The California-centered measles outbreak has spread to Michigan, as the number of cases climbed to 95 in eight states and Mexico, officials said Wednesday.
The California Department of Public Health confirmed that there are now 79 cases in the state, of which 52 can be linked directly to Disneyland. Some people who were contagious visited in January as well as December.
Officials reported one case in Michigan that was connected to the California outbreak. Cases have also been confirmed in Arizona (five), Utah (three), Washington state (two), Oregon (one), Colorado (one), Nebraska (one) and Mexico (two).
The measles outbreak has also expanded beyond those who visited Disneyland in December and January and is infecting people in the broader community.
Nine counties in California have confirmed measles cases: Alameda, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, Santa Clara and Ventura.
Orange County now has 25 confirmed cases. Los Angeles County follows with 16 cases and San Diego County with 13.
The California patients range in age from 7 months to 70 years. The vaccination status is known for at least 42 of the patients. Of those, 34 were unvaccinated, three received partial vaccination and five were fully vaccinated.
Of the cases in California, about one in four have had to be hospitalized, officials said.
Healthcare officials said it was safe for people to go Disneyland and other venues with large crowds if they have been immunized for measles.
"I think it is absolutely safe for you to go to Disneyland if you're vaccinated," said Dr. Gil Chavez, California state epidemiologist.
But he cautioned that those with infants too young to be immunized should avoid large crowds where international travelers are concentrated, such as theme parks and airports.
Six of the California cases occurred in infants too young to be immunized, state officials said.
In Alameda County, officials this week ordered 30 babies to be placed under home isolation after possible exposure to the highly contagious disease. The babies are not infected, health officials said, but had some contact or connection to the Disneyland-related measles patients in the county.
Across California, officials have been scrambling to get ahead of the outbreak, identifying farmers markets, grocery stores, malls and other public locations where contagious people have been.
Those who suspect that they have the measles are urged to first call their healthcare provider before going to a clinic, enabling caregivers to make special preparations so patients don't risk infecting others in the waiting room.
An urgent-care clinic in the San Diego suburb of La Mesa was forced to shut down for a few hours when five people arrived with rashes. Anyone without proof of vaccination who came in contact with the five at the clinic was put under a mandatory quarantine for 21 days.
At Santa Monica High School, students and parents were alerted Friday night that a freshman baseball coach had contracted measles. Health officials concluded that because every student on the baseball team had a record of measles immunization, it was unlikely that students could have caught the highly contagious virus.
No students have been asked to stay away from campus at this time, school officials said.
Earlier Tuesday, almost 70 Palm Desert High School students who haven't been fully immunized for measles were banned from classes for the next two weeks.
After Disneyland officials confirmed that five of its employees had been diagnosed with measles, all Disneyland employees who could have been in contact with those five were asked to provide vaccination records or do a blood test that showed they had built immunity to the disease.
Employees who had not been vaccinated or could not confirm immunity status were asked to go on paid leave until their status could be confirmed, company officials said.
Symptoms of measles include fever as high as 105, cough, runny nose, redness of eyes, and a rash that begins at the head and then spreads to the rest of the body. It can lead to inflammation of the brain, pneumonia and death.
Federal recommendations call for the first dose of measles vaccination, known as MMR, to be given at 12 to 15 months of age, with a second between ages 4 and 6. California law requires two doses of measles vaccination before kindergartners can enroll, but parents may obtain exemptions for the vaccines if they say the inoculations conflict with their personal beliefs.
For the first time in a dozen years, the number of California parents who cited personal beliefs in refusing to vaccinate their kindergartners dropped in 2014, according to a Times data analysis last week.