As of Friday, April 25, the US has confirmed over 900 measles cases since the start of the year. The cases are across 29 states, but most are in or near Texas, where a massive outbreak continues to mushroom in close-knit, undervaccinated communities.
On April 24, the Centers for Disease Control and Prevention had tallied 884 cases across the country. Today, the Texas health department updated its outbreak total, adding 22 cases to its last count from Tuesday. That brings the national total to at least 906 confirmed cases. Most of the cases are in unvaccinated children and teens.
Overall, Texas has identified 664 cases since late January. Of those, 64 patients have been hospitalized, and two unvaccinated school-aged children with no underlying medical conditions have died of the disease. An unvaccinated adult in New Mexico also died from the infection, bringing this year’s measles death toll to three.
The cases and deaths are breaking records. In the past 30 years, the only year with more measles cases than the current tally was 2019, which saw 1,274 cases. Most of those cases were linked to large, extended outbreaks in New York City that took 11 months to quell. The US was just weeks away from losing its elimination status, an achievement earned in 2000 when the country first went 12 months without continuous transmission.
Since 2019, vaccination coverage of the measles, mumps, and rubella (MMR) vaccine among US kindergartners has only fallen. National rates fell from 95 percent in 2019—the threshold considered necessary to keep measles from spreading—to 92.7 percent in the 2023–24 school year, the most recent year for which there’s data.
On the brink
In 2019, amid the record annual case tally, cases had only reached a total of 704 by April 26. With this year’s tally already over 900, the country is on track to record a new high. Before 2019, the next highest case total for measles was in 1994. That year, the country saw 899 cases, which 2025 has already surpassed.
In now-rarified comments from experts at the Centers for Disease Control and Prevention, an agency official on Tuesday evening said the explosive measles outbreak mushrooming out of West Texas will require “significant financial resources” to control and that the agency is already struggling to keep up.
“We are scrapping to find the resources and personnel needed to provide support to Texas and other jurisdictions,” said David Sugerman, the CDC’s lead on its measles team. The agency has been devastated by brutal cuts to CDC staff and funding, including a clawback of more than $11 billion in public health funds that largely went to state health departments.
Sugerman noted that the response to measles outbreaks is generally expensive. “The estimates are that each measles case can be $30,000 to $50,000 for public health response work—and that adds up quite quickly.” The costs go to various responses, including on-the-ground response teams, vaccine doses and vaccination clinics, case reporting, contact tracing, mitigation plans, infection prevention, data systems, and other technical assistance to state health departments.
In the past, the CDC would provide media briefings and other public comments on the responses to such an extraordinarily large and fast-moving outbreak. However, Sugerman’s comments are among the first publicly made by CDC experts under the current administration. He spoke about the outbreak at the very end of an all-day public meeting of the agency’s Advisory Committee on Immunization Practices (ACIP), which discussed a broad range of vaccine and vaccine-preventable diseases over the course of the day.
The meeting was initially planned for February but was abruptly canceled and then rescheduled upon the Trump administration coming into office, including the new health secretary and longtime anti-vaccine advocate, Robert F. Kennedy, Jr. But, despite concern for ACIP’s future, the meeting proceeded more or less as usual on Tuesday and continues today with additional topics. The last 30 minutes of yesterday’s agenda was set aside for an update on the measles outbreak.
“I find it absolutely devastating that we’re having this update today,” ACIP chair Keipp Talbot said at the outset of Sugerman’s update. “There’s no reason why we have healthy children dying of measles in the US when this vaccine is amazing,” Talbot said, referencing the measles, mumps, and rubella (MMR) vaccine. “It’s highly effective and has very long-lasting immunity.” Two doses of MMR offer 97 percent protection against the virus, which is among the most infectious viruses known.
With measles declared eliminated from the US in 2000 and national herd immunity strong, health experts have recommended that American children get two doses of the Measles, Mumps, and Rubella (MMR) vaccine—the first between the ages of 12 and 15 months and the second between the ages of 4 and 6 years, before they start school.
Before 12 months, vulnerable infants in the US have been protected in part by maternal antibodies early in infancy as well as the immunity of the people surrounding them. But if they travel to a place where population immunity is unreliable, experts recommend that infants ages 6 to 11 months get an early dose—then follow it up with the standard two doses at the standard times, bringing the total to three doses.
The reason they would need three—and the reason experts typically recommend waiting until 12 months—is because the maternal antibodies infants carry can interfere with the vaccine response, preventing the immune system from mounting long-lasting protection. Still, the early dose provides boosted protection in that 6-to-11-month interval.
