number of U.S. measles cases - more than 700, so far, in 2019, according to the CDC - the highest since the disease was eliminated in the U.S.

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The number of measles cases reported worldwide in the first three months of 2019 has quadrupled compared with the same time last year, according to the World Health Organization (WHO).

The UN body said provisional data indicated a "a clear trend", with all regions of the world seeing outbreaks.

Africa had witnessed the most dramatic rise - up 700%.

The agency said actual numbers may be far greater, since only one in 10 cases globally are reported.

Measles is a highly infectious viral illness that can sometimes lead to serious health complications, including infections of the lungs and brain.

Ukraine, Madagascar and India have been worst affected by the disease, with tens of thousands of reported cases per million people.

Since September, at least 800 people have died from measles in Madagascar alone.

Outbreaks have also hit Brazil, Pakistan and Yemen, "causing many deaths - mostly among young children", while a spike in case numbers was reported for countries including the US and Thailand with high levels of vaccination coverage.

How a preventable disease returned from the past

Measles cases triple in Europe

Vaccine deniers gaining ground - NHS boss

YouTube takes ads off 'anti-vax' videos

In total, some 170 countries reported 112,163 measles cases to WHO, in comparison to 28,124 cases across 163 countries during the same period in 2018.

The UN says the disease is "entirely preventable" with the right vaccines, but global coverage of the first immunisation stage has "stalled" at 85%, "still short of the 95% needed to prevent outbreaks".

In an opinion piece for CNN, WHO head Tedros Adhanom Ghebreyesus and UNICEF head Henrietta Fore said the world was "in the middle of a measles crisis" and that "the proliferation of confusing and contradictory information" about vaccines was partly to blame.

Why the sudden 'global measles crisis'?
By James Gallagher, health and science correspondent, BBC News
It is one of the most contagious viruses around. However, nothing about measles has changed. It has not mutated to become more infectious or more dangerous. Instead the answers are entirely human.

There are two stories here - one of poverty and one of misinformation. In poorer countries fewer people are vaccinated and a larger portion of the population is left vulnerable to the virus.

This creates the environment for a large outbreak to occur - such as those in the Democratic Republic of the Congo, Kyrgyzstan and Madagascar.

But rich countries with seemingly high vaccination rates are seeing cases spike too. This is because clusters of people are choosing not to vaccinate their children due to the spread of untrue anti-vax messages on social media.

It is worth noting these figures are provisional, the WHO says the true figures will be much higher. And that measles is far from harmless. It kills around 100,000 people, mostly children, every year.

The pair wrote that it was "understandable, in such a climate, how loving parents can feel lost" but that "ultimately, there is no 'debate' to be had about the profound benefits of vaccines".

They added: "More than 20 million lives have been saved through measles vaccination since the year 2000 alone."

In response to recent measles outbreaks, calls have mounted in several countries to make immunisation mandatory.

Last month, Italy banned children under six from attending schools unless they had received vaccines for chickenpox, measles and other illnesses.

A public health emergency has also been declared in areas of New York, ordering all residents to be vaccinated or face a fine.

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The number of measles cases reported worldwide in the first three months of 2019 has quadrupled compared with the same time last year, according to the World Health Organization (WHO). The UN body said provisional data indicated a "a clear trend", with all regions of the world seeing outbreaks.

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Measles cases in the US have surged to a 25-year high - and the vast majority involve children who weren't fully immunized.

As of April 26, at least 704 people have been sickened by the virus this year, the highest number since 1994, according to the Centers for Disease Control and Prevention. Twenty-two states have reported cases, and more than a third involve kids under the age of 5. Nearly 70 children have already been hospitalized because of complications related to the virus.

For decades, public health experts have been asking people to vaccinate their kids against measles, a highly contagious childhood illness that can, in rare cases, cause brain swelling, hearing loss, and even death.

For one thing, the vaccine is highly effective, so getting immunized is a really good way to prevent infections.

Even more importantly, the more people who get vaccinated, the more we increase " herd immunity," or the chances of protecting even those in a community who can't or shouldn't be vaccinated (like newborn babies or people with allergies to vaccine ingredients).

But despite that, the number of unvaccinated people in certain pockets of the country has been creeping up, threatening herd immunity. And now measles is suddenly a significant public health problem again.

"Vaccine-preventable diseases belong in the history books, not in our emergency rooms," said Health and Human Services Secretary Alex Azar in a press briefing Monday. "We are reminding all Americans to talk to their doctors and ensure they are up to date with CDC's recommended vaccination schedule." Here's why - and what people can do to prevent the virus from spreading even further.

