Japan is battling its worst measles outbreak in years.

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As of Feb. 10, a total of 167 cases have been reported in 20 of Japan’s 47 prefectures, with the largest outbreaks in prefectures of Mie and Osaka, according to the National Institute of Infectious Diseases.

Nearly all of the 49 reported patients in Mie Prefecture have links to Miroku Community Kyusei Shinkyo, a religious group that advocates for alternative healing, The New York Times reported.

This is the fastest that Japan has reached this many measles cases at the beginning of a year since 2008.

The United States is also dealing with measles outbreaks in Texas, New York and Washington. There have been more than 120 cases reported in those states so far, The Times reported.

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