At first, 12-month-old Mahi Abdallah spiked a fever. Then his little cough turned into something much worse. His worried mother rushed him to the hospital; the Minnesota toddler could hardly breathe.
"They gave him a breathing machine," said Nuria Koto, 31, a native of Ethiopia. "They tied his face up with tubes…It was hard to watch."
Pneumonia, doctors said. But two days later, the Abdallah family was given a new and troubling diagnosis; Mahi had measles.
The highly contagious and deadly disease was declared eradicated in the United States by the Centers for Disease Control more than a decade ago. But in recent years, measles has reemerged in small clusters around the country.
Health officials have been able to contain the relatively minor outbreaks, but the number of infected are rising and expected to get worse.
Mass outbreaks are still widespread today in parts of Canada, Europe, Africa and Asia. In an increasingly global world, many are worried that until vaccination is universal, more outbreaks are inevitable.
"If you're unvaccinated and you get exposed to measles – you're almost certain to get this disease,'' said Dr. Greg Wallace, head of the CDC's Measles, Mumps, Rubella and Polio Team. "All these outbreaks and transmissions are due to people not being vaccinated."
So far this year, there have been 204 confirmed cases of measles nationwide, according to Wallace. Of those, 86 percent were either unvaccinated or had no documents confirming their vaccination status, he said.
While health officials stress that there is little cause for alarm, many are highlighting the need for the measles, mumps and rubella (MMR) vaccination.
Easily transmittable through coughing and sneezing, measles ranks as one of the world's most contagious diseases. Even after an infected person leaves a location, the virus spores left behind -- on surfaces and in the air -- remain active and able to transmit the disease to anyone who comes in contact for as long as two hours.
Infants are at the highest risk since routine vaccination for measles is not administered until after the age of one.
Koto believes Mahi contracted measles when the family took a trip to Kenya in late spring. She had planned to vaccinate him, as she had her two older children, but he was not yet old enough when they traveled to Africa, she said.
For many in the developing world, the measles, mumps and rubella, or MMR, vaccine, is difficult to obtain though public health officials say inoculating one child costs just 24 cents in the developing world. In the United States, health insurers routinely cover the vaccination.
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In fact, health officials say, in most cases it is travelers who bring the disease home to the United States, where it spreads among those who haven't been inoculated.
Minnesota, with its large community of immigrants from Somalia, Ethiopia and Kenya, may just nurture conditions for the perfect storm.
Many of its citizens return home to visit their native countries where measles is more common. And at the same time, the immigrants living here are not inoculated because of a fear that has spread widely in the United States over past several years: that vaccines cause autism.
Though there have been several studies debunking the claim, Koto believes many in her ethnic immigrant community in Minnesota fear vaccinations for this reason.