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.
"Most of them refuse the vaccine because they think it will cause autism in their children," Koto said. "There is a fear in the Somali community here but I have been talking to my friends and people in the community about getting their children vaccinated. I think it's important they know."
Over the past decade, Minnesota reported more measles cases per capita than any other state in the country, with 26 confirmed cases to date.
California has the highest reported measles cases with 28 confirmed cases affecting patients ranging from 11 months of age to 68 years-old. Of those, more than half of the cases involved people who were not vaccinated, according to the California Department of Public Health.
"I don't think people should be panicked," said Katheen Harriman, the Vaccine-Preventable Diseases Epidemiology Section Chief of the California Department of Public Health Immunization Branch. "Obviously it's concerning and many of these cases are coming from returned travelers."
"We certainly want to encourage travelers in particular but also everybody to take safety precautions," she said.
In the book, "The Panic Virus," author Seth Mnookin writes extensively about measles and claims the most significant factor in the spread of measles in the United States is the increase of pockets of the country where the vaccination rates have declined.
"What we're seeing is something that happens throughout history. When a vaccine is very effective, people lose track of the dangers of that disease," Mnookin said. "Most people of our generation don't have memory of mass hospitalization due to measles and I think there is this false sense of security that a disease like measles is not dangerous – and that's just absolutely not true."
Five weeks after her son was fighting for his life, Koto is relieved to have her now-healthy son back home again. "I am happy to see him without the breathing machine," she said. "He is doing good and playing around."
Taking on the role of an ad hoc spokesperson for vaccination, Koto said she will continue to share Mahi's story in her community to try to urge others to seek the MMR vaccination.