(Bloomberg) — Measles surged to 288 cases this year, the highest number on record since the government declared it had eliminated outbreaks of the highly contagious virus in 2000 and the worst year since 1994.

This year’s contagion is spread among 18 states and New York City, according to the U.S. Centers for Disease Control and Prevention. Sixty-nine percent of patients weren’t vaccinated for the illness that causes head-to-toe rash, muscle pain, fever and bloodshot eyes. The illnesses are the most since 963 cases were reported in 1994, prompted by an outbreak in Colorado, the agency said.

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