The Centers for Disease Control and Prevention said Thursday that they expect the United States will keep its measles elimination status, as the largest outbreak in 27 years gradually slows.

“With the end of the New York state measles outbreak, the United States anticipates maintaining its measles elimination status,” said a CDC spokesperson. “However, this outbreak is a grave reminder that we need heightened vigilance around measles as well as other vaccine-preventable diseases, and we continue to address the myths and misinformation driving these outbreaks.”

As of last week, 1,243 measles cases were confirmed in 31 states, an increase of two cases from the previous week.

For a country to lose its elimination status, an infectious disease must spread locally for a year. Measles was deemed eliminated in the U.S. in 2000.

The New York State Department of Health announced Thursday that more than 42 days — or two incubation periods — have passed without any new cases of measles in Sullivan and Orange counties.

Rockland County, New York, which has had 312 measles cases since last year, declared its outbreak over last Wednesday.

More than 900 people have been infected with measles in the state of New York this year. The outbreak began Oct. 1, 2018.

“Reaching this milestone, as Rockland County did last week, means there are no longer any active cases in New York State associated with the initial measles outbreak from October 2018,” the New York state health department said in a statement.

John Lyon, spokesman for Rockland County Executive Ed Day, said there was possible exposure to an imported measles case Sept. 20 and 21.

But he said the case is not related to the previous outbreak, adding that he doesn’t expect measles to have the same impact on the county due to vaccination efforts.

The New York health department also is responding to a couple of measles cases in Nassau, a case in Monroe and a case in Putnam counties. The measles exposures are linked to international travel and are “not affiliated with the 2018 outbreak,” according to the department.

To help stop the spread of measles and other vaccine-preventable diseases, New York City Mayor Bill de Blasio Cuomo signed legislation to end nonmedical vaccine exemptions in June. A public health emergency was declared for parts of Brooklyn in April.

More than 75% of the cases this year were linked to outbreaks in New York, according to the CDC. The majority of those cases were among people who were not vaccinated.

“The elimination status for the U.S. was important not only for our own pride, but because of its international leadership. It motivates other countries to make similar efforts,” said William Schaffner, medical director of the National Foundation for Infectious Diseases.

The measles outbreaks were linked to travelers who brought measles back from other countries such as Israel, the Philippines and Ukraine, where large outbreaks are occurring.

“There will continue to be importations of measles from other parts of the world,” Dr. Schaffner said. “We will need to remain alert obviously to all imported cases whether in New York or any other part of the United States and assure ourselves that new chains of transmission do not get started.”

The CDC set out in 1978 to eliminate measles in the U.S., and that goal was accomplished in 2000.

Before widespread use of the measles vaccine, an estimated 3 million to 4 million people caught measles each year in the U.S., leading to about 400 to 500 deaths and 48,000 hospitalizations, according to the CDC.

Measles is a highly contagious virus that can spread through coughing and sneezing. The virus can live in the air for up to two hours. In addition to a rash, measles can cause high fever, cough, runny nose and red, watery eyes.

Children under age 5 and adults older than 20 are more likely to experience complications from measles. Complications include ear infections, diarrhea, pneumonia and encephalitis.

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