In the past, this early, extra dose was recommended for infants traveling internationally—to countries that hadn’t achieved America’s enviable level of herd immunity and were vulnerable to outbreaks. But now, with US vaccination rates slipping, herd immunity becoming spotty, cases rising by the day, and outbreaks simmering in multiple states, the US is no longer different from far-off places that struggle with the extremely infectious virus.
In an article published today in JAMA, prominent health experts—including former Centers for Disease Control and Prevention Director Rochelle Walensky—call for the US to update its MMR recommendations to include the early, extra dose for infants who are not only traveling abroad, but domestically, to any areas where measles is a concern.
“With some local immunization levels inadequate to avert outbreaks and ongoing disease spread in various regions of the country, a dichotomy between domestic and international travel is not appropriate,” the experts write. “For many travel itineraries, there may even be a higher risk of measles exposure at the US point of departure than at the international destinations.”
Vaccinating at-risk infants early is critical to their own health—as well as the people around them, the experts note. “[I]nfants younger than one year face a heightened risk of severe measles-related complications such as pneumonia, encephalitis, and death. Younger infants are also at increased risk of developing subacute sclerosing panencephalitis (SSPE), a rare measles complication that has a high fatality rate and may surface years after initial infection,” according to the experts.
Meanwhile, the Texas health department on Tuesday provided an outbreak update, raising the case count to 223, up 25 from the 198 Texas cases reported Friday. Of the Texas cases, 29 have been hospitalized and one has died—a 6-year-old girl from Gaines County, the outbreak’s epicenter. The girl was unvaccinated and had no known underlying health conditions.
The outbreak continues to be primarily in unvaccinated children. Of the 223 cases, 76 are in ages 0 to 4, and 98 are between ages 5 and 17. Of the cases, 80 are unvaccinated, 138 lack vaccination status, and five are known to have received at least one dose of the Measles, Mumps, and Rubella vaccine.
One dose of MMR is estimated to be 93 percent effective against measles, and two doses offer 98 percent protection. It’s not unexpected to see a small number of breakthrough cases in large, localized outbreaks.
Across the border from Gaines County in Texas sits Lea County, where New Mexico officials have now documented 32 cases, with an additional case reported in neighboring Eddy County, bringing the state’s current total to 33. Of those cases, one person has been hospitalized and one person (not hospitalized) died. The death was an adult who did not seek medical care and tested positive for measles only after death. The cause of their death is under investigation.
Of New Mexico’s 33 cases, 27 were unvaccinated and five did not have a vaccination status, and one had received at least one MMR dose. Eighteen of the 33 cases are in adults, 13 are ages 0 to 17, and two cases have no confirmed age.
On Friday, the Centers for Disease Control and Prevention released a travel alert over the measles outbreak. “With spring and summer travel season approaching in the United States, CDC emphasizes the important role that clinicians and public health officials play in preventing the spread of measles,” the agency said in the alert. It advised clinicians to be vigilant in identifying potential measles cases.
The agency stressed the importance of vaccination, putting in bold: “Measles-mumps-rubella (MMR) vaccination remains the most important tool for preventing measles,” while saying that “all US residents should be up to date on their MMR vaccinations.”
US health secretary and long-time anti-vaccine advocate Robert F. Kennedy Jr, meanwhile, has been emphasizing cod liver oil, which does not prevent measles, and falsely blaming the outbreak on poor nutrition.
Vitamin A is a fat-soluble vitamin that stays in the body. Taking too much over longer periods can cause vomiting, headache, fatigue, joint and bone pain, blurry vision, and skin and hair problems. Further, it can lead to dangerously high pressure inside the skull that pushes on the brain, as well as liver damage, confusion, coma, and other problems, according to the American Academy of Pediatrics.
Nevertheless, in an interview with Fox News this week, Kennedy endorsed an unconventional regimen of a steroid, an antibiotic and cod liver oil, praising two Texas doctors for giving it to patients. One of the doctors Kennedy championed was disciplined by the state medical board in 2003 for “unusual use of risk-filled medications,” according to a report by CNN.
In a yet more worrying sign, Reuters reported Friday afternoon that the CDC is planning to conduct a large study on whether the MMR vaccine is linked to autism. This taxpayer-funded effort would occur despite the fact that decades of research and numerous high-quality studies have already been conducted—and they have consistently disproven or found no connection between the vaccine and autism.
