SPOKANE, Wash. (AP) — Spokane county health officials are dealing with a second confirmed case of measles, both involving unvaccinated patients.

The Spokesman-Review reports the disease popped up last week for the first time in 20 years, and led to the second case reported Wednesday afternoon.

Though it's unclear how it started, about 50 unvaccinated individuals who had contact with that person have been ordered to stay home for 21 days.