At least 87 cases of measles have been confirmed in seven states and Mexico, health officials said, as the outbreak centered in California continues to spread.

The California Department of Public Health said on January 26 there were now 73 cases in the state, of which 50 can be linked directly to Disneyland.

Some people who were contagious visited in January as well as December.

Four new measles patients who visited Disneyland were reported in Arizona, bringing Arizona’s total number of Disneyland-related patients to five. Cases connected to Disneyland also have been confirmed in Utah (3), Washington state (2), Oregon (1), Colorado (1), Nebraska (1) and Mexico (1).

The measles outbreak has also expanded beyond those who visited Disneyland in December and January and is infecting people in the broader community.

Nine counties in California have confirmed measles cases: Alameda, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, Santa Clara and Ventura.

Orange County now has 23 confirmed cases. Los Angeles County follows with 15 cases and San Diego County with 13.

The California patients range in age from 7 months to 70 years. The vaccination status is known for at least 39 of the patients. Of those, 32 were unvaccinated and seven were fully vaccinated.

Of the cases in California, about one in four has had to be hospitalized, officials said.

Across California, officials have been scrambling to get ahead of the outbreak, identifying farmers markets, grocery stores, malls and other public locations where contagious people have been.

Health officials are urging people suspected of having the measles to first call their health provider before going to a clinic, enabling caregivers to make special preparations so patients don’t risk infecting others in the waiting room. An urgent-care clinic in the San Diego suburb of La Mesa was forced to shut down for a few hours when five people arrived with a rash. Anyone without proof of vaccination who came in contact with the five at the clinic was put under a mandatory quarantine for 21 days.

At Santa Monica High School, students and parents were alerted Friday night that a freshman baseball coach had been diagnosed with measles. Health officials concluded that because every student on the baseball team had a record of measles immunization, it was unlikely that students could have caught the highly contagious virus.

No students have been asked to stay away from campus at this time, school officials said.

After Disneyland officials confirmed that five of its employees had been diagnosed with measles, all Disneyland employees who could have been in contact with those five were asked to provide vaccination records or do a blood test that showed they had built immunity to the disease.

Any employees who had not been vaccinated or could not confirm their immunity status were asked to go on paid leave until their status could be confirmed, company officials said.

Health care officials said it was safe to go Disneyland and other venues with large crowds if you were immunized for measles.

“I think it is absolutely safe for you to go to Disneyland if you’re vaccinated,” said Dr. Gil Chavez, California state epidemiologist.

However, he cautioned that those with infants too young to be immunized should avoid large crowds where international travelers are concentrated, such as theme parks and airports. Six of the California cases occurred in infants who were too young to be immunized, state officials said.

Symptoms of measles include fever as high as 105, cough, runny nose, redness of eyes, and a rash that begins at the head and then spreads to the rest of the body. It can lead to inflammation of the brain, pneumonia and death.

Federal recommendations call for the first dose of measles vaccination, known as MMR, to be given at 12 to 15 months of age, with a second between ages 4 and 6. California law requires two doses of measles vaccination before kindergartners can enroll, but parents can obtain exemptions for the vaccines if they say the inoculations conflict with their personal beliefs.

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