On May 17, the Center for Disease Control reported there have been 880 cases of measles in 23 states as of May 17. This marks the largest outbreak of measles in the United States in 25 years.

With anti-vaccination movements spreading around the world, diseases like measles and polio that can be prevented by vaccines are again becoming prevalent. How do the workers at the Goodhue County Health & Human Services Department keep the community they serve safe?

In short: it's not easy.

"Apart from clean water, vaccines have had a more profound effect on world health than anything. And have saved millions of lives."

That's what Vicki Iocco, a public health nurse for more than 30 years, likes to tell and remind people.

Iocco is also the immunizations disease prevention and control coordinator for Goodhue County, going to schools and attending community events to encourage residents to get their shots.

The majority of people who come to public health to receive vaccines and immunizations have no health insurance, according to Iocco. She said her department makes "a strong recommendation to get vaccinated," but said staff can't force people to do so.

In Minnesota, a child who is enrolled in child care services, early education programs or school must have immunizations completed and up to date. However, medical exemptions and non-medical exemptions exist.

The Department of Health states that if a health care provider submits that an individual is already immune to a disease or is medically contraindicated, the person doesn't have to get the immunization. For a non-medical exemption, if a child or the parent doesn't want the minor to receive an immunization due to a belief, that may be submitted as a claim as well.

Keeping children healthy

The Department of Health has a program called the Minnesota Vaccines for Children Program, which helps any child in Minnesota, regardless of health insurance, receive the vaccines they need. Iocco said as early as the age of 2 children should've received vaccines to combat 14 diseases.

Vaccines don't end at an early age. Routine ones such the influenza shot can be done every year. Every 10 years, a tetanus-diphtheria-pertussis shot is recommended.

The list of vaccines is always improving, which makes it difficult for someone like Iocco to wrap her head around the anti-vaccination movement.

The anti-vaccination movement isn't a new phenomenon. Information touted by a British doctor in the late 1990s about a connection between vaccines and autism has been proven false. Outcries over thimerosal-a compound that contains mercury-has been reduced or eliminated from vaccines in 1999.

Iocco said the hardest thing public health officials have to combat is the spread of misinformation about immunizations and vaccines. Social media websites including Facebook, Twitter and Instagram have been hot beds for this spread of misinformation, prompting those companies to try to contain or block false content about vaccines more regularly.

Yet with a plethora of information from the CDC and Department of Health just as regularly available as anti-vaccination content, Iocco said they've been told that maybe the nation has done too good of a job treating and preventing these diseases: Some generations didn't fear polio and diphtheria, for example.

The polio vaccine was introduced in 1955. Just three years prior, more than 21,000 cases of paralysis caused by polio was reported in the United States, according to the CDC.

Diphtheria resulted in 15,000 deaths in 1921. The CDC said those rates dropped significantly after the introduction of the vaccine, with only two cases reported between 2004-2017.

Measles can kill

Iocco said measles can spread incredibly quickly and can also be deadly. Mainly the measles cases have been reported in areas on the two coasts. In Goodhue County, Iocco notes, only 3% of kindergartners have exemptions for the measles vaccine.

But measles had been eliminated in the United States in 2000, making the uptick in cases more confounding to people like Iocco.

"Three thousand kids used to die here," Iocco said. "Would we tolerate that if that came back? Would we be OK with 3,000 kids dying from measles?"

Some countries around the world that don't require certain vaccinations, making travel there a risk. Iocco said U.S. citizens should receive certain shots when entering certain places. It's for the country's benefit and your own.

Vaccines come at a low or no cost at the county. Iocco said it's their job "to keep people healthy."

Iocco said trust reliable websites when seeking information about immunizations and vaccinations. A list can be obtained on the county website.

The Health and Human Services Department is open Monday through Friday, 8 a.m. to 4:30 p.m.