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This year’s measles outbreak is the worst the United States has seen in over two decades. Getty Images

Nearly 20 years after public health officials declared measles eliminated in the United States, the disease has come roaring back leading to outbreaks in multiple states this year.

Week after week, the Centers for Disease Control and Prevention (CDC) has reported that incidences of the measles have continued to surge across the country this year.

As of April 24, there have been at least 695 reported measles cases in 22 states, making this year’s outbreak the worst the United States has seen in over two decades, according to a CDC statement.

This surpasses the 2014 record of 667 measles, and the total will likely continue to climb in the coming days and weeks.

The Department of Health and Human Services Secretary Alex M. Azar issued a statement reiterating the safety of the measles vaccine.

“Measles is not a harmless childhood illness, but a highly contagious, potentially life-threatening disease,” Azar said in the statement. “We have the ability to safely protect our children and our communities. Vaccines are a safe, highly effective public health solution that can prevent this disease.”

In California officials at the University of California Los Angeles (UCLA) and California State University Los Angeles have implemented quarantines for anyone exposed to the measles and who cannot prove they have been vaccinated. The quarantine can last up to 21 days.

Currently there are five confirmed cases of measles in Los Angeles. In California there have been 38 measles cases diagnosed since the beginning of the year.

A notable drop in vaccine coverage coupled with a spike in measles cases around the world have created the perfect storm for this outbreak, according to health experts.

“The main reasons we are seeing this outbreak are the combination of (1) not vaccinating in high enough levels to keep measles at bay, which causes pockets of susceptibility among the population along which measles outbreaks can spread, and (2) higher measles activity globally which makes it more likely to import measles to the U.S.,” says Johan Bester, PhD, an expert on vaccinations and the director of bioethics for the University of Nevada, Las Vegas School of Medicine.

This year measles activity has been reported in Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Kentucky, Maryland, Massachusetts, Michigan, Missouri, New Hampshire, New Jersey, New York, Oregon, Texas, and Washington.

New York has been hit the hardest, driving local health officials to take extreme measures in an effort to keep the highly contagious disease from spreading further.

Last month, Rockland County in New York issued an emergency order banning unvaccinated children from public places. Soon after, a judge prohibited the county from enacting the rule.

In addition, the New York City Health Department declared a public health emergency last week, ordering mandatory vaccinations in certain Brooklyn zip codes. Those who don’t vaccinate their children may be guilty of misdemeanor violations and be subject to a $1,000 fine.

People in certain pockets in the United States are refusing to get vaccinated due to religious and cultural reasons — as was the case with Rockland County and Brooklyn.

There’s also the growing anti-vaccine movement, which has been fueled by confusing and misleading digital content that’s circulated on Facebook, YouTube, and other social media platforms, the UN announced earlier this month.

It’s within these anti-vaccine hotspots and vaccine-hesitant groups that the virus spreads quickly and ferociously between unvaccinated individuals.

“When measles gets into communities of unvaccinated people in the U.S. (such as people who refuse vaccines for religious, philosophical, or personal reasons), outbreaks are more likely to occur. These communities make it difficult to control the spread of the disease and make us vulnerable to having the virus re-establish itself in our country again,” Martha Sharan, a spokesperson from the CDC’s National Center for Immunization and Respiratory Diseases, told Healthline.

The second issue at play is that measles is still a very common epidemic in other parts of the world.

So far this year, 170 countries have reported more than 112,000 measles cases to the World Health Organization (WHO) — a 300 percent increase compared to this time last year.

This global surge has increased the likelihood that unvaccinated travelers will contract the virus abroad and bring it back to the United States

Ukraine, Madagascar, and India have had the worst outbreaks, according to the CDC. Measles outbreaks have also struck the Philippines, Pakistan, Yemen, and Brazil.

The reasons for these outbreaks vary per each country, ranging from vaccine hesitancy to challenges with healthcare access and expertise along with low awareness about the importance of vaccines.

“Lack of access in certain countries, particularly those in Africa and parts of Asia, is a huge factor in why it spreads globally, and why when Americans travel abroad, they can contract it,” says Dr. Dominic Gaziano, a practicing general physician and internist and director of the Body & Mind Medical Center in Chicago.

Here’s the good news: The measles is nearly entirely preventable with the right vaccines, according to the United Nations (UN).

The measles-mumps-rubella (MMR) vaccine is extremely effective: one dose is about 93 percent effective at preventing the measles if you’re exposed to the virus. Two doses provide 97 percent protection.

However, in order for a vaccine to protect an entire population, close to 95 percent of people need to be immunized. This creates an effect called herd immunity, which prevents the disease from spreading and protects those who are unable to get vaccinated — such as young children and those with a compromised immune system.

Global coverage is around 85 percent and U.S. vaccination levels are at 92 percent — both of which fall short of the 95 percent coverage needed to prevent outbreaks.

In addition, 1 in 12 children in the United States is not receiving the first dose of the MMR vaccine on time, and according to Sharan, this completely underscores measles susceptibility across the country.

“At this point, measles is considered eradicated, and we only have outbreaks when cases are introduced from abroad. But if we keep vaccinating below the 95 percent threshold, we take the risk that one of these outbreaks will not stop and that measles will again spread uninterrupted in the United States,” says Bester.

The key to containing these outbreaks is clear and simple: More people need to get vaccinated.

If the vaccination rates don’t begin to increase, not only will measles outbreaks continue but we may even start to see other dangerous communicable diseases like polio, rubella, and whooping cough make a comeback.

This year’s measles outbreak is the worst the United States has seen since before the virus was declared eradicated in 2000, according to the latest CDC report. The growing anti-vaccine movement and the global surge in measles activity have, together, created the perfect storm for a massive measles outbreak.

In order to contain these outbreaks, it’s imperative that more people get vaccinated soon.