Multiple times in the past four years, three rural Alabama counties — Perry, Pickens and Russell — have reported having students without immunization documents at more than four times the statewide rate.

Health providers say a main reason for that gap is a general lack of health care in sparsely populated areas. Those counties are short on health care providers, and county health departments are understaffed. A lack of knowledge about the need for vaccines also is a factor.

Meanwhile, the Centers for Disease Control and Prevention reported that 764 cases of measles were confirmed this year across 23 states. According to the agency, that’s the highest number since 1994 — for a disease that was eradicated in the U.S. in 2000. Read more.