updated 12/21/2006 3:48:05 PM ET 2006-12-21T20:48:05

The biggest U.S. measles outbreak in a decade — 34 people stricken in Indiana and Illinois last year — was traced back to a 17-year-old girl who had traveled to Romania without first getting vaccinated, government health officials said Thursday.

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The outbreak accounted for more than half of the 66 measles cases in the United States in 2005. Widespread use of the measles vaccine has dramatically reduced the incidence of the disease over the past four decades; in 2004, there were just 37 cases, the smallest number in nearly 90 years of record-keeping.

The Indiana girl became infected after visiting a Romanian orphanage while on a church-mission trip, health investigators said. The others became infected after they attended a church gathering with her the day after her return.

“Orphanages are known to be higher risk” for measles, said Dr. Philip Gould of the Centers for Disease Control and Prevention. “The main point is to ensure that people do get vaccinated, especially prior to leaving the country, going to a place that physicians suspect that measles is a risk.”

Thirty-three people in Indiana and one from Illinois became infected. Three people were hospitalized, but no one died.

Only two of the 34 people had been vaccinated against measles.

“The outbreak occurred because measles was imported into a population of children whose parents had chosen not to vaccinate their children because of safety concerns, despite evidence that measles-containing vaccine is safe and effective,” the CDC said.

Nearly all of the 32 other U.S. cases in 2005 originated abroad, including 16 involving U.S. residents infected while traveling overseas and seven involving foreigners who were infected before visiting the United States.

In the decade before a vaccine became available in 1963, about 450,000 measles cases and about 450 measles deaths were recorded in the U.S. each year. The disease — often characterized by a rash that begins on the face and spreads — can cause ear infections, diarrhea and pneumonia. It kills about one in 1,000 patients, according to the CDC.

The U.S. vaccination rate against measles is now more than 90 percent.

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