More than a dozen unvaccinated children have been sickened by the measles virus in Washington’s Clark County, with the area’s health officials tallying 16 confirmed cases since Jan. 1. According to a news release posted on Thursday, 13 of the confirmed cases involve children ages 1 to 10 years old, with 14 of the patients identified as “unimmunized.”

At least one case required hospitalization, as well as an additional suspected case.

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“Clark County Public Health is urging anyone who has been exposed and believes they have symptoms of measles to call their health care provider prior to visiting the medical office to make a plan that avoids exposing others in the waiting room,” the news release said. “People who believe they have symptoms of measles should not go directly to medical offices, urgent care centers or emergency departments (unless experiencing a medical emergency) without calling in advance.”

The health department identified several medical facilities, including PeaceHealth Urgent Care – Memorial, Magnolia Family Clinic, The Vancouver Clinic and other emergency rooms as potential locations of exposure, with a timeline dating back to as early as Dec. 31.

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The department also said it’s “requiring exclusion of students and staff without documented immunity to measles” at seven area schools.

A similar move was made in New York, where health officials in December had banned unvaccinated children from attending several schools in the Orthodox Jewish community, which has been battling a measles outbreak since the fall.

As of Thursday, state health officials had confirmed 182 cases of measles, with a heavy concentration occurring in the ultra-Orthodox Jewish community. In nearby New Jersey, officials reported 33 cases, according to The New York Times.

In 2018, 349 cases of measles was reported across 26 states, which accounted for the second-highest number since the disease was considered eliminated in the U.S. in 2000. The outbreaks were largely associated with travelers who brought the virus back from Israel, which is currently a widespread outbreak.

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According to the Centers for Disease Control and Prevention (CDC), measles may present with high fever, cough, runny nose, red, watery eyes, white spots inside the mouth, and rash. It can be serious, particularly in children younger than 5 and in adults older than 20. Complications can result in permanent hearing loss, pneumonia and encephalitis.

Transmission can be prevented with the MMR vaccine, which in addition to measles also protects against mumps and rubella. The CDC recommends children get two doses of the vaccine.