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Florida has become the center of a measles outbreak, with a seventh case of the virus confirmed on Saturday.
The case is a child under five, the youngest to be infected in the outbreak so far.
It is also the first case identified outside of Manatee Bay Elementary School in Weston, near Fort Lauderdale where the infection is known to have spread.
It comes as the decision by Florida's Surgeon General Dr. Joseph Ladapo to allow parents to decide whether to quarantine their children or let them keep going to school has come under increased scrutiny.
Florida currently has the largest outbreak in the US - and there have been 35 cases across fifteen states in 2024 alone.
Cases are 'not going to stay contained just to that one school, not when a virus is this infectious,' Dr. David Kimberlin, co-director of the division of pediatric infectious diseases at the University of Alabama at Birmingham said.
Florida's Surgeon General Dr. Joseph Ladapo (pictured) to allow parents to decide whether to quarantine their children or let them keep going to school has come under increased scrutiny
Cold-like symptoms, such as a fever, cough and a runny or blocked nose, are usually the first signal of measles
'Measles is the most infectious pathogen in humans that we know of,' Kimberlin explained.
'It's like a heat-seeking missile. It will find the people who are not immune, and they're going to get sick.'
On Friday, Michigan registered its first measles case since 2019.
Pennsylvania registered nine measles cases in January, eight of them in Philadelphia.
However, is no further cases are reported there as of early next week, the outbreak will be declared over.
Unvaccinated people have a 90 percent chance of becoming infected if exposed, an issue of increasing importance as the uptake of vaccines such as the MMR are falling.
MMR vaccine coverage across America is below the safe target for the third year in a row.
Coverage has dropped a further two percent between the 2019-2021 school year to the 2022-2023 school year, according to the CDC, which means that roughly a quarter of a million kindergartens are at risk of measles infection across the US.
Measles is a highly contagious, airborne virus that mostly affects children under five years old
The above shows year-by-year cases of measles in the United States
The 93.1 percent rate during the 2022–23 school year is lower than the 95 percent rate in the 2019-2020 school year, leaving measles coverage below the national target of 95 percent for the third year running.
Some 33 out of 1,067 students at the Manatee Bay Elementary School have not received any of the two doses of the MMR vaccine, Dr Peter Licata, the Broward County Public Schools Superintendent, said Wednesday.
Doctors were first told of a measles case - a third grader with no travel history - on Friday February 16.
Dr John Brownstein, epidemiologist and Chief Innovation Officer at Boston Children's Hospital, told ABC News: 'The absence of travel history in the measles cases suggests we are likely seeing local transmission, underscoring the serious risk to the community.
'Measles is highly contagious, and with its long incubation period of 11 to 12 days, there's a high likelihood that more children are infected without showing symptoms yet.
'This situation is alarming and requires immediate public health intervention to prevent further spread.'
Measles is a highly contagious, airborne virus that mostly affects children under five years old.
It can be prevented by two doses of the MMR vaccine and more than 57 million deaths have been averted since 2000, according to the WHO and Centers for Disease Control and Prevention.
The recommended two doses of the MMR vaccine are 97 percent effective against measles, the CDC reports.
One dose is 93 percent effective.
But measles vaccination rates have been declining, with more young children entering schools unvaccinated.
Millions may have missed vaccinations during the COVID-19 pandemic when health systems were overwhelmed and fell behind on routine vaccinations for preventable diseases.
If an unvaccinated child is exposed to measles, an MMR shot should be given as soon as possible.
If given within 72 hours of initial exposure, the shot may offer some protection against measles, or reduce the severity of the illness.