New research recently published in the journal, The Lancet Infectious Diseases identifies the 25 counties in the US most at risk for a measles outbreak.

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Topping the list includes Cook County, Il, Los Angeles County, CA and Miami-Dade County, FL.

The analysis considered an area’s volume of international travel from foreign countries with large measles outbreaks and the prevalence of nonmedical exemptions from childhood vaccinations.

Lead author, Sahotra Sarkar, a philosophy and integrative biology professor at UT Austin and an expert on public health said, “We have long known that vaccine avoidance is a critical public health issue in the U.S. and Europe. Our results show how travel from regions elsewhere compounds this risk.”

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Sarkar and his team’s measles risk analysis correctly predicted areas in Washington, Oregon and New York that are already experiencing major outbreaks.

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Researchers warned the most at-risk areas that have yet to report a case are those near international airports, such as Travis County in Texas, Honolulu County, Salt Lake County and multiple counties in Florida. The Study showed that travel from countries such as India, China, Mexico, Japan, Ukraine, Philippines and Thailand appears to pose the greatest measles risk. The U.S. has already seen measles cases imported from Ukraine, Philippines and Thailand.

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“For measles, most experts believe that there will be one to two deaths per 1,000 cases, most likely infants. We are set to see over 1,000 cases in the U.S. in 2019. So, for the first time since the 1980s, we may expect infant deaths from measles in the U.S”,  Sarkar noted.

Rounding out the top 10 counties most at risk are Queens, NY, King County, WA (Seattle), Maricopa County, AZ (Phoenix), Broward, FL (Fort Lauderdale), Clark County, NV (Las Vegas), Harris County, TX (Houston) and Honolulu, HI.