Alarmed that measles cases in Washington state have climbed to 27 so far this year - more than the past five years combined - public health officials are reminding people that vaccination is their best defense against the disease.
Whatcom County accounted for six of those cases, which were connected to a measles outbreak involving more than 300 people that was declared March 8 in Canada's Fraser Valley.
In late June, eight cases were confirmed in south King County.
Statewide, there were five confirmed cases last year, according to the Washington state Department of Health.
Measles also has surged nationally, where 17 outbreaks have accounted for 554 cases in 20 states this year, according to the U.S. Centers for Disease Control and Prevention.
Lack of vaccination is one reason for the resurgence, leading to the highest number of cases in Washington since 1996, according to the state Department of Health.
Meanwhile, measles remains common in many parts of the world including parts of Europe, Asia, the Pacific and Africa.
And travelers with the disease continue to bring it to the U.S., where it spreads when reaching communities with groups of unvaccinated people.
For example, many of the cases in the U.S. this year have been linked to people traveling to the Philippines, which is in the midst of a large and ongoing outbreak, according to the CDC.
So travelers are among the people who should make sure they're vaccinated, according to Dr. Greg Stern, Whatcom County health officer.
"If you're going to be traveling overseas, especially to places that are known to have large numbers of measles cases and you're not vaccinated," Stern said, "there's a real high risk of, if you get sick, of bringing it back."
The MMR (measles, mumps, rubella) vaccine is recommended for children 12 months and older, health care workers, college students and adults born after 1956.
Pregnant women shouldn't get the vaccine until after they give birth.
Symptoms of measles include fever, runny nose, cough and watery, bloodshot eyes, as well as a rash, which usually starts on the face and spreads down to most of the body.