The young mother started getting advice early on from friends in the close-knit Somali immigrant community here. Don’t let your children get the vaccine for measles, mumps and rubella — it causes autism, they said. 
 
 Suaado Salah listened. And this spring, her 3-year-old boy and 18-month-old girl contracted measles in Minnesota’s largest outbreak of the highly infectious and potentially deadly disease in nearly three decades. Her daughter, who had a rash, high fever and cough, was hospitalized for four nights and needed intravenous fluids and oxygen. 
 
 “I thought: ‘I’m in America. I thought I’m in a safe place and my kids will never get sick in that disease,’ ” said Salah, 26, who has lived in Minnesota for more than a decade. Growing up in Somalia, she’d had measles as a child. A sister died of the disease at age 3. 
 
 Salah no longer believes that the MMR vaccine triggers autism, a discredited theory that spread rapidly through the local Somali community, fanned by meetings organized by anti-vaccine groups. The activists repeatedly invited Andrew Wakefield, the founder of the modern anti-vaccine movement, to talk to worried parents. 
 
 Immunization rates plummeted, and last month the first cases of measles appeared. Soon there was a full-blown outbreak, one of the starkest consequences of an intensifying anti-vaccine movement in the United States and around the world that has gained traction in part by targeting specific communities. 
 
 “It’s remarkable to come in and talk to a population that’s vulnerable and marginalized and who doesn’t necessarily have the capacity for advocacy for themselves, and to take advantage of that,” said Siman Nuurali, a Somali American clinician who coordinates the care of medically complex patients at Children’s Hospitals and Clinics of Minnesota. “It’s abhorrent.” 
 
 Although extensive research has disproved any relationship between vaccines and autism, the fear has become entrenched in the community. “I don’t know if we will be able to dig out on our own,” Nuurali said. 
 
 Anti-vaccine activists defend their position and their role, saying they merely provided information to parents. 
 
 “The Somalis had decided themselves that they were particularly concerned,” Wakefield said last week. “I was responding to that.” 
 
 He maintained that he bears no fault for what is happening within the community. “I don’t feel responsible at all,” he said. 
 
 (Centers for Disease Control and Prevention) 
 
 MMR vaccination rates among U.S.-born children of Somali descent used to be higher than among other children in Minnesota. But the rates plummeted from 92 percent in 2004 to 42 percent in 2014, state health department data shows, well below the threshold of 92 to 94 percent needed to protect a community against measles. 
 
 Wakefield, a British activist who now lives in Texas, visited Minneapolis at least three times in 2010 and 2011 to meet privately with Somali parents of autistic children, according to local anti-vaccine activists. Wakefield’s prominence stems from a 1998 study he authored that claimed to show a link between the vaccine and autism. The study was later identified as fraudulent and was retracted by the medical journal that published it, and his medical license was revoked. 
 
 The current outbreak was identified in early April. As of Friday, there were 44 cases, all but two occurring in people who were not vaccinated and all but one in children 10 or younger. Nearly all have been from the Somali American community in Hennepin County. A fourth of the patients have been hospitalized. Because of the dangerously low vaccination rates and the disease’s extreme infectiousness, more cases are expected in the weeks ahead. 
 
 Measles, which remains endemic in many parts of the world, was eliminated in the United States at the start of this century. It reappeared several years ago as more people — many wealthier, more educated and white — began refusing to vaccinate their children or delaying those shots. 
 
 
 
 
 
 The ramifications already have been significant. A 2014-2015 measles outbreak infected 147 people in seven states and spread to Mexico and Canada. In California, high school students were sent home because of infected classmates. One patient who was unknowingly infectious visited a hospital and exposed dozens of pregnant women and babies, including those in the neonatal intensive care unit. Another adult patient was hospitalized and on a breathing machine for three weeks. 
 
 Federal guidelines typically recommend that children get the first vaccine dose at 12 to 15 months of age and the second when they are 4 to 6 years old. The combination is 97 percent effective in preventing the viral disease, which can cause pneumonia, brain swelling, deafness and, in rare instances, death. State health officials are now recommending doses for babies as young as 6 months if there is concern for ongoing measles exposure. 
 
 Minnesota’s Somali community is the largest in the country. The roots of the outbreak there date to 2008, when parents raised concerns that their children were disproportionately affected by autism spectrum disorder. A limited survey by the state health department the following year found an unexpectedly high number of Somali children in a preschool autism program. But a University of Minnesota study found that Somali children were about as likely as white children to be identified with autism, although they were more likely to have intellectual disabilities. 
 
