A measles outbreak in New York City has spread further, the health department said Wednesday.
Two new measles cases were confirmed in the city, bringing the total number to 26. The outbreak is still centered in northern Manhattan, according to Health Commissioner Mary Bassett.
One of the new cases is unrelated to the outbreak, as the person was visiting the city from the Philippines. So far, 12 children and 14 adults have been infected.
"After more than two weeks since the last confirmed case, this is a reminder that we must continue to remain vigilant," Bassett said in a statement.
What New Yorkers need to know about the measles outbreak
The outbreak was first reported at the beginning of March, with 16 cases in upper Manhattan and the Bronx. That number of measles cases grew over the next few weeks, and additional cases were reported in Brooklyn. Bassett said last week that a previously identified case on the Lower East Side was not measles.
The first two people infected in the outbreak include a city resident and someone from out of state. The cases were unrelated and neither person travelled internationally, but both were at an airport with a high volume of international travel.
The heath department has asked urgent care centers, emergency departments and clinics to recognize symptoms in patients and take necessary precautions.
Anyone, at any age, who is unvaccinated can contract measles, which is highly contagious.
The virus, which resides in an infected person's nose and throat mucus, can spread through coughing and sneezing.
But the virus is also active for up to hours on infected surfaces. So measles can also spread if an infected person touches their mouth or nose and then touches something else.
Symptoms usually appear 10 to 12 days after exposure. They can also appear a week before or three weeks after exposure.
Measles begins with fever, cough, runny nose, and red, watery eyes. After two or three days, little white "Koplik spots" can appear on the gums and inside cheeks, though these are rarely seen. Three to five days after early symptoms, a red, spotty rash appears on the face and spreads about the body.
The virus can spread from person to person four days before to four days after the rash appears.
New Yorkers are urged to make sure all household members, including children 1 years old and older, are vaccinated. For information about how to get vaccinated, call 311.
Blood tests can be used to inform adults of their immunity. Some of the adults infected in the outbreak believed they were immunized.
One third of reported measles cases have at least one complication, which include pneumonia, seizure and infections of the brain. Some measles cases have resulted in death.