Measles cases in the United States have surged to their highest levels since the disease was declared eliminated in 2000. According to NBC News’ analysis of state health department data, the U.S. has reported 1,277 cases since the beginning of the year. This alarming rise includes the first measles-related deaths in a decade, involving two children in Texas and an adult in New Mexico, all of whom were unvaccinated.
The resurgence of measles is partly attributed to declining vaccination rates both nationally and globally. During the 2023-24 school year, less than 93% of U.S. kindergarteners received the recommended two doses of the measles, mumps, and rubella (MMR) vaccine, a drop from 95% in the 2019-20 school year. This decline poses a significant threat to public health, as vaccination rates need to be at least 95% to prevent outbreaks.
Outbreaks and Their Origins
Periodic outbreaks continue to challenge the notion of measles elimination in the U.S. A significant outbreak occurred earlier this year in a Mennonite community in West Texas, where vaccination rates are notably low. In Gaines County, the epicenter of the outbreak, only 82% of kindergarteners had received the two required doses of the MMR vaccine, well below the threshold needed to curb the spread.
Dr. David Sugerman, a senior scientist at the Centers for Disease Control and Prevention (CDC), highlighted at an April meeting of the CDC’s vaccine advisory committee that measles would need to continue spreading until January 20 of the following year for the U.S. to lose its elimination status. Most cases this year are linked to the Southwest outbreak, with Texas alone reporting over 700 cases. Smaller outbreaks related to international travel have also been detected nationwide.
Historical Parallels and Responses
The West Texas outbreak bears similarities to a 2019 outbreak among Orthodox Jewish communities in New York, which also had low vaccination rates. That year, the U.S. recorded 1,274 measles cases. A robust vaccination campaign, including a vaccine mandate in New York City and the administration of 60,000 doses in affected communities, successfully contained the spread.
“New York’s response was an incredible feat and something we’re obviously trying to emulate,” Sugerman said.
However, Sugerman noted that financial constraints, exacerbated by the loss of COVID-19 grant money, have posed challenges in Texas. The CDC recently cut $11.4 billion in COVID-19 funding, some of which supported state health departments in responding to disease outbreaks. Each measles case can cost between $30,000 to $50,000 to address, quickly accumulating costs for health departments.
Challenges in Combating Misinformation
Experts express concern that federal messaging around vaccines could complicate efforts to control the outbreak. While Health and Human Services Secretary Robert F. Kennedy Jr. has advocated for measles vaccinations, he has also framed vaccination as a personal choice and promoted unproven treatments like steroids and antibiotics. He has also falsely claimed that immunity from measles vaccines diminishes quickly.
Dr. Ana Montanez, a pediatrician in Lubbock and Gaines County, emphasized at an April press conference that misinformation is the “biggest nemesis” for healthcare providers. She noted that some patients were opting for vitamin A instead of vaccination, influenced by Kennedy’s misleading claims about its efficacy. The CDC acknowledges that vitamin A can be administered under medical supervision, but it is not a treatment for measles.
“Countering the misinformation put out there about using vitamin A for treatment of measles has been a struggle, an upward struggle,” Montanez stated.
Public Health Implications
Despite the challenges, the MMR vaccine remains highly effective, with two doses providing 97% protection against measles and offering lifelong immunity. The virus poses significant risks, particularly to infants and young children whose immune systems are not fully developed. In Texas, health officials have recommended an early dose for infants aged 6 to 11 months and a two-dose schedule for unvaccinated children older than 12 months, with the second dose following 28 days after the first.
Measles typically begins with symptoms such as a high fever, cough, runny nose, and conjunctivitis. It can progress to a rash and, in severe cases, lead to pneumonia or encephalitis. According to the CDC, approximately 1 to 3 out of every 1,000 children with measles die from complications.
The current situation underscores the critical need for maintaining high vaccination rates and addressing misinformation to prevent further outbreaks. As health officials and communities grapple with these challenges, the focus remains on safeguarding public health and preventing the loss of measles elimination status in the U.S.