The agency’s move is exactly what Democratic senators feared when Kennedy was confirmed as the country’s top health official. In Senate hearings, Kennedy refused to say that vaccines do not cause autism. Democratic senators quickly warned that his anti-vaccine stance could not only move the country backward in the fight against vaccine-preventable diseases, but also hold back autism research aimed at finding the real cause(s) as well as better treatments.
“When you continue to sow doubt about settled science it makes it impossible for us to move forward,” Senator Maggie Hassan (D-N.H.) said in a Senate hearing. “It’s the relitigating and rehashing … it freezes us in place.”
Cook, along with Lubbock’s director of public health, Katherine Wells, said they see no end in sight for the outbreak, which now spans nine counties in Texas, many of which have low vaccination rates. “This outbreak is going to continue to grow,” Wells said, declining to forecast how high the final case count could go after a reporter raised the possibility of several hundred.
So far, 116 of the 146 cases are under the age of 18, with 46 being between the ages of 0 and 4. Only five of the 146 were vaccinated with at least one dose of the Measles, Mumps, and Rubella (MMR) vaccine.
Messaging
On a more positive note, Wells reported that the outbreak has seemed to sway some vaccine-hesitant parents to get their children vaccinated. Just yesterday in Lubbock, over 50 children came into the city’s clinic for measles vaccines. Eleven of those children had vaccine exemptions, meaning their parents had previously gone through the state process to exempt their child from having to receive routine childhood vaccines to attend school. “Which is a really good sign; that means our message is getting out there,” Wells said.
So far in the outbreak, which erupted in late January, messaging about the disease and the importance of vaccination has exclusively come from state and local authorities. The Centers for Disease Control and Prevention only released a brief statement late Thursday, which was not sent through the agency’s press distribution list. It did, however, note that “vaccination remains the best defense against measles infection.”
During a cabinet meeting Wednesday, US Health Secretary and anti-vaccine advocate Robert F. Kennedy Jr. responded to a question about the outbreak, offering a variety of inaccurate information. Kennedy downplayed the outbreak, falsely claiming that “it’s not unusual.” But, this is an unusual year for measles in the US. As epidemiologist Katelyn Jetelina noted on Bluesky, the number of US measles cases this year has already surpassed the total case counts from eight of the previous 15 years. And it is only February.
Other affected counties in Texas include Dawson (6 cases); Ector (1); Lubbock (1); Lynn (1); Terry (20); and Yoakum (4).
In Texas, the majority of the cases continue to be in children: 26 are in infants and young children ages 0 to 4, and 51 are between ages 5 and 17. All but five cases have been in unvaccinated people. Sixteen people (roughly 18 percent) have been hospitalized.
In New Mexico, there have been no hospitalizations, and five of the nine cases are in adults. The other four cases were between the ages of 5 and 17.
Given low vaccination rate in the area and the contagiousness of measles, health officials expect the outbreak to continue to grow. Measles is one of the most infectious viruses known; 90 percent of people who are unvaccinated and exposed will fall ill. The disease is marked by high fevers and a telltale rash and can cause severe complications in some, including younger children.
In the US, about 20 percent of people with measles are typically hospitalized. Five percent develop pneumonia, and up to 3 in 1,000 die of the infection. In rare cases, measles can cause a fatal disease of the central nervous system later in life called Subacute sclerosing panencephalitis. Measles also wipes out immune responses to other infections (a phenomenon known as immune amnesia), making people vulnerable to various illnesses.
“Rather than instructing individuals to receive any and all vaccines, LDH staff should communicate data regarding the reduced risk of disease, hospitalization, and death associated with a vaccine and encourage individuals to discuss considerations for vaccination with their healthcare provider,” he wrote.
“Ripped in half”
Susan Hassig, an infectious disease epidemiologist and professor emerita at Tulane University’s School of Public Health, told the Times-Picayune that this is problematic advice. Many people don’t have primary care providers. “They go to an urgent care or a clinic,” Hassig said. “In Louisiana, they go to the emergency room.”
The memo lands amid widespread fear that Kennedy’s appointment will lead to further erosion of America’s trust in vaccination and its vaccination rates. Already, rates of routine childhood vaccination in kindergartners across the nation have slipped into the range of 92 percent, woefully below the 95 percent threshold to prevent onward disease spread. Exemptions from school vaccination requirements are at an all-time high.
