An ongoing measles outbreak has led to a public health emergency being declared in Clark County, Washington.

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The outbreak is in an anti-vaccination hotspot near Portland, Ore., according to CBS News.

The latest update from the county’s health department said that 23 measles cases have been confirmed and two more suspected cases are under investigation, CBS News reported.

Most cases involve children aged 1 to 10. Four cases are in youngsters aged 11 to 18, and one case in a person between ages 19 and 29.

While measles is highly contagious, it’s also one of the most preventable diseases, according to Dr. Jonathan Mou, at Adventist Health in Portland.

“Once it sets into a community, the likelihood of it getting beyond that community or more widespread within that community is high, especially when vaccination rates are low,” Mou told CBS News.

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