For the third week in a row, US health officials have added dozens of new reports to the year's list of confirmed measles cases, bringing the total to 555 - already the highest number in the past five years.
If the outbreaks aren't brought under control, public health experts worry that the cases in 2019 will hit a record nearly two decades after measles was "eliminated" in the United States.
The number of people sickened by the highly contagious, potentially deadly disease increased by 90 during the second week of April, with 20 states now having reported cases in 2019. In 2000, health officials announced that they had rid the country of measles.
The states that have reported cases to the Centers for Disease Control and Prevention (CDC) are Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Kentucky, Maryland, Massachusetts, Michigan, Missouri, Nevada, New Hampshire, New Jersey, New York, Oregon, Texas and Washington.
The total so far is the second-greatest number of cases reported since 2000. The CDC figures, updated Monday, report cases as of April 11.
In 2014, the United States reported a record 667 cases, including one large outbreak primarily among unvaccinated Amish communities in Ohio that accounted for more than half of the cases that year.
New York City has had the most cases. As of Monday, 329 cases, virtually all of them in Brooklyn, have been reported since the outbreak began in October.
Of those, 273 were reported this year, including 44 cases since last week, when New York City officials declared a public health emergency and ordered mandatory measles vaccinations to halt the outbreak concentrated among ultra-Orthodox Jews in Brooklyn.
That was the broadest vaccination order in the United States in nearly three decades.
Last week's order said all individuals 6 months and older who live, work or attend school within four zip codes of Williamsburg, Brooklyn, should be vaccinated. Anyone who resists faces a misdemeanor charge and could be fined up to US$1,000.
On Monday, health officials said they had issued 23 violations to yeshivas and day care facilities. No individuals were fined but non-compliant schools have been given notices of violation which will eventually lead to fines if they are not corrected.
All the violations were in connection with unvaccinated children or not complying with records requests.
One daycare, United Talmudical Academy, has been closed for repeatedly failing to comply with records requests.
On Monday, a group of Brooklyn parents also filed a lawsuit in Brooklyn Supreme Court against New York's health department and its commissioner to prevent the city order [iapps.courts.state.ny.us] for mandatory measles vaccinations from taking place.
The plaintiffs claim the order is unlawful because there is insufficient evidence of a measles epidemic or dangerous outbreak to justify extraordinary measures, such as forced vaccination or criminal penalties.
The six current outbreaks, in California, New Jersey, New York and Washington states, are linked to travelers who brought measles back from other countries such as Israel, Ukraine and the Philippines, where large measles outbreaks are occurring, the CDC said.
Gabrielle Paluch contributed to this report from New York.
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