Further, the country is also in the midst of the worst flu season in 15 years. The percent of doctor’s visits for influenza-like illnesses (a standard metric for flu season) hit 7.8 percent this week, a high not seen since the 2009–2010 season amid the emergence of the H1N1 swine flu. The Centers for Disease Control and Prevention estimates that there have been at least 29 million illnesses, 370,000 hospitalizations, and 16,000 deaths from flu so far this season. This week, 11 children died of flu, bringing the 2024–2025 pediatric death toll to 68.
Among the recent deaths was a healthy 9-year-old girl in North Carolina, who died from flu complications on January 29. “I literally feel like my heart has been ripped in half,” her mother told WRAL News.
The vote was largely along party lines, with a tally of 52 to 48. Sen. Mitch McConnell (R–Ky.), a polio survivor and steadfast supporter of vaccines, voted against the confirmation, the only Republican to do so.
Before the vote, Minority Leader Charles Schumer (D–N.Y.) claimed that if there had been a secret ballot today, most Republicans would have voted against Kennedy. “But sadly, and unfortunately for America, Republicans are being strong-armed by Donald Trump and will end up holding their nose and voting to confirm Mr. Kennedy… What a travesty,” Schumer said.
Senator Mike Crapo (R–Idaho) shot back, supporting Kennedy’s nomination and chastising his colleagues for their continued “attacks” on Kennedy. “He has made it very clear that he will support safe vaccinations and just wants to see that the research on them is done and done well,” Crapo said, seemingly not acknowledging the vast wealth of high-quality research that has already been done on vaccine safety and efficacy.
As the top health official for the Trump administration, Kennedy says he will focus on improving nutrition and reducing chronic diseases, in part by cracking down on food additives, processed foods, and the influence of food and drug makers on federal agencies. Prior to his confirmation, he campaigned on the slogan “Make America Healthy Again,” aka MAHA, which he has moved to trademark.
Anti-vaccine advocacy
While his stated goals have drawn support and praise from some lawmakers and health advocates, his confirmation has been highly controversial because he is one of the most prominent and influential anti-vaccine advocates in the country. He has worked for decades to erode trust in safe, life-saving vaccinations as the head of the anti-vaccine organization he founded, Children’s Health Defense, and spread misinformation and conspiracy theories. Upon seeking the confirmation, he transferred his trademark application to an LLC managed by Del Bigtree, another prominent anti-vaccine advocate who has spread conspiracy theories.
In an interview with Ars Technica last week, Zach Holbrooks, the executive director of the South Plains Public Health District (SPPHD), which includes Gaines, said that the area has a large religious community that has expressed vaccine hesitancy.
Additional cases likely
Pockets of the county have yet lower vaccination rates than the county-wide averages suggest. For instance, one independent public school district in Loop, in the northeast corner of Gaines, had a vaccination rate of 46 percent in the 2023–2024 school year.
Measles is one of the most infectious diseases known. The measles virus spreads through the air and can linger in the airspace of a room for up to two hours after an infected person has left. Ninety percent of unvaccinated people who are exposed will fall ill with the disease, which is marked by a very high fever and a telltale rash. Typically, 1 in 5 unvaccinated people with measles in the US end up hospitalized, and 1 in 20 develop pneumonia. Between 1 to 3 in 1,000 die of the infection. In rare cases, it can cause a fatal disease of the central nervous system called Subacute sclerosing panencephalitis later in life. Measles can also wipe out immune responses to other infections (a phenomenon known as immune amnesia), making people vulnerable to other infectious diseases.
“Due to the highly contagious nature of this disease, additional cases are likely to occur in Gaines County and the surrounding communities,” the state health department said.
While Gaines is remarkable for its low vaccination rate, vaccination coverage nationwide has slipped in recent years as vaccine misinformation and hesitancy have taken root. Overall, vaccination rates among US kindergartners have fallen from 95 percent in the 2019–2020 school year into the 92 percent range in the 2023–2024 school year. Vaccine exemptions, meanwhile, have hit an all-time high. Health experts expect to see more vaccine-preventable outbreaks, like the one in Gaines, as the trend continues.
The statement seemed to offer an assurance that other vaccines were not subject to the new restrictions. “Changes regarding seasonal vaccines like COVID and influenza do not change the Department’s policy or messaging regarding childhood immunizations,” it read.
This flu season, the health department has reportedly canceled standard vaccination events and clinics. On social media, the department has avoided mentioning flu shots in posts about the flu, instead advising people to wash their hands and cover their coughs.
