One of America’s worst measles outbreaks in recent years continues to spread, with 292 reported cases in western Texas and eastern New Mexico as of March 17. A nearby Oklahoma county has confirmed its first case, which officials believed to be linked to the outbreak’s epicenter in Gaines County, Texas. Two people have so far died from measles infections since the outbreak began in late January.
The actual number of cases is likely higher than the official count, based on reports from doctors who are treating patients as well as statistical analysis (two deaths would suggest thousands of cases, based on the measles’ mortality rate of roughly 1 in 1,000 infections). Officials fear the virus’s spread could persist into the spring and summer travel seasons, allowing the virus to reach other parts of the country; more cases and deaths could follow.
The outbreak has now exceeded the total number of reported measles cases in the US last year, which itself had already represented an increase from 2023. Measles vaccination rates in most US states have fallen below the 95 percent threshold scientists consider necessary to control the disease, and those rates have continued to drop. The Texas emergency appears to have begun in an insular religious community with high vaccination exemption rates; 14 percent of all children in Gaines County have exemptions.
The nation’s health leadership, meanwhile, is undermining the best defense against measles. While US health secretary Robert F. Kennedy Jr. has paid lip service to the value of vaccines, he has also pitched alternative treatments unsupported by medical science. He’s also launching new government investigations into the long-debunked theory linking autism and vaccines — investigations seem designed to erode public trust in the measles shot’s safety at the very moment it is most needed.
What’s happening right now could only be the beginning. The more the US strays from the public health playbook that helped the country to reach official measles elimination in 2000, the more outbreaks will likely occur — and the bigger they’ll be.
We may be entering a new era when this once-dormant virus is again an active threat to people’s health. Here’s what you can do to protect yourself and your family.
You really, really don’t want to get measles
Most Americans have been lucky enough to live in a world without measles, a disease that globally still kills over 100,000 people, most of them young children. Its risks, therefore, have become largely hypothetical.
But for the unvaccinated, those risks are real. Measles is a formidable and extremely contagious virus. It is dangerous during the initial infection, which can lead to high fever and the signature measles rash, while some patients will go on to develop pneumonia or encephalitis, an inflammation of the brain, both of which can be deadly.
Measles has a fatality rate of 0.1 percent, but an estimated 20 percent of cases require hospitalization. The disease is particularly threatening to kids, especially young infants, as well as pregnant women and people who are immunocompromised.
Some vaccine skeptics, including RFK Jr., downplay the risk of measles. “It used to be, when I was a kid, that everybody got measles. And the measles gave you lifetime protection against measles infection,” he said recently on Fox News. But measles was and is not some harmless disease: Between 400 to 500 children died annually from measles in the US in the decade before a vaccine was introduced in 1963. From 1968 to 2016, there were about 550 measles deaths total in the US, based on data from the Centers for Disease Control and Prevention. Until the recent deaths in the Texas outbreak, it had been 10 years since a single measles death had been recorded in the US.
Even those who do survive a measles infection can face long-term health consequences, particularly for those in high-risk groups. Some of those infected in the current outbreak may be dealing with the fallout for years.
Measles can cause what’s known as immunity amnesia. The virus can wipe out more than half a person’s preexisting antibodies that protect them against other pathogens, which can leave them more vulnerable to other diseases for years after their infection.
In rare cases, measles can lead to fatal brain swelling years after the initial infection. Patients can also suffer hearing loss from ear infections experienced during their illness, while those who develop acute encephalitis can suffer permanent neurological damage.
What you can do to protect yourself from measles
Vaccination remains the best defense against measles: Two doses of the MMR vaccine — given to protect against measles, mumps, and rubella — is 97 percent effective at preventing a measles infection (and therefore spread). It is perhaps the most effective vaccine we have for any disease, and any risks from the vaccine are astonishingly low compared to the dangers of measles itself.
In this new world where you’re more likely to see a measles outbreak in your community, people should consider taking steps to protect their health or that of their loved ones. Here’s what you can do.
Parents, if you have young children—the group most at risk from measles — talk to your pediatrician about vaccination. The usual schedule is one shot around age 1 and another shot around age 5, but there is some flexibility. The CDC already advises that infants as young as 6 months can receive one dose if they are traveling internationally, and the recommended age for the second dose ranges from 4 to 6 years old. Several leading public health experts, including former CDC director Rochelle Walensky, wrote in a recent JAMA op-ed that the recommendations should be updated to advise one shot for infants traveling in the US to areas with higher risk of exposure.
Reports of vaccinated people getting sick in Texas have at the same time raised questions about how protected vaccinated people actually are. As good as it is, 97 percent effectiveness isn’t 100 percent, and it is possible to be vaccinated and still get sick. For a small percentage of people, the vaccine simply doesn’t produce immunity. It is also possible that immunity could wane over time, but that was previously not an issue because high vaccination rates had snuffed out the virus’s spread.
In part because there may not be a lot of excess vaccine supply, the priority should be vaccinating those people who do not have any protection at all: those very young children and the people who weren’t vaccinated as kids. Pregnant women should not receive the vaccine, but women planning to become pregnant could talk to their doctor about a booster shot; likewise, people with immune conditions should talk with their doctor before getting an additional dose, as the vaccine’s live virus could present a risk depending on their level of immunodeficiency.
Those in high-risk groups may want to take additional precautions, such as wearing masks, if there are reports of measles infections in their immediate area. (That doesn’t just mean the areas of the current outbreak — isolated infections have also been found in California and Maryland in people who recently traveled internationally.)
For other people who have already been vaccinated but are worried about transmission, it may be reasonable to consider a booster shot. But there are some important steps you should take first.
First, check your vaccination records if you can find them. If you received two doses as a child, you very likely had a successful immune response; only three in 100 people don’t. If you received one dose — as was generally the case before 1989 — you’re probably still good, but it is a little more likely that you never developed immunity, according to Aaron Milstone, an infectious disease pediatrician at the Johns Hopkins University School of Medicine.
Either way, the next step would be to talk to your doctor. (As always, with anything regarding your health.) They can administer a “titer test” that measures the measles antibodies in your body. If they’re still present — great, you should be good. If they’re not, you may want to ask your doctor about getting an additional measles shot.
The risks should be kept in context: If you’re not near a confirmed measles case, your personal risk remains negligible. If you’re vaccinated and have antibodies, you are very likely protected from the virus regardless.
But they can not be ignored either. Milstone said he and his fellow infectious disease doctors could not believe it when they heard the news in February of a child’s death from measles in the United States of America.
“You hope people don’t have to die for others to take this seriously,” Milstone said.
