Maryland has logged its first case of measles since 2019, and officials are warning the public to look out for symptoms of the highly contagious and often serious infection that was once considered wiped out in this country.

The case was reported in Montgomery County, and officials warned people they may have been exposed if they visited Cabin John Ice Rink in Bethesda in the evening of May 24 or an office building at 16220 Frederick Road in Gaithersburg midday on May 30.

Mary Anderson, a spokeswoman for Montgomery County Health and Human Services, said the department hasn’t been notified of any additional cases. She said no more information about the person with confirmed measles would be released.

Measles is particularly concerning because the virus can hang in the air for two hours after someone sneezes or coughs. The infection is marked by a rash that normally develops days after infection. Other symptoms, such as high fever and cough, can take a week or longer to develop. Complications, usually in children younger than 5 and adults over age 20, range from ear infections and diarrhea to pneumonia and encephalitis.

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About one 1 in 5 unvaccinated people who are infected with measles requires hospitalization, and one in 20 children get pneumonia, the most common cause of death from measles in youth, according to the U.S. Centers for Disease Control and Prevention. Pregnant people, infants and immunocompromised people are also at risk for complications.

Public health officials have grown concerned since the start of the coronavirus pandemic that some children have fallen behind on routine vaccinations. Unvaccinated kids are vulnerable to infections and excluded from school unless they have a religious or medical exemption.

The number lacking the two-shot measles vaccination regimen isn’t clear; state officials have told The Baltimore Banner they plan to release survey results from this school year soon. Anderson said Montgomery County was caught up on student vaccinations, with 98% of children vaccinated.

The last major outbreak of measles in Maryland and nationally was in 2019. There were five cases logged in the state and 1,274 nationwide. That was not quite twice the previous high in 2014, according to figures from the CDC.

The numbers have been far lower across the United States since, but are trending up, with 13 cases in 2020, 49 in 2021 and 121 in 2022. There were 10 cases by April of this year.

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Prior to 2019, public health officials had been concerned that more people were using religious and philosophical reasons for declining vaccinations, and concerns grew during the pandemic as fears and misinformation swirled about COVID-19 vaccine safety.

Others couldn’t access or afford the vaccines, and local and state health departments have been working to link people to clinics and health insurance. State health officials told The Banner that Maryland has dedicated extra funding for vaccinations of all kinds. (COVID-19 vaccines are not required in schools.)

Public health officials warn that those infected with measles are contagious beginning four days before a rash appears and up to four days afterward. Those born in the United States before 1957, were previously infected or have received two shots of vaccine are considered immune.

Those with symptoms should call a medical provider or health department rather than going immediately a medical facility and potentially infecting others.