 Around that time, health-care providers began receiving reports of parents refusing the MMR vaccine. 
 
 As parents sought to learn more about the disorder, they came across websites of anti- 
 
 vaccine groups. And activists from those groups started showing up at community health meetings and distributing pamphlets, recalled Lynn Bahta, a longtime state health department nurse who has worked with Somali nurses to counter MMR vaccine resistance within the community. 
 
 At one 2011 gathering featuring Wakefield, Bahta recalled, an armed guard barred her, other public health officials and reporters from attending. 
 
 Fear of autism runs so deep in the Somali community that parents whose children have recently come down with measles insist that measles is preferable to risking autism. One father, who did not want his family identified to protect its privacy, sat helplessly by his daughter’s bed at Children’s Minnesota hospital last week as she struggled to breathe during coughing fits. 
 
 
 
 Nurse Lydia Fulton administers the vaccine for measles, mumps and rubella to a young patient at a clinic in Minneapolis. A triage center has been set up there as a major measles outbreak continues. (Courtney Perry for The Washington Post) 
 
 The 23-month-old was on an IV for fluids and had repeatedly pulled out the oxygen tube in her nose. Her older brother, almost 4, endured a milder bout. Neither had received the MMR vaccine. 
 
 The children now have antibodies to protect against measles, but they still need the vaccine to prevent mumps and rubella. Their father, who is 33 and studying mechanical engineering while working as a mechanic, wants to wait. His worry: autism. A colleague has a son “who is mute.” 
 
 “I would hold off until she’s 3 . . . or until she fluently starts talking,” he said. 
 
 His wife no longer harbors doubts, however. As soon as both children are well, she said, “they are going to get the shot.” 
 
 The pervasive mistrust was evident Sunday night during a meeting, sponsored by several anti-vaccine groups, that drew a mostly Somali crowd of 90 to a Somali-owned restaurant here. Patti Carroll, a member of the Vaccine Safety Council of Minnesota, described its goal as giving parents more information, including about their right to refuse to vaccinate. People have been “bullied big-time” by doctors and public health officials, she said. 
 
 The presentation by anti-vaccine activist Mark Blaxill drew cheers and applause. Blaxill, a Boston businessman whose adult daughter has autism, played down the threat of measles and played up local autism rates. 
 
 “When you hear people from the state public health department saying there is no risk, that [vaccines] are safe, this is the sort of thing that should cause you to be skeptical,” Blaxill said. 
 
 Two pediatricians in the audience stepped up to a microphone to denounce the claims. 
 
 “I am very concerned, especially in the midst of a measles outbreak, to have folks come into a community impacted by this disease and start talking about links between MMR and autism,” said Andrew Kiragu, interim chief of pediatrics at Hennepin Medical Center in Minneapolis. “This is a travesty.” 
 
 He and the other doctors were interrupted by boos and yelling. 
 
 “For God’s sake, I want to know if vaccines are safe!” Sahra Osman shouted. She has a nearly adult son who received an autism diagnosis when he was 3. “My people are suffering! We’re not ignorant. I read a lot. I know a lot. I educate myself. . . . You don’t know what you are talking about.” 
 
 Tahlil Wehlie comforts his son, Luqman, who is recovering from measles. His 18-month-old daughter also became ill and was hospitalized. (Courtney Perry for The Washington Post) 
 
 While scores of studies from around the world have shown conclusively that vaccines do not cause autism, that is often not a satisfactory answer for Somali American parents. They say that if science can explain that vaccines do not cause autism, science should be able to say what does. 
 
 But researchers don’t really know. A growing body of evidence suggests that brain differences associated with autism may be found early in infancy — well before children receive most vaccines. Other studies have found that alterations in brain-cell development related to autism may occur before birth. There are some genetic risk factors for autism, and advanced parental age has been associated with the condition. 
 
 Meanwhile, the ongoing spread of the anti-vaccine message is making it harder to control the burgeoning number of measles cases. 
 
 The groups continue advising parents, “in the middle of their crisis,” on how to opt out of vaccines, said pediatric nurse practitioner Patsy Stinchfield, an infection-control expert leading the outbreak response at Children’s Minnesota. That message is “exactly the opposite of what clinicians and public health officials are urging, which is to get vaccinated as soon as possible.” 
 
