A measles outbreak in Minnesota is widening as the state’s public health and emergency preparedness officials scramble to stop the spread.

As of Thursday afternoon, April 27, the Minnesota Department of Health had confirmed 28 cases in Hennepin County and one in Stearns County. All were among children under age 5, most of them unvaccinated.

“Measles is very contagious and can spread very quickly,” said Denise Kragenbring, public health supervisor with Kandiyohi County Public Health.

…Because measles spreads easily among unvaccinated populations, it’s especially important to be adequately protected during outbreaks, local health officials said.

It appears that one of those unvaccinated populations are the Somali immigrants, who have not vaccinated their infants or toddlers. In part, they are afraid of the rumored connection to autism.

Fears of the MMR vaccine have taken hold within the Somali community, particularly after 2008, when many parents became concerned about what seemed to be a cluster of autism cases among Somali students in the Minneapolis schools. Measles vaccination rates among young Somali children have fallen sharply since, providing fertile ground for an outbreak to develop.

On Friday, health officials reported three new measles cases, bringing the total to 32 and marking the outbreak’s spread from Hennepin and Stearns County to Ramsey County. Officials are still trying to identify the source, but believe it was imported by a traveler from a foreign country, since measles no longer occurs naturally in the United States.

Though health officials are heavily promoting the Measles-Mumps-Rubella (MMR) vaccine, it is being reported that one of the stricken had been vaccinated.

The U.S. isn’t the only region reporting measles outbreaks. Gaps in vaccination coverage has also led to a surge in European incidents of this infectious disease in the past few months.

During the first two months of 2017, more than 1,500 measles cases were reported from 14 European countries due to “an accumulation of unvaccinated individuals”, said officials from the European Centre for Disease Prevention and Control (ECDC).

In 10 countries — Austria, Belgium, Croatia, France, Germany, Italy, Poland, Romania, Spain and Sweden — the number of cases reported in January-February 2017 was more than double that of the first two months of 2016.

The reports from Italy are especially troubling. The rate of reported infections has substantially increased, and young adults are the ones who have been most impacted.

The concern is such that American health officials have issued enhanced travel recommendations.

This year, the country has reported 1603 measles cases (through April 16th) according to the Ministero della Salute. To put into perspective how above average that number is – there were 840 cases in all of 2016 and 250 in 2015.

Most cases have occurred in people older than 15 (the median age is 27 for people affected.) It is hypothesized that the effects of people not vaccinating their babies 20 years ago are now coming to light in these adults who are susceptible to measles.

Italy is a hot destination for travelers, especially in the summer months. The county is the fifth most visited country for international arrivals—about 50 million tourists annually. Roughly 10 percent of those tourists arrive from the United States (~4.5 million.)

Because of this, the United Stated Centers for Disease Control and Prevention (CDC) has new recommendations regarding measles vaccinations for anyone traveling to Italy – adults and children. The bottom line is that everyone traveling to Italy needs to make sure that their immunizations are up to date.