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The nation’s largest measles outbreak in nearly two decades continues with the latest outbreak in New York City causing Mayor Bill de Blasio to declare a public health emergency.

Measles is a highly contagious infectious disease caused by the measles virus. Doctors say symptoms usually develop 10 to 12 days after exposure to an infected person and last seven to 10 days. However, a person can carry the virus for up to four days with no symptoms, and the virus spreads through the air by respiratory droplets produced from coughing or sneezing.

Symptoms include fever, cough, runny nose, inflamed eyes and rash. Prior to the recent outbreak, the United States was declared free of circulating measles in 2000.

You can infect a massive number of people in short period of time if you have measles,” said Dr. Moro Salifu of SUNY Downstate Medical Center. “It means people have to be cautious when they see someone coughing or sneezing that is out the ordinary. Those who have the vaccination won’t have to worry.”

In January and February, Washington state reported an outbreak of at least 58 confirmed cases of measles. Nearly one in four kindergartners in one Washington county did not receive vaccinations, according to state data. The epidemic forced Washington state Gov. Jay Inslee to declare a state of emergency.

In New York, an international traveler arrived in Rockland County with a suspected case of the measles. These cases are presently clustered in eastern Ramapo. As of Wednesday there were 173 confirmed reported cases of measles in Rockland County.

New York City is being hit by a measles outbreak outbreak affecting the Orthodox Jewish community in Brooklyn where 285 people had the virus since October. Unvaccinated individuals living in four ZIP codes who may have been exposed to measles will be required to receive the measles-mumps-rubella vaccine in order.

Under the mandatory vaccinations, members of the City’s Department of Health and Mental Hygiene will check the vaccination records of any individual who may have been in contact with infected patients. Those who have not received the MMR vaccine or do not have evidence of immunity may be given a violation and could be fined $1,000.

The current outbreak led to Mayor Bill de Blasio declaring a public health emergency this week. The declaration comes after the NYC Health Department issued Commissioner’s Orders last week to all yeshivas and day care programs serving the Orthodox Jewish community in Williamsburg.

“There’s no question that vaccines are safe, effective and life-saving,” said de Blasio. “I urge everyone, especially those in affected areas, to get their MMR vaccines to protect their children, families and communities.”

The measles outbreak has highlighted the issues of municipalities forcing citizens to get vaccinated. Advocates say no one should be forced to take the vaccine because of the side effects that could have long-lasting impacts.