The Samoa government has lifted a weeks-long state of emergency after a measles outbreak there killed dozens of infants, children and adults.

Officials said Saturday its nationwide measles vaccination campaign reached approximately 95% of the country’s population of about 200,000, which is considered by world health officials sufficient enough to prevent its spread.

Restrictions on public gatherings were lifted and schools reopened.

The outbreak began in September and amounted to more than 5,600 cases of measles within a span of a couple of months. Many of the 81 people who died were younger than 5 years old.

The director general of Samoa’s Ministry of Health told the New York Times that the country had been complacent on routine vaccinations. Its measles-mumps-rubella, or MMR, vaccination rate had fallen to 30% last year, down from 90% just six years prior.

A tragic medical malpractice case in early 2018 fueled vaccination fears and distrust, leaving the younger unvaccinated population particularly vulnerable when the disease arrived via a traveler from New Zealand.

The Samoa nurses who made the fatal error of using an expired anesthetic instead of water when mixing the vaccine solution received five-year jail sentences. The Samoan government temporarily recalled the vaccine during an investigation into the nurses, a move the World Health Organization chastised for exacerbating the epidemic.

A delegation of doctors from Hawaii joined an international humanitarian effort to help carry out the vaccination campaign.

The MMR vaccine is a requirement for all schoolchildren in Hawaii, but Department of Health officials say the state must remain on guard against the disease because of the state’s nature as a Pacific travel hub.

Measles deaths surged globally in recent years despite an effective vaccine to prevent it, according to the World Health Organization.