 Staffers at her hospital have been working round-the-clock to vaccinate hundreds of people who may have been exposed; an MMR dose given within 72 hours of exposure can prevent measles. 
 
 When their two sick children are well, Suaado Salah and her husband, Tahlil Wehlie, plan to talk to friends and acquaintances to spread the word that the anti-vaccine groups are wrong and that all youngsters should get immunized. 
 
 “Because when the kids get sick, it’s going to affect everybody. It’s not going to affect only the family who have the sick kid,” she said. “They make sick for everybody. That’s when you wake up and say, ‘Okay, what happened?’ ” 
 
 But she understands the apprehension that fed the outbreak. With a parent whose child has autism, she said, “it’s something that you’re looking for an answer for how it happened and what happened to your kid.” 
 
 
 
 Salah shares pasta with Luqman as his 5-year-old brother looks on. Luqman had not been immunized for measles, because of his mother’s fear that the vaccine causes autism. (Courtney Perry for The Washington Post) 
 
 Alice Crites in Washington and Emily Sohn in Minneapolis contributed to this report. ||||| Q: I’ve been exposed to someone who has measles. What should I do? 
 
 A: Immediately call your doctor and let him or her know that you have been exposed to someone who has measles. Your doctor can determine if you are immune to measles based on your vaccination record, age, or laboratory evidence, and 
 
 make special arrangements to evaluate you, if needed, without putting other patients and medical office staff at risk. If you are not immune to measles, MMR vaccine or a medicine called immune globulin may help reduce your risk developing measles. Your doctor can help to advise you, and monitor you for signs and symptoms of measles. If you do not get MMR or immune globulin, you should stay away from settings where there are susceptible people (such as school, hospital, or childcare) until your doctor says it’s okay to return. This will help ensure that you do not spread it to others. 
 
 Q: Am I protected against measles? 
 
 A: CDC considers you protected from measles if you have written documentation (records) showing at least one of the following: You received two doses of measles-containing vaccine, and you are a(n)— school-aged child (grades K-12) adult who will be in a setting that poses a high risk for measles transmission, including students at post-high school education institutions, healthcare personnel, and international travelers. 
 
 doses of measles-containing vaccine, and you are a(n)— You received one dose of measles-containing vaccine, and you are a(n)— preschool-aged child adult who will not be in a high-risk setting for measles transmission. 
 
 dose of measles-containing vaccine, and you are a(n)— A laboratory confirmed that you had measles at some point in your life. 
 
 A laboratory confirmed that you are immune to measles. 
 
 You were born before 1957. 
 
 Q: What should I do if I’m unsure whether I’m immune to measles? 
 
 A: If you’re unsure whether you’re immune to measles, you should first try to find your vaccination records or documentation of measles immunity. If you do not have written documentation of measles immunity, you should get vaccinated with measles-mumps-rubella (MMR) vaccine. Another option is to have a doctor test your blood to determine whether you’re immune. But this option is likely to cost more and will take two doctor’s visits. There is no harm in getting another dose of MMR vaccine if you may already be immune to measles (or mumps or rubella). 
 
 Q: I think I have measles. What should I do? 
 
 A: Immediately call your doctor and let him or her know about your symptoms you are having. Your doctor can determine if you are immune to measles based on your vaccination record or if you had measles in the past, and 
 
 make special arrangements to evaluate you, if needed, without putting other patients and medical office staff at risk. 
 
 Q: My doctor or someone from the health department told me that I have measles. What should I do? 
 
 A: If you have measles, you should stay home for four days after you develop the rash. Staying home is an important way to not spread measles to other people. Talk to your doctor to discuss when it is safe to return. You should also Cover your mouth and nose with a tissue when you cough or sneeze, and put your used tissue in the trash can. If you don’t have a tissue, cough or sneeze into your upper sleeve or elbow, not your hands. 
 
 Wash your hands often with soap and water. 
 
 Avoid sharing drinks or eating utensils. 
 
 Disinfect frequently touched surfaces, such as toys, doorknobs, tables, counters. Call your doctor is you are concerned about your symptoms. 
 
 Q: How effective is the measles vaccine? 
 
 A: The measles vaccine is very effective. One dose of measles vaccine is about 93% effective at preventing measles if exposed to the virus. Two doses are about 97% effective. 
 
 Q: Could I still get measles if I am fully vaccinated? 
 