While Louisiana is seeing an early surge in influenza, the rest of the country is on an upward trend in what appears to be a normal-looking season so far. Nationally, the percentage of doctor visits that were for ILIs is 3.8 percent, with the upswing in ILI activity similar to what was seen in the 2019–2020 flu season at this point in the year. At the peak of flu seasons, the percentage of visits for ILIs usually tops out around 7 percent to 8 percent.
US ILI activity charted by week across several flu seasons Credit: CDC
Two children died last week of flu, bringing the season’s total pediatric deaths to four. In the 2023–2024 season, 206 children died with influenza-associated disease. Most of the deaths occurred in early 2024.
COVID-19 is also ramping up a winter wave. While standard disease burden indicators—hospitalization and deaths—are low, they’re trending positive. Wastewater surveillance, meanwhile, is showing a steep incline, with levels of the virus being detected at “moderate” levels.
Enlarge/ A US child infected with measles during a 2024 outbreak. The child’s cheek shows the characteristic rash associated with this viral infection.
With one of the highest vaccine exemption rates in the country, Oregon is experiencing its largest measles outbreak in decades. This year’s count is now higher than anything seen since 2000, when the Centers for Disease Control and Prevention declared the highly contagious virus eliminated from the US.
Last month, when the outbreak tally was still in the 20s, health officials noted that it was nearing a state record set in 2019. There were 28 cases that year, which were linked to a large outbreak across the border in Washington state. But, with that record now surpassed, the state is in pre-elimination territory.
“Before 2019, you have to go all the way back to the early 1990s to see case counts this high,” Paul Cieslak, medical director for communicable diseases and immunization at Oregon Health Authority, said in a statement. “The reason is, we maintained very high vaccination rates and very high population levels of immunity. Unfortunately, we’ve seen an erosion in the percentage of people who are getting vaccinated against measles.”
Vaccination decline
In 2000, when measles was declared officially eliminated, only about 1 percent of kindergarteners in the state had exemptions from childhood vaccines, such as measles. But in the years since, Oregon has become one of the states with the highest exemption rates in the country. In the 2022–2023 school year, 8.2 percent of Oregon kindergarteners had exemptions from vaccinations, according to a CDC analysis published in November. Only Idaho had a higher rate, with 12.1 percent of kindergarteners exempt. Utah was a close third, with 8.1 percent, followed by Arizona (7.4 percent) and Wisconsin (7.2 percent).
Oregon’s exemption rate has risen since then, with the exemption rate now at 8.8 percent, according to the Oregon Health Authority. Any exemption rate above 5 percent is concerning. At that threshold, even if every non-exempt child is vaccinated, a state will not be able to achieve the target of 95 percent vaccine coverage expected to prevent sustained transmission of infectious diseases.
Health officials are directly linking the rise of non-medical exemptions to the current measles outbreak, which is centered in Clackamas, Marion, and Multnomah counties. All three are in the northwestern corner of the state, with Clackamas and Multnomah in the Portland area.
“In Clackamas County, as in other Oregon counties, pockets of unvaccinated people raise risk of infection in communities where they live,” Clackamas County Health Officer Sarah Present said. “That’s why the counties reach out to every case that’s been identified and try to determine exactly where they’ve been while infectious.”
Notorious virus
Measles is among the most infectious viruses known. It is notorious for its ability to stay aloft in indoor air for up to two hours after an infected person has been present. For unvaccinated people who are exposed, up to 9 out of 10 will end up falling ill. Those who become infected are contagious from about four days before developing the tell-tale rash and four days after it erupts. Other common symptoms of the infection include high fever, runny nose, cough, and conjunctivitis (pink eye). Many children become severely ill, requiring hospitalization.
In a small percentage of cases, measles can lead to severe complications, including pneumonia, encephalitis, and a progressive neurological disorder (subacute sclerosing panencephalitis), which develops five to 10 years after an initial infection. Additionally, measles is known to cause “immune amnesia.” That is, being infected with measles virus wipes out existing antibodies and immune responses to other germs, leaving people more vulnerable to other diseases.
So far this year, the US has logged 236 measles cases. Of those, 40 percent were in children under the age of 5, while 30 percent were in children and teens between the ages 5 and 19. Eighty-seven percent were either unvaccinated or had an unknown vaccination status. Forty-four percent (103 of 236) were hospitalized.
This year’s tally is already well ahead of the total for 2023, which reached just 59 cases. It is still significantly lower than the 1,274 cases seen in 2019, when the US nearly lost its elimination status.
