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More than 167 people in the state of New York have contracted measles in the state’s largest outbreak since the 1990s, NBC reported earlier this week (January 8). The highly contagious virus, which scientists say was brought to New York by travelers returning from a visit to Israel last September, has prompted statewide efforts to vaccinate children and adults to try to prevent an epidemic.

“In my memory, I don’t know of a measles outbreak that was this significant,” Howard Zucker, the state commissioner of health in New York, tells CNN.

Douglas Puder, a pediatrician at Clarkstown Pediatrics in Rockland County—one of the areas that has been most affected—tells NBC that there is “clear and present danger right here in our community.” The number of cases in Rockland has risen to 105 since October, with another four being investigated. More than 80 percent of those cases are in people who have not been vaccinated against the virus.

Measles cases are also being reported in other areas of the Lower Hudson Valley and New York City, according to the state government website, which provides a phone number for the New York State Measles Hotline for people to call to find out more about the disease and vaccine. Brooklyn has confirmed 55 cases as of Tuesday, according to lohud, while a further seven have been reported in Orange County.

Health workers have seen to the immunization of around 13,000 children since the beginning of the outbreak, Zucker tells CNN. And officials are enforcing fines for schools that fail to adhere to immunization reporting rules. One school in Rockland was fined nearly $25,000, lohud reports.

“It’s up to us to keep this from spreading,” Puder tells NBC. “This could become a truly major epidemic.”

See “A Record Year for Measles Cases in Europe”