Measles Cases Surge Across North America, Threatening Elimination Status
The United States is experiencing its worst year for measles in over three decades, with 1,288 cases reported as of Wednesday, raising concerns that the nation could lose its status of having eliminated the highly contagious, vaccine-preventable disease.
The current national case count, as reported by the U.S. Centers for Disease Control and Prevention, already surpasses the total from 2019 – a year when America nearly relinquished its elimination status – and the year is only halfway over. Public health officials caution that the actual number of infections may be even higher.
The resurgence is not limited to the U.S., with significant outbreaks also reported in Canada and Mexico. Currently, North America faces major outbreaks in Chihuahua, Mexico (2,966 cases), Ontario, Canada (2,223 cases), and Alberta, Canada (1,246 cases), alongside the escalating situation in the United States.
West Texas Outbreak Drives National Increase
The largest outbreak in the U.S. originated five months ago in undervaccinated communities in West Texas. The situation has been dire, resulting in three deaths – two children in Texas and one adult in New Mexico – and numerous hospitalizations nationwide. However, there are emerging signs of progress, particularly in Texas.
Katherine Wells, public health director for Lubbock County, noted that the county hasn’t recorded a new case in the last 50 days. “What concerned me early on in this outbreak was is it spreading to other parts of the United States, and that’s definitely what’s happening now,” she said. Fourteen states currently have active measles outbreaks, while outbreaks in four other states have been contained.
A History of Elimination and the Risk of Resurgence
Measles was declared eliminated in the U.S. in 2000 by the World Health Organization and the CDC. However, maintaining elimination status requires sustained high vaccination rates. Dr. Jonathan Temte, a family physician in Wisconsin who helped certify the U.S. elimination in 2000, explained that the closer a disease gets to eradication, the more challenging it becomes to stamp it out.
While the U.S. has not reached the levels seen in 1991, when 9,643 cases were confirmed, the current trajectory is alarming. The measles, mumps, and rubella (MMR) vaccine is remarkably effective, preventing measles in 97% of individuals after two doses. Despite this, vaccine hesitancy and declining vaccination rates are fueling the current surge.
Declining Vaccination Rates and Funding Shortfalls
A recent study revealed a concerning trend: childhood vaccination rates against measles have fallen in nearly 80% of the over 2,000 U.S. counties with available data following the COVID-19 pandemic. CDC data further indicates that only 92.7% of kindergarteners in the U.S. received the MMR vaccine during the 2023-2024 school year, falling short of the 95% threshold needed to prevent outbreaks.
Compounding the problem is a lack of investment in local public health departments. State and federal leaders have maintained stagnant funding for vaccination programs, hindering efforts to reverse the declining trend. Wells emphasized the need for increased investment, stating that she regularly discusses outbreak preparedness with public health leaders across the country, but acknowledges the system’s limitations.
A “Canary in a Coal Mine”
Lauren Gardner, leader of Johns Hopkins University’s independent measles and COVID-19 tracking databases, described the measles outbreak as a “canary in a coal mine,” indicating a broader issue with vaccination attitudes in the country. She believes the problem is likely to worsen.
The outbreaks are not occurring in a vacuum. Similar patterns are emerging in other communities. The outbreaks in Ontario, Chihuahua, and Texas are linked to large Mennonite communities, where historically lower vaccination rates and a degree of distrust in government have been observed, though Mennonite churches do not formally discourage vaccination. In 2019, outbreaks in New York were traced to close-knit Orthodox Jewish communities.
The federal government has affirmed its commitment to addressing the issue, stating that the CDC “continues to recommend [measles, mumps and rubella] vaccines as the best way to protect against measles” and is “supporting community efforts” to contain ongoing outbreaks. However, public health officials like Dr. Temte express a sense of frustration. “When we have tools that can be really helpful and see that they’re discarded for no good reason, it’s met with a little bit of melancholy on our part,” he said.
The current measles surge serves as a stark reminder of the critical importance of vaccination and the ongoing need to address vaccine hesitancy and invest in public health infrastructure to protect communities from preventable diseases.
