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ST. LOUIS — Another measles case was identified Tuesday in New Madrid County in southeast Missouri, bringing the state’s total to three, as health officials also try to learn more about a person with measles who visited the busy ÃÛÑ¿´«Ã½ Aquarium last week.

The infected visitor to ÃÛÑ¿´«Ã½ was an unvaccinated adult from Southern Illinois who toured the aquarium at Union Station between 1 and 6 p.m. Wednesday, April 30, said Dr. Mati Hlatshwayo Davis, health department director for the city of ÃÛÑ¿´«Ã½.

The person also dined at an area restaurant but is unsure of the location and paid in cash, Davis said. Because the person is from Illinois, the investigation into the case is being led by the Illinois Department of Public Health.

Davis said that makes it challenging to ascertain the likelihood of more local exposures to the highly contagious disease.

“I don’t have as concrete a timeline, as concrete of exactly what places the individual went to, and as concrete a story as to when their symptoms developed,� Davis said. “All of these factors would help us to develop a better picture, and maybe be able to better anticipate what’s to come.�

ÃÛÑ¿´«Ã½ health department staff late Monday obtained a list of that day’s visitors to the aquarium, which included at least one school field trip, Davis said.

Davis was not yet able to provide more details about the school or number of students, but said staff was prioritizing reaching out to visitors with children.

“We are working to notify anyone present during the established exposure window,� she said. “Staff are currently contacting everyone to let them know of exposure and relaying next steps.�

Aquarium officials say 939 people visited the attraction on April 30, most of whom were from the local area. The busiest time was in the morning.

Measles is a respiratory virus spread through droplets that can linger in the air and on surfaces for up to two hours after an infected person has left a space.

All the surfaces at the aquarium are cleaned multiple times throughout the day, said Tami Brown, the aquarium’s executive director. Animals cannot get measles.

“The aquarium maintains a strict cleaning and disinfecting protocol that we focus on every day,� Brown said.

Symptoms develop 11 to 14 days after exposure to measles and include high fever, cough, runny nose, red watery eyes and a rash that begins on the face and spreads to the rest of the body. Anyone with symptoms should isolate and contact a health provider.

“Please note that a rash may not develop for several days,� Davis said. “So please, do not wait for one to appear if you are experiencing any of the other listed symptoms.�

As of May 1, 935 measles cases have been reported across the U.S. this year, the second-most in the past 25 years and likely to grow, . About 13% of this year’s cases have ended up hospitalized, and three people have died, two whom were children.

A child visiting Branson was diagnosed with measles on April 18, marking the first reported case of the measles in Missouri. No other exposures have been identified from that case, according to the state health department.

On Tuesday, the New Madrid County Health Department in an adult county resident. “There is no indication of widespread public exposure,� a press release stated.

The Illinois visitor to the aquarium brings the total number of measles cases in Southern Illinois to four — two that were identified over the weekend and two in the Marion area that were identified in April, .

Three of the cases are linked and located in neighboring Franklin and Williamson counties, which meets the definition of an “outbreak� in that area (three or more cases that are linked to one another).

That adds to the 12 outbreaks that had been reported by the CDC as of May 1. Most of this year’s measles cases — 869 out of 935 — are associated with an outbreak.

Avoiding measles

The best way to avoid measles is to get the measles, mumps and rubella (MMR) vaccine. The first shot is recommended for children between 12 and 15 months old and the second between 4 and 6 years old before entering kindergarten.

Adults unsure of their vaccination status should talk to their health provider about their concerns and options, Davis said.

Vaccination rates have dropped across the country since the COVID-19 pandemic, which intertwined politics with vaccination efforts and fueled resistance. That has fueled the latest increase in cases, which are mostly among the unvaccinated.

of Missouri public school kindergarteners vaccinated against measles, health officials say the state is vulnerable, especially those who are immunocompromised, pregnant women and babies too young to get vaccination.

To keep infections from spreading, a 95% vaccination rate is needed.

Rates among kindergarteners : Six counties have rates under 80%. The lowest — 61% — is in Scotland County, along Iowa’s border. In the city of ÃÛÑ¿´«Ã½, the rate is 75%.

Davis urged those who are hesitant about getting the vaccine to talk frankly with a heath provider about their concerns.

“But please, please do not allow yourself to not have the opportunity to protect yourselves, your family and this city, our community, at this time,� David said. “We have an opportunity to get ahead of this. Let’s do all we can.�

Last month, Davis said she called on the ÃÛÑ¿´«Ã½ Metropolitan Pandemic Task Force to prepare for the possibility of measles cases. The task force, made up of area hospital leaders, was created to coordinate efforts during the COVID-19 pandemic.

The leaders are discussing clinical protocols, sharing the latest information and creating a list of contacts at the hospitals, clinics and area health departments who can respond quickly when there is a measles case.

“I believe we are in a better place than most jurisdictions because we did not wait,� Davis said. “We were proactive.�

Davis, who was appointed by former Mayor Tishaura O. Jones in 2021, recently announced she would be stepping down as health director.