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An individual from northeastern Iowa has been confirmed as the first measles case in the state since 2011, according to the state Department of Public Health.

The individual, who the DPH would not further identify, was unvaccinated and had recently returned from Israel, where the DPH says the measles transmission occurred.

From Jan. 1 to April 11, 555 cases of measles have been confirmed in 20 states, according to the Centers for Disease Control. This is the second-greatest number of cases reported in the United States since measles was eliminated in 2000.

The states that have reported cases to CDC are Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Kentucky, Maryland, Massachusetts, Michigan, Missouri, Nevada, New Hampshire, New Jersey, New York, Oregon, Texas, and Washington.

Iowa's case was reported after April 11 and is not included in the national count yet.

There are two main reasons for the outbreak, say federal health officials: more international travel and lower vaccination rates.

Measles outbreaks – three or more reported cases – are now ongoing in New York City, Rockland County, New York; New Jersey; Michigan; and Butte County, California.

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New York City declared a public health emergency last week in parts of  Brooklyn after nearly 300 cases in two neighborhoods were identified since last October. Both neighborhoods are home to ultra-Orthodox Jews, some of whom have resisted vaccinations.

On its website, the CDC posted a Level 1 warning about travel to Israel, recommending anyone who travels there be vaccinated.

Iowa Public Health officials are following up with potentially exposed people to ensure they are vaccinated against the illness.

The measles – or rubeola – virus causes symptoms that may not show up for 10-14 days, but begins with a mild to moderate fever, often accompanied by a persistent cough, runny nose, inflamed eyes (conjunctivitis) and sore throat that lasts two or three days, according to Mayo Clinic. A spreading rash and high fever usually follows.

A person with measles can spread the virus to others for about eight days, starting four days before the rash appears and ending when the rash has been present for four days.

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