WASHINGTON (AP) — The U.S. is having its worst year for measles spread in more than three decades, and the year is only half over.

The national case count reached 1,288 on Wednesday, according to the U.S. Centers for Disease Control and Prevention, though public health experts say the true figure may be higher.

The CDC’s count is 14 more than 2019, when America almost lost its status of having eliminated the vaccine-preventable illness — something that could happen this year if the virus spreads without stopping for 12 months. But the U.S. is far from 1991, when there were 9,643 confirmed cases.

In a short statement, the federal government said that the CDC “continues to recommend (measles, mumps and rubella) vaccines as the best way to protect against measles.” It also said it is “supporting community efforts” to tamp down ongoing outbreaks as requested.

Fourteen states have active outbreaks; four other states’ outbreaks have ended. The largest outbreak started five months ago in undervaccinated communities in West Texas. Three people have died — two children in Texas and an adult in New Mexico — and dozens of people have been hospitalized across the U.S.

But there are signs that transmission is slowing, especially in Texas. Lubbock County’s hospitals treated most of the sickest patients in the region, but the county hasn’t seen a new case in 50 days, public health director Katherine Wells said.

“What concerned me early on in this outbreak was is it spreading to other parts of the United States, and that’s definitely what’s happening now,” she said.

In 2000, the World Health Organization and CDC said measles had been eliminated from the U.S. The closer a disease gets to eradication, the harder it can seem to stamp it out, said Dr. Jonathan Temte, a family physician in Wisconsin who helped certify that distinction 25 years ago.

It’s hard to see measles cases break records despite the widespread availability of a vaccine, he added. The measles, mumps and rubella vaccine is safe and is 97% effective at preventing measles after two doses.

“When we have tools that can be really helpful and see that they’re discarded for no good reason, it’s met with a little bit of melancholy on our part,” Temte said of public health officials and primary care providers.

Wells said she is concerned about continuing vaccine hesitancy. A recent study found childhood vaccination rates against measles fell after the COVID-19 pandemic in nearly 80% of the more than 2,000 U.S. counties with available data, including in states that are battling outbreaks this year. And CDC data showed that only 92.7% of kindergarteners in the U.S. had the measles, mumps and rubella vaccine in the 2023-2024 school year, below the 95% needed to prevent outbreaks.

State and federal leaders have for years kept funding stagnant for local public health departments’ vaccination programs that are tasked with reversing the trend. Wells said she talks with local public health leaders nationwide about how to prepare for an outbreak, but also says the system needs more investment.

“What we’re seeing with measles is a little bit of a ‘canary in a coal mine,’” said Lauren Gardner, leader of Johns Hopkins University’s independent measles and COVID-19 tracking databases. “It’s indicative of a problem that we know exists with vaccination attitudes in this county and just, I think, likely to get worse.”

Currently, North America has three other major measles outbreaks: 2,966 cases in Chihuahua state, Mexico, 2,223 cases in Ontario, Canada and 1,246 in Alberta, Canada. The Ontario, Chihuahua and Texas outbreaks stem from large Mennonite communities in the regions. Mennonite churches do not formally discourage vaccination, though more conservative Mennonite communities historically have low vaccination rates and a distrust of government.

In 2019, the CDC identified 22 outbreaks with the largest in two separate clusters in New York — 412 in New York state and 702 in New York City. These were linked because measles was spreading through close-knit Orthodox Jewish communities, the CDC said.

AUSTIN (AP) — Officials in Texas are facing mounting questions about whether they did enough to get people out of harm’s way before a flash flood swept down the Guadalupe River and killed more than 100 people, including 27 children and counselors at an all-girls Christian camp.

More than 160 people are still believed to be missing in Texas days after flash floods killed over 100 people during the July Fourth weekend, the state’s governor said Tuesday. In the days since the devastation, state, federal and Kerr County officials have deflected pointed questions about preparations and warnings.

The Associated Press has assembled an approximate timeline of the 48 hours before, during and after the deadly flash flood, beginning with the activation of the state’s emergency response resources on July 2 — the same day Texas signed off on the camp’s emergency plan for disasters.

By daybreak on July Fourth, it was clear that some children from Camp Mystic were swept away by floodwaters even as others were able to escape to safety in their pajamas.

___

Wednesday, July 2:

The Texas Division of Emergency Management activated state emergency response resources anticipating the threat of flooding in parts of West and Central Texas.

On the same day, Texas inspectors signed off on Camp Mystic’s emergency planning, records obtained by the AP show.

Thursday, July 3:

10:00 a.m.: Lt. Gov. Dan Patrick said Friday that county judges and city mayors were invited to be on a daily call Thursday to discuss weather forecasts. Patrick also said a regional coordinator personally reached out to officials in the area.

“The message was sent,” Patrick said. “It is up to the local counties and mayors under the law to evacuate if they feel the need.”

1:18 p.m.: The National Weather Service’s Austin/San Antonio office issued a flood watch estimating rainfall amounts of one to three inches, with isolated amounts of five to seven inches for parts of south central Texas, including Kerr County. “Excessive runoff may result in flooding of rivers,” the alert read.

Friday, July 4:

1:14 a.m.: Citing radar, the National Weather Service issued a flash flood warning for central Kerr County until 4:15 a.m., warning that it was life threatening.

