Authorities in a number of states hope to stop the spread of mumps, measles, and whooping cough before the start of the new school year.

Health officials in multiple states have been working with school nurses, preschools, and family groups in the hopes of stopping dangerous outbreaks of vaccine-preventable diseases.

Last year, outbreaks of mumps hit Washington state, and measles in Minnesota. In Indiana, officials reported double the number of cases of whooping cough as the year before.

These diseases led to hundreds of people being sickened, but they are just a fraction of the infections from vaccine-preventable diseases that infect thousands of Americans every year.

In recent years, school and health officials have been grappling with pockets of unvaccinated students, along with diminished vaccine effectiveness, which has helped lead to outbreaks and an increased number of infections in certain areas.

In Washington, the mumps outbreak was first reported in October of last year, and remains actively open with 888 people infected in 15 counties.

The mumps virus can cause a variety of symptoms including fever, head ache, tiredness, and loss of appetite. In severe cases, it can cause swelling of the salivary glands, testes, or ovaries. Swelling in the reproductive system can affect a person’s fertility.

While the disease usually isn’t very common, over the last two years there has been a significant increase in cases in the United States. This year there have already been 4,240 reported cases. And in 2016 there were 6,366 cases, according to the U.S. Centers for Disease Control and Prevention.

Comparatively, in 2012 there were just 229 reported cases.

Lindsay Bosslet, the public information officer at King County Department of Health in Washington, said they are talking to school nurses and preschools to ensure they’re up to date on vaccination information.

“We’re focusing on vaccine outreach,” she said, pointing out that two doses of the MMR vaccine is approximately 97 percent effective at protecting against mumps.

Bosslet said that in King county, which has had 311 cases since the outbreak began, is also reaching out to specific communities who are skeptical or unfamiliar with vaccinations.

The “Somali community is a focus, so in that situation we partnered with a Somali outreach program [in addition to] faith-based leaders,” Bosslet said.

Danielle Koenig, immunity health promotions supervisor with the Washington Department of Health, said the state department was working on providing resources to schools so that they feel prepared to stop an outbreak.

“We give them material and resources,” Koenig, said. “Our lab processes the test and we offer materials to the schools.”

However, the recent outbreaks in a variety of states and on school campuses have led the vaccine advisory board at the U.S. Centers of Disease Control and Prevention to review the current recommendations on the mumps vaccine and see if it should be changed to make it more effective.

Koenig said it can be difficult to stamp out a mumps outbreak, since the virus can linger in a community for a long period of time. Mumps usually spreads between people in prolonged close contact, which is why college campuses and schools are often places where outbreaks can start.

“A lot of the mumps outbreak we see happen in close quarters,” she explained. With this vaccine “you do have people who don’t respond… it can overcome some immunity as well when you’re sharing such a tight space.”

In Minnesota, a recent outbreak of measles spread so quickly it became the worst outbreak in 27 years. The outbreak infected 79 people, most of them children below the age of 10.

Lynn Bahta, an immunization clinic consultant at the Minnesota Department of Health, said they’ve been pouring over immunization data from schools to see which areas might be most at risk in the event of an outbreak, and visit those schools or child care centers directly.

“Our immunization law requires that schools and licensed child care centers submit a summary of immunization data of what population of [students] is in compliance with the law,” Bahta explained.

Bahta said the health department has focused on the Somali community since their immunization compliance rate has only been in the mid 40 percent range in recent years, and the majority of those infected in the measles outbreak were of part of the Somli community.

Bahta explained that certain groups have also come into that community to raise questions over vaccine safety in recent years. As a result, the health department has been trying to reassure the community that the vaccines are safe.

“We’ve been doing a lot of work in both schools and childcare specifically… where there’s a larger concentration of unvaccinated children,” she said.

She explained that the community has already stepped up after the measles outbreak earlier this year.

“It’s one of the most infectious illnesses that someone can get,” Bahta said of measles. “It can ramp up very quickly if you have a community that isn’t responsive.”

However, she said this community worked quickly to get children vaccinated and protected against the virus.

The “community coalesced together to protect their young,” she said.

As a result, she expects to see vaccination rates will have increased this year.

“We saw a 16-fold increase in vaccination activity,” Bahta said. “It was children of all ages.

Measles can cause headache, rash, fever, and in rare cases, swelling of the brain and death.

Some of health department’s work has involved helping parents understand what forms they need to fill out and where they can get children vaccinated.

Additionally, the health department has been offering information to administrators about what actions they can take if their students aren’t vaccinated, and they have been offering information sessions to talk to parents directly about vaccines.

“It can be something as basic as exhibiting at a parenting night at school,” Bahta said.

The measles outbreak was officially declared over last week.

In Indiana, public health officials are still investigating why there has been a doubling of pertussis or whooping cough cases this year.

In July the Indiana State Department of Health announced there had been 136 cases of pertussis since the beginning of the year, up from 66 during the same time last year. The pertussis vaccine is usually given as part of the TDap vaccine, but is only effective in about 8 to 9 children out of every 10 who get it.

Whooping cough can be especially dangerous for infants under the age of 6 months, who are too young to get the vaccination, making herd immunity especially important.

In a statement sent to Healthline, the ISDH said they are working with the Indiana Department of Education, as well as school nurses and other healthcare providers, to review immunization requirements for schools. In addition, they have published a special newsletter focused on vaccines being sent out at the start of the school year to inform parents.

“Pertussis is very contagious and can cause serious complications, especially in young infants,” State Health Commissioner Dr. Jerome Adams, MD, MPH, said in a statement from July. “I urge Hoosiers to protect themselves and their families by getting vaccinated and following good cough etiquette and hand-washing practices.”

Dr. William Schaffner, an infectious disease expert at Vanderbilt University Medical Center, said that once a community has seen an outbreak or uptick in cases, parents and health officials are often especially alert for any signs of future outbreaks.

“Those communities that have had outbreaks in the past have had tons of communications about vaccines and getting up to date,” He explained. “I might imagine that some of those communities… might be better immunized and prepared than children in other jurisdictions.”

Schaffner, said there are also simple things that parents can do to minimize the risk that their children would contribute to an outbreak.

“I think that just being attuned to reminding kids of good hand hygiene and if the child becomes ill keeping them out of school so they don’t spread the disease further,” he said.