TRIPLER ARMY MEDICAL CENTER, Hawaii - According to the Centers for Disease Control and Prevention, before the measles vaccine was available in 1963, nearly all children got measles by the time they were 15 years old. It was estimated that three to four million people in the U.S. were infected each year.

In 2000, the measles virus was declared eliminated in the U.S., thanks to a highly effective vaccination program.

But over the last few years measles outbreaks have been making an increased appearance in TV and news headlines. The CDC reports that there have been more than 1,270 confirmed cases in the U.S. from Jan. 1 to Dec. 5, 2019, raising the question, should military communities be concerned?

Dr. Michael Butel, Public Health Command-Pacific chief of Epidemiology, and Lt. Col. Frederick Davidson, PHC-P Human Health Services director, dive into this question to explain what you need to know about the measles and outbreaks.

"The measles is a virus and it is transmitted through direct contact with infectious droplets, or as an aerosol when an infected person breathes, coughs, or sneezes," explained Davidson. "Some of the symptoms include sore throat and fever, but the most classic sign is a rash."

While the measles is a virus that should be taken seriously, Department of Defense health officials report that the measles is currently a low threat.

"Cases of measles are really rare in military communities since they are a highly vaccinated population," explained Butel.

A big reason for this is, all service members are required to get the measles vaccine, and all Family members are strongly encouraged to get it.

Children attending DoD Education Activity schools must provide proof of immunization.

"Having good immunization rates protects populations from the measles," Butel continued. "It takes about 90 to 95 percent of your overall population to be protected to keep it from spreading."

However, small pockets of people throughout the U.S. have chosen not to vaccinate their children due religious beliefs, medical conditions, or fears that vaccinations cause more harm than good.

"Several years ago there was a published paper that tried to link vaccination with autism. That publication was totally falsified and it had to be retracted in 2010. That doctor actually lost their license for basically falsifying information, which created a lot of bad rumors," Butel explained.

But that's not the only rumor health officials are battling.

"The other one is, people think that too many vaccinations can be harmful, that simply is not true. Every day our bodies are exposed to numerous agents in the environment that can stress our immune system, so there has been no evidence to show that having multiple vaccines causes problems," Butel continued.

The World Health Organization warns that outbreaks occur in areas where people are unvaccinated, and that unvaccinated young children are at the highest risk of measles and its complications. Unvaccinated pregnant women are also at risk. Any non-immune person (anyone who has not been vaccinated or was vaccinated but did not develop immunity) can become infected.

"What we want people to understand is that vaccinations are the best protection against the measles," said Davidson. "Military Family members who are not vaccinated are at the greatest risk to get measles."

The CDC recommends two doses of measles-mumps-rubella vaccine for best protection. The first dose should be between 12 through 15 months old, and the second dose at 4 through 6 years old.

The CDC also recommends that if your Family is traveling overseas, babies 6 through 11 months old receive one dose of the MMR vaccine before leaving. And children 12 months or older receive two doses of the MMR vaccine (separated by at least 28 days) before departure.

For adults, the CDC recommends that if you are an adult now but only got one dose of the measles vaccine as a child and if you were born after 1957 you need at least one dose of the measles vaccine unless a laboratory confirmed that you had past measles infection or are immune to measles.

Certain adults may need two doses. Adults who are going to be in a setting that poses a high risk for measles transmission should make sure they have had two doses separated by at least 28 days.

The CDC notes that two doses of the MMR vaccine provides 97 percent protection against measles and one dose provides 93 percent protection.

"If you are not sure whether you are up to date on your measles vaccine, talk with your doctor," Davidson added. "Especially if you are planning to travel internationally."

"Outbreaks are still common in parts of the world with under-vaccinated populations," said Butel.

The CDC reports, that most cases in the U.S. result from international travel. The disease is brought into the country by unvaccinated people who get infected in other countries. Typically two out of three of these unvaccinated travelers are Americans. They can spread measles to other people who are not protected against measles, which sometimes leads to outbreaks.

If you have been exposed to someone who has measles the CDC recommends to call your doctor and let them know that you have been exposed to measles. Your doctor can make special arrangements to evaluate you, if needed, without putting other patients and medical staff at risk. They can also determine if you are immune to measles based on your vaccination record, age, or laboratory evidence.

"The most important thing I can recommend is get vaccinated," said Davidson.