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Deadly measles outbreaks have driven case counts higher than they’ve been in the United States since the early 1990s, and the country is on the brink of losing its measles elimination status.

When the US Centers for Disease Control and Prevention convened a group of experts to talk about measles back in March 2000, cases had been so low for so long that the status of disease in the country could be completely redefined: The experts concluded that measles was no longer endemic in the United States.