Measles, mumps and rubella vaccines are seen in a cooler at the Rockland County Health Department in Pomona, New York. Credit: Seth Wenig | AP

The number of people sickened by measles in the first three months of this year is more than for all of 2018 and the second-highest number reported since U.S. health officials declared the highly contagious and sometimes deadly disease “eliminated” in 2000.

The upsurge, now at 387 cases, reflects outbreaks that have spread to 15 states, including New York, California, Texas and Washington, according to figures released Monday by the U.S. Centers for Disease Control and Prevention. That surpasses the 372 reported for all of last year. Many of those outbreaks originated after unvaccinated individuals traveled to Europe, the Philippines and Israel, where the infection is more common, and returned to the United States after contracting the illness.

“Europe is even worse now than North America,” Peter Hotez, an infectious disease expert at the Baylor College of Medicine, said. “This is all the new normal. Nobody ever thought we’d ever be at this place.”

The outbreaks and the increasingly aggressive public health response to them have also prompted a spike in activity among anti-vaccine activists. Across the nation and around the world, a global movement that spreads misinformation about vaccines has helped drive down child immunizations, lowering the community immunity that is critical for protection against one of the world’s most contagious diseases.

After Rockland County, New York, banned unvaccinated children from all public spaces last week as it battles a growing measles outbreak that originated in an Orthodox Jewish community, anti-vaccination activists likened the public health measures to the Nazi persecution of Jews that included forcing them to wear yellow stars.

In Austin, Del Bigtree, CEO of an anti-vax group called ICAN, wore a yellow star during a rally last Thursday to identify with parents who decline to vaccinate their children. A spokesman for Bigtree said he took the action “to let the Jewish community of Rockland County know he stands with them.”

After photos of Bigtree were posted on Twitter, the official account of the Auschwitz Memorial and Museum in Poland tweeted in response: “Instrumentalizing the fate of Jews who were persecuted by hateful anti-Semitic ideology and murdered in extermination camps like #Auschwitz with poisonous gas in order to argue against vaccination that saves human lives is a symptom of intellectual and moral degeneration.”

Jonathan Greenblatt, CEO of the Anti-Defamation League, said in a statement: “Groups advancing a political or social agenda should be able to assert their ideas without trivializing the memory of the six million Jews slaughtered in the Holocaust.”

Texas has one of the most organized and politically active anti-vaccine groups. Texans for Vaccine Choice, which organized the rally last week, receives support from tea party Republicans and some of the state’s most influential conservative organizations, state lawmakers have said.

Hotez, who has been an outspoken critic of the anti-vaccine lobby, called its latest actions “highly offensive” and asked the leadership of the state Republican Party to publicly denounce its actions. He added: “I don’t know what they think they gain by mocking the Holocaust.”

The rise in measles cases was both predicted and predictable, Hotez said. In a study last year, he and colleagues from several Texas academic centers identified pockets of vulnerability where the risk of measles and other vaccine-preventable childhood diseases is higher because parents hesitate or refuse to get their children immunized.

Of 15 counties with the most nonmedical vaccine exemptions across the country, about half are now reporting measles outbreaks, including communities in Washington state, Texas and Michigan, he said.

The researchers characterized many of these areas as “hot spots” because their high exemption rates put them at risk for epidemics, not just of measles but for other vaccine-preventable pediatric infectious diseases such as whooping cough.

In Austin last week, 80 people who work at the Texas Capitol were vaccinated, for instance, because a House page contracted whooping cough, a bacterial infection also known as pertussis, which often starts with what feels like a mild cold, followed by weeks of intense coughing fits. The disease gets its name from the sound people make when they are gasping for breath.

The growing measles counts come as state legislatures weigh measures to tighten vaccine requirements. In Washington state, where the biggest measles outbreak in more than two decades has sickened 74 people and cost over $1 million, the Legislature is deciding whether to eliminate personal or philosophical exemptions that allow parents to avoid immunizing their children against measles, mumps and rubella. In Maine, a measure to eliminate nonmedical exemptions for all communicable diseases is pending.