COLUMBUS, Ohio (WCMH) — Columbus Public Health (CPH) is investigating an outbreak of measles cases that have been reported in childcare facilities in the area.

CPH confirmed that there are an additional 11 measles cases in five different daycares in central Ohio, adding to the four confirmed cases reported last week in one unspecified childcare facility in the city.

CPH has not named the five daycare centers but has confirmed that each has been cooperative with the investigation and that all parents involved have been notified.

Of the 15 total cases reported, all are in children under five years old who are unvaccinated, per Columbus Public Health.

Measles is a highly contagious virus transmitted through coughing and sneezing. According to the CDC, infected individuals can spread the virus up to four days before becoming symptomatic.

“Measles can be a very serious infection,” said Columbus Public Health Director Dr. Mysheika Roberts. “Of our 15 cases, seven have required hospitalization. Those symptoms can be anywhere from pneumonia, and a little kid having pneumonia is not good, and it can escalate to even neurological disease.”

The virus is commonly identified through its hallmark rash, a network of flat red spots that might start at the hairline and spread downward across a person’s body. But by the time the rash occurs, a person has already been contagious for several days. Other symptoms both agencies urged people to look out for include a high fever, runny nose, and watery eyes.

It typically takes 8 to 12 days after exposure for symptoms to develop, according to both public health agencies.

The CDC recommends all children receive two doses of the MMR vaccine, with the first between 12 and 15 months old and the second at 4 through 6 years of age or at least 28 days after the first dose.