The number of new measles cases in the first two months of this year already surpasses the entire annual totals of all but three years since the disease was declared eliminated in 2000. Many of this year’s cases stem from an outbreak in Washington state, and nearly all of those involve children who weren’t vaccinated against the disease.

The unusually large number of cases early in the year does not necessary portend a record high annual total in 2019. In 2015, for instance, there were 154 cases in the first two months of the year followed by 34 for the remainder of the year, putting it at right about average relative to the past decade’s annual totals.

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In addition to the cases in Washington there are ongoing measles outbreaks in New York, Texas and Illinois, the CDC reported. “These outbreaks are linked to travelers who brought measles back from other countries such as Israel and Ukraine, where large measles outbreaks are occurring,” the agency notes on its website.

In recent years, groups promoting vaccine denial have been able to cultivate large followings on Internet platforms such as Facebook and YouTube. Growing public outcry over those companies’ inaction in response to the spread of misinformation led both Facebook and YouTube to announce in recent weeks concrete steps to address the problem.

In late February YouTube announced it was taking steps to prevent anti-vaccine channels from making money off their videos. This week Facebook announced it would be reducing the visibility of anti-vaccine pages on Facebook and Instagram. That move followed congressional testimony from Ethan Lindenberger, a high school senior who described how his mother got anti-vaccine information almost exclusively from Facebook. Lindenberger got his vaccinations himself when he turned 18.