 A: Very few people—about three out of 100—who get two doses of measles vaccine will still get measles if exposed to the virus. Experts aren’t sure why. It could be that their immune systems didn’t respond as well as they should have to the vaccine. But the good news is, fully vaccinated people who get measles are much more likely to have a milder illness. And fully vaccinated people are also less likely to spread the disease to other people, including people who can’t get vaccinated because they are too young or have weakened immune systems. 
 
 Q: Do I ever need a booster vaccine? 
 
 A: No. CDC considers people who received two doses of measles vaccine as children according to the U.S. vaccination schedule protected for life, and they do not ever need a booster dose. Adults need at least one dose of measles vaccine, unless they have evidence of immunity. Adults who are going to be in a setting that poses a high risk for measles transmission should make sure they have had two doses separated by at least 28 days. These adults include students at post-high school education institutions, healthcare personnel, and international travelers. If you’re not sure whether you were vaccinated, talk with your doctor. More information about who needs measles vaccine. 
 
 Q: How common was measles in the United States before the vaccine? 
 
 A: Before the measles vaccination program started in 1963, about 3 to 4 million people got measles each year in the United States. Of those people, 400 to 500 died, 48,000 were hospitalized, and 4,000 developed encephalitis (brain swelling) from measles. 
 
 Top of Page 
 
 Q: What are the vaccine coverage levels like in the United States? 
 
 A: Nationally, the rates of people vaccinated against measles have been very stable since the Vaccines for Children (VFC) program began in 1994. In 2016, the overall national coverage for MMR vaccine among children aged 19—35 months was 91.1%. However, MMR vaccine coverage levels continue to vary by state, with MMR coverage levels of <90% observed in 2016 in several states and local areas. At the county or lower levels, vaccine coverage rates may vary considerably. Pockets of unvaccinated people can exist in states with high vaccination coverage, underscoring considerable measles susceptibility at some local levels. For more information about 2016 childhood vaccination coverage, see a CDC MMWR. 
 
 Q: Where do cases of measles that are brought into the United States come from? 
 
 A: Travelers can bring measles into the United States from any country where the disease still occurs or where outbreaks are occurring including Europe, Africa, Asia, and the Pacific. Worldwide, the 19 cases of measles per 1 million persons are reported each year; about 89,780 die. In recent years, many measles cases came into the United States from common U.S. travel destinations, such as England, France, Germany, India. During 2014, many measles cases came from the Philippines and Vietnam. 
 
 Q: Why have there been more measles cases in the United States in recent years? 
 
 A: In 2008, 2011, 2013, 2014, and 2015, states reported more measles cases compared with previous post-elimination years. CDC experts attribute this to: more measles cases than usual in some countries to which Americans often travel (such as England, France, Germany, India, the Philippines and Vietnam), and therefore more measles cases coming into the US, and/or 
 
 more spreading of measles in U.S. communities with pockets of unvaccinated people. For details about the increase in cases by year, see Measles Outbreaks. 
 
 Q: What is CDC’s role in responding to measles cases and outbreaks? 
 
 A: State and local health departments have the lead in investigating measles cases and outbreaks when they occur. CDC helps and supports health departments in these investigations by— communicating with public health officials from states with reported measles cases and providing technical assistance. 
 
 gathering data reported by states on confirmed measles cases and evaluating and monitoring these data from a national perspective. 
 
 testing specimens for difficult diagnostic cases of suspected measles infection when requested by states. 
 
 using Advanced Molecular Detection (AMD) methods to determine measles virus genotypes and strains. 
 
 providing rapid assistance on the ground during outbreak investigations, often through a formal request by the state health department. 
 
 investing in state and local health departments for public health infrastructure and laboratory capacity to support front-line response to suspected and confirmed measles cases. 
 
 alerting clinicians, healthcare facilities, and public health officials around the country about current outbreaks and providing vaccine policy and clinical guidance for healthcare providers. 
 
 providing information to public and healthcare providers through a variety of media including the CDC website. More information about the surveillance of vaccine-preventable diseases, like measles. 
 
 Q: Has measles been eliminated from the United States? 
 
 A: Yes. In 2000, the United States declared that measles was eliminated from this country. The United States eliminated measles because it has a highly effective measles vaccine, a strong vaccination program that achieves high vaccine coverage in children, and a strong public health system for detecting and responding to measles cases and outbreaks. 
 
 Q: What does “measles elimination” mean? 
 
 A: CDC defines measles elimination as the absence of continuous disease transmission for 12 months or more in a specific geographic area. Measles is no longer endemic (constantly present) in the United States. 
 