Around 3:00 a.m.: Kerrville City Manager Dalton Rice said he was running on the river trail around 3 or 3:30 a.m. Friday and “everything was fine.”

“Four o’clock when I left, there was no signs of it rising at that point,” Rice said during a news conference later. “This happened very quickly over a very short amount of time.”

Rice said the isolated location and the heavy rain in a short period of time made a dangerous event that was not predictable, even with radar and National Weather Service warnings.

“This is not like a tornado where you can have a siren. This is not like a hurricane where you’re planning weeks in advance,” Rice said. “It hit. It hit hard.”

Between 3 and 5 a.m.: Floodwaters begin to inundate Camp Mystic. Young campers, counselors and staff are roused from sleep and begin a desperate rush to higher ground, according to social media accounts. The accounts detail how some young girls had to climb through cabin windows. One staffer said she was on the roof with water rising toward her at 4:00 a.m.

3:30 a.m.: Erin Burgess woke up to thunder at around 3:30 a.m. Friday in her home in Bumble Bee Hills, a housing development about halfway between Hunt and Ingram. Within a half hour or so, she told the AP that the water was rushing into her house. Burgess and her 19-year-old son clung onto a tree outside for an hour before the water receded.

3:35 a.m.: The National Weather Service extended its flash flood warning for central Kerr County until 7 a.m. based on radar and automated gauges.

3:35 a.m.: A U.S. Geological Survey gauge along the Guadalupe River about five miles north of Camp Mystic and about a mile east of Hunt shows the river had reached nearly 16 feet. The river at that location is subject to minor flooding at 10 feet.

Between 4 and 5 a.m.: Kerr County Sheriff Larry Leitha said he was first notified about the situation from one of his sergeants.

4:03 a.m.: The National Weather Service named a flash flood emergency for south-central Kerr County, saying in all caps that it was a “particularly dangerous situation. Seek higher ground now!” Citing radar and automated rain gauges, the bulletin said low water crossings and the Guadalupe River at Hunt were flooding.

4:35 a.m.: A U,S, Geological Survey gauge along the Guadalupe River about five miles north of Camp Mystic and about a mile east of Hunt stops sending data. The last recorded river level from the instrumentation was 29.5 feet.

5:30 a.m.: Police knocked on Matthew Stone’s door in a Kerrville riverfront neighborhood, urging residents to evacuate. Stone said he had received no emergency warning on his phone. “We got no emergency alert. There was nothing,” Stone said. Then: “a pitch black wall of death.”

5:34 a.m.: The National Weather Service bulletin reported a flash flood emergency from Hunt through Kerrville and Center Point, saying “automated rain gauges indicate a large and deadly flood wave is moving down the Guadalupe River.”

5:38 a.m.: In a comment on a Facebook post from the Kerr County Sheriff’s Office, one woman begged for someone to help her mother-in-law who was trapped in a trailer between Hunt and Ingram.

5:52 a.m.: Minutes later, another woman commented on the same Facebook post that Bumble Bee Hills was flooded and needed help.

6:06 a.m.: The National Weather Service extended the flash flood warning until 10:00 a.m. The bulletin also said local law enforcement reported “major flooding” and water rescues along the Guadalupe River.

6:19 a.m.: Another Facebook commenter on the Kerr County Sheriff’s page said a “friend and her family are on their rooftop in Hunt, waiting for rescue.”

6:45 a.m.: A U.S. Geological Survey gauge in Kerrville shows the Guadalupe River peaks at 34.29 feet, a figure that is preliminary and subject to change. It is the third-highest river level at that location, according to the data. The record of 39 feet was set on July 2, 1932,

6:59 a.m.: Erin Burgess was surveying damage in her flooded home after the river water receded. The line of muck reached halfway up her kitchen cabinets.

7:24 a.m.: The National Weather Service advises that the flash flood emergency extends to Sisterdale.

11:29 a.m.: Camp Mystic parents receive an email noting the grounds have “sustained catastrophic level floods” and that they are without power, water and internet. Parents with a daughter not accounted for were directly contacted, the camp said.

11:30 a.m.: Local officials held the first press conference to describe the situation and response. Asked what kind of warning system went out to make sure county residents got out safely, Judge Rob Kelly, the county’s chief elected official said: “We do not have a warning system.”

When a reporter followed up to ask why camps weren’t evacuated when the camps were in harm’s way, Kelly said they didn’t know “this flood” was coming.

“We had no reason to believe that this was going to be any, anything like what’s happened here,” Kelly said. “None whatsoever.”

3:30 p.m.: Two news conferences on Friday afternoon were the first to offer an initial death toll. Lt. Gov. Dan Patrick said six to 10 bodies had been found so far. Around the same time, Kerr County Sheriff Larry Leitha reported that 13 people had died in the flooding. Patrick also announced that the whereabouts of about 23 girls attending Camp Mystic were not known.

7:11 p.m.: A state agency responsible for search and rescue operations, the Texas Game Wardens, post on Facebook that they made entry into Camp Mystic and “are evacuating the campers to safety.” Roughly two dozen campers were still missing.

9 p.m.: Texas Gov. Greg Abbott signed a disaster declaration at a news conference. Leitha reported about 24 fatalities.