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A Washington state community near Portland, Ore., has declared a public health emergency after 23 reported cases of measles were confirmed.

Another two cases are under investigation.

Clark County officials said 20 of those cases were in people who were not vaccinated. The immunization status of the other three cases hasn’t been verified.

The Washington Post reports that nearly seven per cent of children in the county were exempt from vaccines required for kindergarten in the 2017-18 school year for “personal or religious” reasons. (Another 1.2 per cent were exempt from the requirement for medical reasons.)

That’s well above the national average of 2 per cent.

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Most cases are in children under 10, but there are four cases of children between 11-18 years old, and one case in an adult between 19-29 years old.

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Contagious people may have gone to the Portland International Airport. A list of places where people may have been exposed to the measles is available on the Clark County website.

In the year 2000, measles were eliminated from the U.S., but there were 349 cases of measles in 2018, according to the Centre for Disease Control.

“The majority of people who got measles were unvaccinated,” the CDC states on its website. “Measles can spread when it reaches a community in the U.S. where groups of people are unvaccinated.” Tweet This

Measles is a disease that causes fevers, coughs, rashes and a runny nose. In rare cases, it can be deadly, and it’s more dangerous for babies and vulnerable people.

The disease is spread through the air by sneezing, coughing, or even just breathing.

“Measles is one of our most infectious diseases,” explained Julie Bettinger, a professor at the Vaccine Evaluation Center of the University of British Columbia. She said if you’re susceptible — meaning you haven’t been vaccinated or you were vaccinated a long time ago — you are very likely to contract measles if you come into contact with it.

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“To prevent outbreaks, we like to see immunization coverage rates above 90 per cent, and actually for measles, above 95 percent to really be able to stop transmission,” Bettinger said.

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A 2018 study in the journal PLOS shows that the rate of non-medical exemptions has risen since 2009 in at least 12 states – including Oregon.

“Several US ‘hotspot’ metropolitan areas stand out for their very large numbers of NMEs,” the study read, listing Portland as one of the hotspots.

The lack of vaccinations at a North Carolina school in November, 2018, led to an outbreak of the chickenpox, the largest outbreak since vaccinations for the infection were introduced.

Officials at the time said exemptions from vaccines were a contributing factor to the outbreak.

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READ MORE: North Carolina’s largest chickenpox outbreak since 1995 blamed on vaccine exemptions

In Canada, Statistics Canada reports that 89 per cent of children under two years old had received the MMR vaccine, which vaccinates for mumps, measles and rubella. It didn’t list reasons for why 11 per cent hadn’t been vaccinated.

Bettinger said there’s similar areas in Canada — some have almost 100 per cent immunization coverage, and others have lower rates.

She said it could be because of a multitude of reasons, but noted that the measles vaccine, in particular, unfortunately has a bad reputation.

“That goes back probably 20 years to scientists … who were actually conducting what was shown to be fraudulent research,” she explained, which she said led to a “crisis of confidence in our vaccine system.”

She said to address the problem it needs to be addressed from a systemic point of view, from an individual level to a health care provider lever.

Asked whether Canadians should be concerned about the Clark County outbreak, she said people who aren’t immunized will need to be careful, as only one person needs to be infected to bring the disease to a community.

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