Up to now, Minnesota has escaped measles infections when the country recorded more than 700 cases, the highest number in 25 years. However, health officials here know that the outbreak could only get on the plane.

This highly contagious disease is emerging worldwide and travelers from other countries have triggered 13 outbreaks and scattered isolated cases in 22 states, including Michigan, New York and California.

The Pan American Health Organization declared the elimination of measles in the United States in 2000, which means that an epidemic can not begin until an infected person does not have imported the virus and did not pass it on to those who are not immune.

This is what happened here in 2017, when a measles outbreak hit 75 people, many in the Somali-American community, where only 40% of young children had received the measles, mumps and rubella.

Although many parents have chosen to be vaccinated for their children during the epidemic, recent monitoring data indicate that measles immunization rates have fallen to their pre-epidemic levels in recent years. children aged 24 to 36 months among Americans of Somali origin.

"We definitely have some way to go to ensure that the community is fully vaccinated," said Kris Ehresmann, director of infectious diseases at the Minnesota Department of Health.

But officials are also concerned about other populations with low vaccination rates. A recent analysis of Star Tribune school vaccination registers revealed that one-third of Minnesota schools had lower maternal immunization rates than required to prevent measles and chickenpox outbreaks.

"We have many concerns," said Patsy Stinchfield, senior director of infection control at Children's Minnesota.

National epidemics, however, raise concerns and questions, especially among those who have no first-hand experience of a disease that was largely eradicated in the United States .

"We hear from parents who want to check the immunization status of their child," Stinchfield said.

Some parents wonder what to do before traveling with children under 12 months, the recommended age for the first of two doses of measles vaccine.

"If people are traveling, a first dose can be given as early as 6 months of age," Stinchfield said. But the child would still need the standard dose at two doses after reaching the age of 1 year.

The Atlanta Centers for Disease Control and Prevention said travel was not recommended for people without measles immunity.

Studies have shown that measles vaccine can stay in the air for up to two hours after an infected person has left an indoor space.

"Airports are a source of concern for airports, and I think it's a reasonable concern," Stinchfield said.

The city of New York has one of the largest epidemics, with 423 cases mainly in Orthodox Jewish communities. There is also a big epidemic in Israel. During the Passover holidays, when many people traveled to be with the family, local Orthodox Jews took precautions, said Rabbi Yehuda Shurpin of Chabad Shul in St. Louis Park.

"I am aware of many community members who have made sure everyone is aware of their vaccines and have also been trying to get early reminders for young children who would normally have them. -being already reached a little older, "said Shurpin.

Very few religions advise against vaccines, and community leaders with low vaccination rates have tried to encourage parents to give their children MMR vaccines to keep the community healthy.

But in some cases, concerns about the refuted connection between MMR and autism persist.

Focus groups led by the Wilder Foundation for the Star Tribune in 2017 revealed that Somali parents were more fearful of autism than measles. Many felt besieged and pressured during the epidemic, complaining that the health authorities did not take the time to listen to their concerns.

Many parents have stated that once their children grow up and have no signs of autism, they will then be allowed to be vaccinated against the MMR.

"Our first job is to listen and find out what's driving their fear," Stinchfield said. "We are talking about what we know about autism and what we do not know about autism."

Studies increasingly indicate that the autism spectrum is based on genetic grounds, and that autism develops much earlier than when the first MMR vaccine was administered.

Dr. Peter Hotez, a vaccine advocate and dean of the National School of Tropical Medicine at Houston's Baylor College of Medicine, said health leaders need to do a better job of responding to misinformation about vaccines.

"I have the impression that the majority of parents are not deeply rooted," Hotez said. "They were besieged by misinformation about anti-vaccines and no one told them otherwise."