 Q: If measles is eliminated, why do people still get it in the United States? 
 
 A: Every year, unvaccinated travelers (Americans or foreign visitors) get measles while they are in other countries and bring measles into the United States. They can spread measles to other people who are not protected against measles, which sometimes leads to outbreaks. This can occur in communities with unvaccinated people. Most people in the United States are protected against measles through vaccination. So measles cases in the U.S. are uncommon compared to the number of cases before a vaccine was available. Since 2000, when public health officials declared measles eliminated from the U.S., the annual number of people reported to have measles ranged from a low of 37 people in 2004 to a high of 667 people in 2014. 
 
 Q: Is measles a concern for the United States? 
 
 A: Yes. Since measles is still common in many countries, travelers will continue to bring this disease into the United States. Measles is highly contagious, so anyone who is not protected against measles is at risk of getting the disease. People who are unvaccinated for any reason, including those who refuse vaccination, risk getting infected with measles and spreading it to others. And they may spread measles to people who cannot get vaccinated because they are too young or have specific health conditions. 
 
 Q: Could measles ever re-establish itself in the United States? 
 
 A: Yes, measles could become endemic (constant presence of a disease in an area) in the United States again, especially if vaccine coverage levels drop. This can happen when people forget to get vaccinated on time, 
 
 don’t know that they need a vaccine dose (this is most common among adults), or 
 
 refuse vaccines for religious, philosophical or personal reasons. Research shows that people who refuse vaccines tend to group together in communities. When measles gets into communities with pockets of unvaccinated people, outbreaks are more likely to occur. These communities make it difficult to control the spread of the disease. And these communities make us vulnerable to having the virus re-establish itself in our country. High sustained measles vaccine coverage and rapid public health response are critical for preventing and controlling measles cases and outbreaks. 
 
 Q: Will the United States ever get rid of measles completely? 
 
 A: Yes, it’s possible. The first step is to eliminate measles from each country and region of the world. Once this happens, there will be no place from which measles can spread. All member states in the six World Health Organization regions have committed to eliminating measles by the year 2020. Once every country eliminates a disease, health officials consider the disease “eradicated” from the world. See the Measles and Rubella Initiative for more information. 
 
 Q: What is wild-type measles virus? 
 
 A: When an unvaccinated person gets measles, wild-type measles virus causes the infection. Scientists divide wild-type measles viruses into genetic groups called genotypes. Of 24 known genotypes, the World Health Organization (WHO) lists 6 genotypes that are known to currently circulate and are most commonly seen: B3, D4, D8, D9, G3, H1. 
 
 Q: How is the type of measles virus identified? 
 
 A: Scientists identify the genotype in a laboratory using a method called nucleic acid sequencing. The genotype is based on the RNA (ribonucleic acid) sequence of the measles virus that caused the disease in an infected person. Learn about Genetic Analysis of Measles Viruses. 
 
 Top of Page ||||| Measles (Rubeola) 
 
 Measles is a highly contagious disease caused by a virus. It is a serious disease that can lead to hospitalization and even death. The best way to prevent measles is to get vaccinated. Learn about the disease and the vaccine that prevents it. ||||| Unfounded Autism Fears Are Fueling Minnesota's Measles Outbreak 
 
 Enlarge this image toggle caption Mark Zdechlik/MPR Mark Zdechlik/MPR 
 
 Health officials in Minnesota have been scrambling to contain a measles outbreak that has sickened primarily Somali-American children in the state. So far health officials have identified 34 cases, still mostly in Hennepin County, and they're worried there will be more. 
 
 In Minnesota, the vast majority of kids under two get vaccinated against measles. But state health officials say most Somali-American 2-year-olds have not had the vaccine — about six out of ten. As the outbreak spreads, that statistic worries health officials, including Michael Osterholm, who directs the University of Minnesota's Center for Infectious Disease Research and Policy. 
 
 "It is a highly concentrated number of unvaccinated people," he says. "It is a potential kind of gas-and-match situation." 
 
 Measles is a highly contagious respiratory disease that causes a rash and fever. It can be deadly, but the Centers for Disease Control and Prevention says two doses of vaccination are about 97 percent effective in heading off the disease. 
 
 The Minnesota Department of Health says the outbreak began in Hennepin County, home to Minneapolis and the heart of the nation's Somali-American community. 
 