Measles was eliminated in the US but unvaccinated travelers have brought it back to places where it has spread

Before a vaccine was introduced in the US in 1963, there were 4 million measles cases with 48,000 hospitalizations and 500 deaths in the US every year. That means for anyone born before 1960, there's a good chance they suffered through a measles infection (and developed immunity to the virus as a result).

The beauty of the vaccine is that most people who get the recommended two doses will never get sick with measles, even if they're exposed. And by 2000, because of widespread vaccination, the virus was declared eliminated in the US: Enough people were immunized that the virus no longer circulated here, outbreaks were uncommon, and deaths from measles were scarce.

But that's now changing. Globally there's been a 300 percent rise in measles cases this year compared to the same period in 2018, according to the World Health Organization. Ukraine, Madagascar, India, Pakistan, Philippines, Yemen, and Brazil are among the countries most affected, according to WHO.

The US is also seeing a record number of measles cases: more than 700 as of Friday - which is the highest number since 1994, years before the disease was officially eliminated.

So what's driving the uptick? The vast majority of cases (474) have occurred in Orthodox Jewish communities in New York City and the New York suburb of Rockland. An outbreak at two Los Angeles universities is also now rapidly spreading. So most of the new cases are concentrated in New York and California. (The CDC's website has a detailed overview of US cases and outbreaks.)

Eight-eight percent of all cases have involved outbreaks in what CDC calls " close-knit communities," or people of a similar background who share values and beliefs and interact often.

To date, all outbreaks have been linked back to international travel: Americans or travelers who picked up the virus in a country where measles is spreading more broadly and then brought it back to the US. (The top three countries where measles cases in the US originated were Ukraine, Israel, and the Philippines.) But, again, most of these cases - more than 500 - are happening in unimmunized people. Had these travelers gotten their vaccines, we wouldn't be seeing a record number of cases right now.

Get your vaccines - even if you think you've been vaccinated

The CDC is now recommending that everyone - children and adults - makes sure they're up to date with their vaccines. The top priority, though, is people who are at higher risk of the disease: those who are traveling internationally, live in communities (particularly close-knit ones) with ongoing or recent outbreaks, or work in health care settings.

Measles is prevented through the combination MMR (measles, mumps, and rubella) shot. The CDC normally recommends that children get two doses: the first dose at 12 through 15 months of age, and the second at 4 through 6 years of age.

But because of the recent outbreaks here, and the surge in cases globally, health officials are suggesting babies as young as 6 months get a first dose before they travel. For children 12 months or older, CDC recommends 2 doses separated by 28 days.

Adults who have not had measles or who never got their shots should also ask their doctor about getting two doses separated by 28 days.

If you aren't sure of your vaccine status, you can also ask your doctor about a booster or request a blood test to check on your immunity. People born before 1957, when measles was widespread, are assumed to be immune since they probably suffered through an infection. Those born in the years 1957 to 1989 may not be fully immunized, since they likely got an older and weaker version of the vaccine, and it was common then to give kids only one shot.

"We have come a long way in fighting infectious diseases in America," Azar said, "but we risk backsliding and seeing our families, neighbors, and communities needlessly suffer from preventable diseases."

President Trump, who has previously spoken out against vaccines, came to their defense last week. "They have to get the shots. The vaccinations are so important," Trump told reporters. "This is really going around now."

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Measles has surged in some parts of the US. Some people might need a booster.

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Measles cases in the US have surged to a 25-year high - and the vast majority involve children who weren't fully immunized. As of April 26, at least 704 people have been sickened by the virus this year, the highest number since 1994, according to the Centers for Disease Control and Prevention.

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Outbreaks have been reported in 22 states. Children under age 5 account for about half of the cases.

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Heidi Clarke holds her son Micah Risner, 5, as nurse Ann Rowland administers immunizations in Portland, Ore. The current measles outbreak is the worst in decades in the United States. Credit Credit Alisha Jucevic for The New York Times

The measles outbreak continues to spread in the United States, surpassing 700 cases this year, federal health officials said on Monday. The virus has now been found in 22 states.

More than 500 of the 704 cases recorded as of last Friday were in people who had not been vaccinated, the Centers for Disease Control and Prevention reported. Sixty-six people have been hospitalized.

Confirmed Measles Cases

by County in 2019

WASH.

ORE.

MI.

NEV.

IND.

ILL.

COLO.

KY.

MO.

CALIF.

TENN.

ARIZ.

GA.

TEX.

FLA.

About 400 of the cases have been found in New York City and its suburbs, mostly in Orthodox Jewish communities. That outbreak has spread to Detroit.

