This is the highest number of measles cases in the U.S. since 1994.

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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.

On Wednesday, the Centers for Disease Control and Prevention (CDC) announced a grim milestone: measles cases have topped 1,000 for the first time since 1994.

“Today, the unthinkable has happened,” Dr. William Schaffner, an infectious disease expert at Vanderbilt University Medical Center, said in a statement. “We have had a safe and effective vaccine against measles available in the U.S. for more than 40 years, and thanks to immunization, measles transmission had been eliminated in the U.S in 2000. Now, we have turned back the clock.”

Schaffner highlighted low-immunization rates in pockets of the United States and more accessible travel as leading to the high number of measles cases.

“Measles still exists in other parts of the world,” said Schaffner, also the medical director for the National Foundation for Infectious Diseases. “It is just a plane ride away and can spread throughout a community when vaccination rates are low.”

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

“We cannot say this enough: Vaccines are a safe and highly-effective public health tool that can prevent this disease and end the current outbreak,” Azar said. “The measles vaccine is among the most-studied medical products we have and is given safely to millions of children and adults each year.”

Week after week, the CDC has reported that incidences of the measles have continued to surge across the country this year.

As of June 5, there have been 1,001 reported measles cases in at least 26 states, making this year’s outbreak the worst the United States has seen in over two decades, according to a CDC statement.

A notable drop in vaccine coverage coupled with a spike in measles cases around the world has 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, Maine, Maryland, Massachusetts, Michigan, Missouri, New Mexico, Nevada, New Hampshire, New Jersey, New York, Oklahoma, Oregon, Pennsylvania, Texas, Tennessee, 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.

Earlier this year 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.

According to data from April, at least 170 countries have reported more than 112,000 measles cases to the World Health Organization (WHO) — a 300 percent increase compared to the same 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.