 Somali-American leaders here are in firm agreement with the Minnesota health department in trying to knock down the pseudoscience behind the unfounded claims that getting vaccinated can lead to autism. But anti-vaccine groups have been quick to fan fears, even as the outbreak spreads. 
 
 A social and commercial hub of the community is the Cedar-Riverside neighborhood, adjacent to downtown Minneapolis. Inside a building called the Riverside mall, more than a dozen stalls are tightly clustered, open-air style. 
 
 Sprawling from stall to stall are brightly-colored clothes and other textiles along with small home furnishings. Most of the Somali-Americans shopping here want nothing to do with a reporter's questions. But Khadra Abdulle offers her thoughts about the measles outbreak. 
 
 "I heard [about] it," she says, "but I haven't seen it. I don't know anybody who has that problem right now." 
 
 She's quick to name the fear that's working against the measles vaccine among Somali-Americans. 
 
 "They believe it causes autism." 
 
 A weekend meeting in Minneapolis, organized by anti-vaccine groups (the Vaccine Safety Council of Minnesota, the Minnesota Natural Health Coalition, the National Health Freedom Action and Minnesota Vaccine Freedom Coalition and The Organic Consumers Association) attracted dozens of Somali-Americans. Some members of the audience shouted down physicians — including pediatrician Dr. Stacene Maroushek — who showed up to try to convince them vaccination is crucial. 
 
 "We know If there's less than a certain rate of vaccination, the virus is much more likely to spread," she told the gathering. "That's a scientific fact." 
 
 Kris Ehresmann, the infectious disease division director at the Minnesota Department of Health, describes the Minnesota measles outbreak as a "public health nightmare" — a lot of unvaccinated people, living in densely populated neighborhoods and a tremendously contagious disease. 
 
 Ehresmann says she's beyond frustrated with the dis-information campaign by anti-vaccine advocates, who have been working against efforts to contain the outbreak. 
 
 "I'll be honest. It makes me very angry," she says. 
 
 But Ehresmann says the desire to get the truth out is mobilizing public health officials. 
 
 "We've had people on Somali TV, Somali radio. We've participated in chat rooms. The commissioner met with imams to talk to them about how we can work with the faith community to do outreach," she says. 
 
 In 2000, U.S. public health officials declared that measles had been eliminated in the U.S., thanks to a strong vaccination program. That means measles is no longer native to the U.S., but as vaccination rates have eroded in some areas, it can spread quickly if a sick traveler brings it in. 
 
 In 2014, there were 667 cases in the U.S., including a large outbreak among Amish communities in Ohio. In 2015, there were 188 cases, including some linked to an outbreak that started at the Disneyland amusement park. Prior vaccination is critical to keeping people from contracting the virus if they are exposed to it. 
 
 Almost 30 years ago measles sickened 460 people in Minnesota and three children died in that outbreak. Osterholm served as the state epidemiologist at the time, and says those deaths still haunt him. He's worried it could happen again. 
 
 "I think we could surely see a major increase in the number of cases beyond what we have now," he says. "With that comes the increasing likelihood someone will die." 
 
 This story is part of a reporting partnership with NPR, Minnesota Public Radio and Kaiser Health News.
– The Minnesota Department of Health has identified 34 cases so far in a measles outbreak, with a University of Minnesota infectious disease expert worried it's leading to a "gas-and-match situation" that will result in more cases and possibly even deaths, NPR reports. What health officials are worried may help along the outbreak, so far mainly concentrated in Hennepin County: a fear among local Somali-Americans that the measles vaccine causes autism. Measles was declared eradicated in the US in 2000, but it's still brought into the country by travelers, spurring recent outbreaks. The current situation a tinderbox, per Kris Ehresmann, the director of the infectious disease unit of the state's health department, because measles is such a highly contagious disease that its presence in a community that often lives in congested quarters and fears the vaccine is a recipe for disaster. Ehresmann says health officials are trying their best to step up outreach efforts, which includes sending representatives to appear on Somali TV and radio and in chatrooms, as well as involving local imams in the conversation. What may also help spread the word: community members who've come around to the health officials' way of seeing things. A young Somali mother in Minneapolis profiled in the Washington Post explains how her two young children got measles this spring, her 18-month-old hospitalized for four nights—and how she now plans to encourage others to get the vaccine, especially those who attend local anti-vax meetings. "Because when the kids get sick, it's going to affect everybody," she notes. (The first US measles death in a dozen years took place in 2015.)