Elimination in 2000 meant measles virus was no longer circulating in the United States, as it presumably had since European settlers first brought it to this hemisphere in the 15th or 16th century. Each year after 2000, a few cases arrived from overseas, either in immigrants or in returning tourists, but each outbreak was snuffed out.

More than 94 percent of American parents vaccinate their children against measles and other diseases, Dr. Robert Redfield, director of the C.D.C., said on Monday.

His agency "is working to reach the small percentage of vaccine-hesitant individuals," he said. "Vaccines are safe and do not cause autism."

About 100,000 children in this country under age 2 have not been vaccinated, he said, meaning they are vulnerable in this outbreak.

Some infants are not immunized because their parents avoid vaccination. Others cannot be protected either because they are allergic to components of the vaccine or are, for example, taking cancer or organ-transplant medications that suppress their immune systems.

"We must join together as a nation to once again eliminate measles," Dr. Redfield said.

This year's widespread outbreak was sparked by people infected with measles who have come into this country since last year, the C.D.C. said. The measles strains detected were most frequently from Ukraine, Israel and the Philippines.
[Get answers to common questions about the measles outbreak.]
Communities have begun to take extraordinary measures to slow the infection rate and crack down on resistance to immunization.

New York City's Mayor Bill de Blasio declared a state of emergency and threatened residents of four Brooklyn ZIP codes with $1,000 fines if they refused to vaccinate. City officials closed a yeshiva preschool for violating vaccination orders.

Rockland County, N.Y., the center of another outbreak, initially barred unvaccinated children from all indoor public places, including schools, malls, supermarkets, restaurants and houses of worship.

After a court blocked that order, the county instead barred from public spaces anyone who had measles symptoms or who had recently been exposed to the disease, threatening them with fines of up to $2,000 a day.

There have been no confirmed measles deaths in this country, but officials have said it is just a matter of time.
[Here's our full coverage about the measles outbreak.]
Even with modern medical care, the disease normally kills about one out of every 1,000 victims, according to the C.D.C.

Pneumonia and encephalitis - swelling of the brain - are the most common severe complications, and epidemics among malnourished children who cannot get modern hospital care have mortality rates of 10 percent or more, according to the World Health Organization.

Measles is among the most contagious of diseases. Virus-laced droplets can hover in still indoor air for up to two hours after someone infected has coughed or sneezed. Up to 90 percent of people who are exposed will catch the virus if they are not immunized.

The vaccine is considered very safe, and two doses are about 97 percent effective at conferring immunity. The vaccine is normally given at ages 1 and 5, but during outbreaks pediatricians may give it to healthy children as young as six months old.

Around the world, measles cases fell 80 percent between 2000 and 2016, with deaths dropping to 90,000 a year from 550,000. But two years ago, cases began rebounding, driven by a combination of poverty, warfare, tight vaccine supplies and, in some countries, hesitation about vaccination.

Earlier this month, the W.H.O. said there were three times as many measles cases around the world this year as there were in the first three months of 2018.

Outbreaks of tens of thousands of cases have occurred recently in poor or war-torn countries like Madagascar, Ukraine and Yemen. But case numbers are also climbing in wealthy countries with modern health care systems, like Israel, Britain, France and Italy. Deaths from measles have occurred in those countries.

Before measles vaccination became widespread in the United States in 1963, up to four million Americans got measles each year, the C.D.C. said. Of the roughly 500,000 cases that were reported to medical authorities each year back then, about 48,000 were hospitalized, 4,000 developed encephalitis, and 400 to 500 died.

Nationally, since the mid-1990s, more than 91 percent of American children have been vaccinated against measles.

Anyone born before 1957 is assumed to have had the disease as a child and to be immune to it.

Americans born between 1957 and 1989 are in something of a middle ground. Some got the early "killed virus" vaccine, which later proved to be too short-lived and was replaced by a "weakened virus" vaccine. Until 1989, it was routine to give one shot; now children get two.

One shot of the new vaccine provides 93 percent immunity in the overall population, while two shots drive that up to 97 percent, which is considered more than enough to keep the virus from spreading.

But each individual's immune system is different, so some Americans worried about the current outbreak have visited their doctors for a simple blood test that can show how immune they are to measles, mumps and rubella.

Immunization levels vary from state to state, largely dependent on how easy state legislatures make it to get exemptions. All states permit exemptions for children who are allergic to the vaccine, have a compromised immune system or have another medical reason to avoid it.

Some states permit religious exemptions, even though no major religion opposes vaccination, and a few states also permit "philosophical" or "personal choice" exemptions.

