As the case count in the Washington state measles outbreak now hovers at 51, other states are beginning to get a taste of Washington’s plight. This week, measles cases were reported in nine more states reaching from coast to coast.

As of Friday, the CDC confirmed that ten states have confirmed measles cases: California, Colorado, Connecticut, Georgia, Illinois, New Jersey, New York, Oregon, Texas, and Washington.

In the vast majority of these states, the disease has been traveling among people who either have not had the vaccine at all or haven’t had both doses, as was the case for four of the cases identified in Texas earlier this week. The measles vaccine is 97 percent effective when someone receives both doses.

The MMR vaccine can protect against the measles, and is usually administered in two doses. Army.mil

Measles activity has been most closely monitored in Washington State, where a public health emergency was declared earlier in January. Clark County, Washington is reporting 50 cases, and King County has reported one. In nearby Multnomah County in Oregon — home to Portland, an “anti-vaccination hotspot — four measles cases have been reported.

Meanwhile, New York City and New York state are both reporting measles outbreaks, according to the CDC’s monitoring page, though the origins of those outbreaks can be traced back to early October. As it stands, the measles count in Rockland County, New York has hit 130 since October 2018 (that’s higher than the CDC’s count for 2019, partially because Rockland County is counting 2018 cases as part of this outbreak). Additionally, New York City has reported 67 measles cases between November 2018 and February 2019 in Brooklyn.

Fortunately, outside of New York and Washington State, the measles case count is far lower. Texas has confirmed six measles cases outside of Houston and one in Bell County, just north of Austin. Connecticut reported two, and the remaining states on the CDC’s list have all reported between one and three cases.

Importantly, just because a state is reporting a measles case doesn’t mean that state is experiencing an outbreak, though the CDC monitors cases closely due to their highly contagious nature. Nevertheless, there are always a few measles cases every year in the US: In 2018, the CDC reported 372.

It’s hard to tell whether this will be a banner year for measles cases across the country in terms of volume. Right now, the CDC has the total at 79 cases (counting only since January — the Rockland County and New York City outbreaks have one foot in 2018). But speaking to the Houston Chronicle, Peter Hotez, Ph.D., dean of the National School of Tropical Medicine at Baylor College of Medicine, floated the possibility that 2019 could be unique.

“2019 might be the year we really see the public health consequences of anti-vaxxers,” Hotez said. “In a sense, we already saw that in 2018, but it looks like cases may pick up more in 2019.”

Regardless of whether 2019 is the year of reckoning for those who have neglected the MMR vaccine, it’s already tragic enough for the residents of these ten states who have had to grapple with the disease.