Why doctors say measles isn't just back, it's a warning sign for us all

Why doctors say measles isn't just back, it's a warning sign for us all

A measles outbreak concentrated in Texas and New Mexico shows the consequences of declining MMR vaccination rates and signals the urgent need to rebuild public health confidence before eradicating the diseases.

In a recent perspective published in the journalNew microbes and new infectionsResearchers described the current status of measles outbreaks with a focus on the United States, highlighting risk factors for the disease and recommendations for public health policy and clinical practice.

Without immediate action by policymakers and health care professionals, many communities could be at risk for severe disease outbreaks, leading to the return of endemic measles transmission in the United States

Global measles outbreaks

The Centers for Disease Control had reported 884 cases of measles in the U.S. as of April 2025, with 11 outbreaks spanning 29 states. Texas was the hardest hit, reporting 646 cases, while New Mexico reported 65.

Most infections are along the border that divides western Texas and southern New Mexico, accounting for over 90% of Texas' cases and nearly all of New Mexico's cases. Gaines County, Texas, has 393 cases, more than any single state, and saw two unvaccinated deaths involving a child from the local Mennonite community. Both children died in Lubbock. A third death, an unvaccinated adult, occurred in Lea County.

During the pandemic, parents stayed home and doctors focused on Covid-19, causing many children to miss routine vaccinations, a gap that has not yet been filled.

Those numbers marked the highest measles numbers the U.S. had seen since the disease was eliminated in 2000. Previous spikes included 667 cases in 2014 during the “Disneyland Outbreak” in California or in 2019 in New York's Jewish communities. Alarmingly, 2025 figures surpassed the 2019 total in just a few months.

According to the latest CDC update, the U.S. has now reported 1,197 measles cases, just 77 cases not in the 2019 total, which was the highest since national measles elimination was declared in 2000. Measles activity has now been confirmed in 35 states, up from 34 last week, likely reflected in Arizona's first reported cases of the year of the year. Four new outbreaks were reported, bringing the total to 21 nationwide, compared to just 16 outbreaks in all of 2024. Notably, 90% of this year's measles cases have occurred as part of the outbreaks, an increase from 69% last year, indicating cluster expansion following sustained transmission.

Internationally, measles cases have also increased.

In Europe, Europe is performing at record levels, particularly in Kazakhstan and Romania. The European Center for Disease Prevention and Control (ECDC) has reported that there were 56,634 cases of measles in 41 countries in the 12 months from April 2023 to March 2024. Five countries, Kazakhstan, Romania, Kyrgyzstan, Azerbaijan and the Russian Federation, accounted for 85% of all cases. Alarmingly, 11 countries reported more than 100 cases per million population, well above the World Health Organization (WHO) threshold for measles elimination. Hospitalization was required in 71% of reported cases and five measles-related deaths were documented. This escalation highlights immunity gaps and declining vaccination coverage in parts of the region, raising challenges in achieving elimination goals.

Africa continues to be severely affected without excluding any country. These patterns underscore growing global vaccine hesitancy.

Disease risk factors

The immune amnesia of measles has a hidden long-term cost: It can increase the risk of death from other infections such as tuberculosis for up to two years, especially in regions with high infectious disease burdens.

The current surge in American measles cases is being driven not by immigration but by declining vaccination coverage and domestic transmission. Most cases come from American residents who traveled abroad and were returned infected.

Because measles is extremely contagious, around 95% of the population should have immunity to prevent outbreaks, but national vaccination rates remain short. In 2023, fewer than 93% of children have had two doses of the measles, mumps and rubella (MMR) vaccine, and coverage is even lower in certain communities.

These estimates also exclude some undocumented and homebound children, who are less likely to receive vaccines, leaving numerous unprotected clusters. This year, 97% of measles cases occurred in people who were not vaccinated.

One example is Gaines County, Texas, which has the lowest vaccination rates in the state and the highest number of cases. A significant factor is the Mennonite community in the old colony, which maintains conservative traditions, resists assimilation, and has low access to healthcare messaging and public health, in part due to language barriers. This group is distinct from the Mennonite Church of America and typically speaks a Low German dialect. Although their doctrine does not explicitly prohibit vaccinations, cultural conservatism and historical exclusion from public health initiatives contribute to the under-observation.

Their low vaccination rates reflect other underserved groups such as New York Orthodox Jews, the Ohio Amish and clusters in California, each of which has faced recent outbreaks.

Coronavirus disease 2019 (Covid-19) disrupted routine vaccinations and increased public skepticism toward all vaccines. Even as pandemic restrictions have been lifted, uptake of MMR vaccines has continued to decline, fueled by political polarization and growing far-right ideologies that promote mistrust of science and public health.

This trend is consistent with global patterns; Global MMR vaccination rates fell to a 20-year low in 2021 and remain below target levels.

Additionally, rising anti-immigration sentiment is impacting health care access for undocumented immigrants, who face barriers such as cost, fears of deportation, and language barriers.

Texas, with the second largest undocumented population, risks expanding vulnerable groups. Equitable vaccination is critical to protecting public health and maintaining herd immunity.

Implications for politics and medicine

Reaching 'yes' on vaccines takes time and empathy: Parents often need multiple unprinted conversations to move from hesitancy to acceptance, as pushing barriers too hard can backfire.

Measles poses significant risks, primarily due to its serious complications, including pneumonia and encephalitis, which can be fatal.

Measles also weakens the immune system, leaving individuals more susceptible to other infections up to two years later. This “immune amnesia” may increase mortality rates beyond the initial illness, particularly in areas with other widespread diseases, and underscore the urgency for sustained and comprehensive prevention strategies.

Health care providers, especially primary care physicians, play a critical role in increasing vaccination rates. You need to engage parents in ongoing, respectful conversations that address fears and misinformation without judgment.

Children should receive routine MMR vaccines at 12 and 60 months of age, with early or accelerated doses given when the risk of exposure is high.

Denying care to families who refuse vaccines has not been proven effective. Instead, repeated, sensitive discussions can gradually change the mind.

Public health efforts must also address the cultural, religious and political influences behind vaccine hesitancy. Successful campaigns must take community beliefs into account, as demonstrated by an effective faith-led vaccination drive in India. This approach can build local outreach, such as in Gaines County, where religious communities have low vaccination rates.

Without decisive local and global action, communities will remain vulnerable to measles and other preventable diseases, raising concerns about the potential return of endemic measles in the United States. The authors describe measles as a “canary in the coalmine” and signals broader population susceptibility to vaccine-loss disease.

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