Authorities say there are now 40 confirmed cases of measles in a Pacific Northwest outbreak.
Public health officials said Wednesday that 38 cases are in southwest Washington state, one is outside Portland, Oregon, and one is in Seattle.
Two of the confirmed patients from southwest Washington travelled to Hawaii and were quarantined there and a third person was contagious while on a trip to Bend, Oregon.
Authorities believe no one was exposed to the measles in Hawaii.
Clark County Public Health says there are now 13 additional suspected cases.
Of the confirmed cases, most patients are under age 10.
All but a handful were not immunized against the disease.
Washington Gov. Jay Inslee last week declared a state of emergency due to the outbreak.
Gillian Flaccus, The Associated Press