The CDC reported a rise in the number of infectious disease outbreaks throughout the country in 2019, including measles, Hepatitis A, and encephalitis.

“It’s been a tough year for infectious diseases,” said Dr Jonathan Mermin of the US Centers for Disease Control and Prevention. There were nearly 1,300 cases of measles in the US through November, That’s the largest number in 27 years. There were no deaths but about 120 people ended up in the hospital.

Three-quarters of this year’s cases were in Orthodox Jewish communities in or near New York City. As with most US outbreaks, it started with travelers infected overseas who spread it to people who hadn’t gotten a measles vaccine.