Graham did say the State Health Department has confirmed that every Washington case of measles since the first confirmed case has matched the same wild strain of measles the first case had. More children in the Region received the full two-dose series on time, according to their countries' immunization schedules, in 2017 than in any year since World Health Organization started collecting data on the second dose in 2000.
In 34 of the countries, estimated coverage with a second dose of measles vaccine was below 95 per cent.
Many factors contribute to suboptimal immunization coverage and the spread of measles.
Heidi Larson, a specialist in vaccines and public health at the London School of Hygiene and Tropical Medicine, said the increase in cases was a "wake-up call on the importance of building confidence in vaccination". In Washington state, permissive vaccination rules are being blamed for the outbreak.
In many countries, anti-vaccine campaigners seek to dissuade parents from getting their children immunized, despite strong scientific evidence that vaccines are safe and effective.
The data released on Thursday shows that 82,596 people contracted the measles in 47 of 53 countries in the WHO-classified European Region between January and December a year ago.
Rubella, also known as German measles, can cause a mild rash on the face, swelling of glands behind the ears, and in some cases, swelling of the small joints and low-grade fever.
Canada has been free of endemic measles since 1998, meaning the virus isn't constantly present. Data from the US Centers for Disease Control and Prevention's 2017 ChildVaxView Report, which details MMR vaccination coverage among children 19-35 months by state and region using data from the National Immunization Survey-Child from 2017, reports that Washington state has the sixth lowest coverage rate in the nation at 88.5%. Some of them also managed to limit the spread of the virus following importation to very few cases in 2017 and 2018, showing that elimination of the disease is well within reach for the whole Region.
Graham said that "patient zero" is not a term the Health Department even uses. Health records indicate that 43 of the ill individuals were unvaccinated, and vaccination status is unverified in 6 cases.
Melnick added that while 78% of schoolchildren in Clark County are vaccinated, some schools have much lower rates.
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