. ▁ ▁A ▁ 2 0 0 5 ▁meas les ▁out break ▁in ▁the ▁US ▁state ▁of ▁Indiana ▁was ▁attributed ▁to ▁parents ▁who ▁had ▁refused ▁to ▁have ▁their ▁children ▁v acc in ated . ▁ ▁The ▁Cent ers ▁for ▁D ise ase ▁Control ▁and ▁Pre vention ▁( CD C ) ▁reported ▁that ▁the ▁three ▁biggest ▁out break s ▁of ▁meas les ▁in ▁ 2 0 1 3 ▁were ▁attributed ▁to ▁clusters ▁of ▁people ▁who ▁were ▁un v acc in ated ▁due ▁to ▁their ▁philosoph ical ▁or ▁religious ▁belief s . ▁As ▁of ▁August ▁ 2 0 1 3 , ▁three ▁po ckets ▁of ▁out break — New ▁York ▁City , ▁North ▁Carolina , ▁and ▁Texas — cont ributed ▁to ▁ 6 4 % ▁of ▁the ▁ 1 5 9 ▁cases ▁of ▁meas les ▁reported ▁in ▁ 1 6 ▁states . ▁ ▁The ▁number ▁of ▁cases ▁in ▁ 2 0 1 4 ▁quad ru ple d ▁to ▁ 6 4 4 , ▁including ▁transmission ▁by ▁un v acc in ated ▁visitors ▁to ▁Disney land ▁in ▁California . ▁Some ▁ 9 7 % ▁of ▁cases ▁in ▁the ▁first ▁half ▁of ▁the ▁year ▁were ▁confirmed ▁to ▁be ▁due ▁directly ▁or ▁indirect ly ▁to ▁import ation ▁( the ▁remainder ▁were ▁unknown ), ▁and ▁ 4 9 % ▁from ▁the ▁Philippines . ▁More ▁than ▁half ▁of ▁the ▁vict ims ▁( 1 6 5 ▁out ▁of ▁ 2 8 8 , ▁or ▁ 5 7 %) ▁during ▁that ▁time ▁were ▁confirmed ▁to ▁be ▁un v acc in ated ▁by