While the number of reported measles cases across the United States is at 704 and counting, there are none in Scotland County or North Carolina as a whole.

On Monday, U.S. health officials said the national tally already has eclipsed the total for any full year since 1994, when 963 cases were reported.

Twenty-two states have reported cases, but the vast majority have been in New York — mainly in New York City and in nearby Rockland County. Most of the New York cases have been unvaccinated people in Orthodox Jewish communities.

“There are currently no reported cases of measles in North Carolina in 2019,” said Sarah Lewis Peel, a spokesperson for the N.C. Department of Health and Human Services.

In New York City this month, officials ordered mandatory vaccinations in four Brooklyn ZIP codes, threatening possible fines of up to $1,000 for noncompliance. City officials said 57 unvaccinated people have received summonses. The city also has shut down seven religious schools that failed to exclude unvaccinated children, though five were later allowed to reopen after submitting a corrective plan.

Anyone planning to travel outside the United States should check with his or her health-care provider about receiving appropriate vaccinations, Peel said. More information about communicable diseases can be found at https://epi.publichealth.nc.gov/cd.

Vaccines are safe and highly effective in protecting adults and children from serious illness and disease, according to the N.C. Department of Health and Human Services.

Measles in most people causes fever, a runny nose, cough and a rash all over the body, according to the Centers for Disease Control and Prevention. A very small fraction of those infected can suffer complications such as pneumonia and a dangerous swelling of the brain. For every 1,000 children who get measles, one or two will die from it, according to the CDC.

Measles is one of 12 diseases children entering child care or public/private school in North Carolina are required to be vaccinated against. The other 11 are diphtheria, hepatitis B, HIB disease (a bacterial illness), meningococcal meningitis, mumps, whooping cough, pneumococcal (which can cause pneumonia), polio, rubella, retanus and chickenpox.

Religious and medical exemptions are allowed under North Carolina law.

The measles, a once-common disease, became increasingly rare after a vaccine became available in the 1960s. In 2000, health officials declared the disease eliminated in the U.S., meaning that all new cases stemmed from infected travelers and not from homegrown transmission.

A decade ago, the cases numbered fewer than 100 a year. But they have been jumping since then.

No deaths have been reported this year, but 66 patients were hospitalized.

The CDC says this year’s count includes 44 people who caught the disease while traveling in another country. Some of them triggered U.S. outbreaks, mostly among unvaccinated people.

The return of measles may be an early warning sign of a resurgences of other vaccine-preventable diseases such as rubella, chickenpox and bacterial meningitis, some experts say.

In recent decades, health officials have relied on doctors to prod families to vaccinate their children against measles and other diseases. That push has been bolstered by requirements in every state that children be vaccinated to attend public schools.

But as vaccination rates have fallen in some communities and cases exploded, officials recently have taken more dramatic steps. In Rockland County, officials last month banned all unvaccinated children from indoor public places.

Last week in California, more than 1,000 students and staff at two Los Angeles universities were quarantined on campus or sent home after cases began to appear. It was a limited order, and half already are out of quarantine, officials said Monday.

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Worst U.S. outbreak since 1994

The Associated Press