Only Mississippi, West Virginia and California allow solely medical exemptions; California previously had a very permissive law, but it changed it after the measles outbreak that began at Disneyland in 2014. Now the state has high vaccination rates among kindergartners.

Some states with high vaccination rates have "pockets of unvaccinated people," the C.D.C. said. At various times, some religious minorities like Orthodox Jews and the Amish in Ohio have had low vaccination rates.

Some wealthy liberal communities, like Vashon Island in Washington State, have also had low rates. Recently conservative groups opposed to vaccines have sprung up, such as Texans for Vaccine Choice, which is associated with the Tea Party.

Donald G. McNeil Jr. is a science reporter covering epidemics and diseases of the world's poor. He joined The Times in 1976, and has reported from 60 countries.

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Measles Cases Surpass 700 as Outbreak Continues Unabated

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Outbreaks have been reported in 22 states. Children under age 5 account for about half of the cases. The measles outbreak continues to spread in the United States, surpassing 700 cases this year, federal health officials said on Monday. The virus has now been found in 22 states.

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SYMPTOMS:
-high fever -red eyes -sore throat   -white spots in mouth  -rash

PREVENTION:
-vaccination (MMR Vaccine)
-Recover and rest

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The measles virus lives in the mucus of your nose and throat. It's spread through the air and by coming into direct contact with someone who has it. The virus can stay active on surfaces and in the air for up to 2 hours.

It's very contagious. If you haven't been vaccinated and are in a room with someone who has measles, you have a 90% chance of getting it.

Part of what makes measles so dangerous is that you can be contagious 4 days before you get the telltale rash. So you could easily spread the virus without knowing you have it. You'll continue to be contagious 4 days after the rash goes away.

Measles Symptoms

A high fever is normally the first sign of measles. It usually starts 10 to 12 days after you were exposed to the virus. The fever will last 4 to 7 days. During that time, you might develop the following symptoms:

Sore throat

Tiny white bumps in your mouth (doctors call these Koplik spots)

Rash. It usually starts at the hairline and spreads to the neck, torso, limbs, feet, and hands.

If you get measles, you'll be sick for a couple of weeks. Fortunately, it's preventable.

The Measles Vaccine

Immunizations are by far the best way to prevent the spread of measles. Thanks to the measles- mumps- rubella (MMR) vaccine, the virus has been mostly wiped out in the United States. That doesn't mean no one gets measles anymore; it's just not constantly around. If you live in the U.S. and do get it, it's usually because someone brought it in from another country.

The MMR vaccine is 97% effective after two doses. Doctors recommend that children get the first dose when they're between 12 and 15 months old, and the second between 4 and 6 years old.

The vaccine is safe for most people. Pregnant women, people with weakened immune systems (from diseases like leukemia and tuberculosis), and those with certain allergies can't get the vaccine. As a result, the odds are higher that they'll get the virus if they are exposed to it.

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The measles virus lives in the mucus of your nose and throat. It's spread through the air and by coming into direct contact with someone who has it. The virus can stay active on surfaces and in the air for up to 2 hours. It's very contagious.

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-Measles in many countries are affected because of unvaccinated people.
-2019 has the highest rate of measles since 2014.
-came about in 1994 in the US

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Centers for Disease Control and Prevention

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CDC updates this page monthly.

Measles cases in 2023

As of April 28, 2023, a total of 10 measles cases were reported by 8 jurisdictions. *

Measles cases in 2022

From January 1 to December 31, 2022, a total of 121 measles cases were reported by 6 jurisdictions. *

Measles cases in 2021

From January 1 to December 31, 2021, a total of 49 measles cases were reported by 5 jurisdictions. *

Measles cases in 2020

From January 1 to December 31, 2020, 13 individual cases of measles were confirmed in 8 jurisdictions.*

*Jurisdictions refer to any of the 50 states, New York City, and the District of Columbia.

Measles cases in 2019

From January 1 to December 31, 2019, 1,274* individual cases of measles were confirmed in 31 states.

This is the greatest number of cases reported in the U.S. since 1992. The majority of cases were among people who were not vaccinated against measles. Measles is more likely to spread and cause outbreaks in U.S. communities where groups of people are unvaccinated.

For more information please see the following reports:

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measles mumps rubella varicella (mmrv) vaccine safety

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CDC updates this page monthly. As of April 28, 2023, a total of 10 measles cases were reported by 8 jurisdictions. * From January 1 to December 31, 2022, a total of 121 measles cases were reported by 6 jurisdictions. * From January 1 to December 31, 2021, a total of 49 measles cases were reported by 5 jurisdictions.