“Vaccines are the tugboats of preventive health.”
William Foege, M.D., American physician and epidemiologist
“This is the tip of the iceberg. I think this is going to get a lot worse before it gets better.”
Rekha Lakshmanan, Immunization Partnership, Houston, chief strategy officer
Last year, I wrote two posts on measles (rubeola). (See, “Measles Is Back: Why?,” Germ Gems, February 7, 2024; and “Measles Resurgence: Going from Bad to Worse,” Germ Gems, December 18, 2024.) But, right now, the U.S is facing its largest measles outbreak in six years. So, here we go again.
This measles outbreak started in January 2025, in a close-knit Mennonite community in West Texas. According to the Centers for Disease Control and Prevention (CDC), by February 21, 2025, this outbreak afflicted 93 people in rural Texas and nearby New Mexico. By February 25, 2025, one child in Texas had died from the disease. And, this outbreak is projected to continue for some time. My goal in writing this Germ Gems post is to describe this outbreak and put it in the larger context of ongoing underuse of vaccines against preventable infections, like measles.
What everyone should know about measles; a recap. Measles can be serious and even fatal, especially for small children. It is caused by an airborne virus that is highly contagious. In fact, experts consider measles to be one of the most contagious infectious diseases killing approximately 130,000 people globally per year with deaths occurring mainly in the developing world.
While measles is highly contagious and there is no specific treatment for the disease, it is preventable. In the 1960s, the highly effective and safe measles, mumps and rubella (MMR) vaccine was introduced. Over the past 50 years, this vaccine has saved an estimated 94 million lives globally.
Because of the MMR vaccine and massive vaccination programs around the world, measles has been eliminated in 81 countries. (In 2000 in the U.S., endemic measles was declared eliminated.) The disease has not, however, been eradicated. Major road blocks such as vaccine hesitancy and misinformation have prevented wiping this disease from the face of the Earth.
In 2023, the World Health Organization estimated that there were 107,500 measles deaths globally, largely in countries with low vaccination rates. Moreover, on December 18, 2024, I was prompted to write the Germ Gems post, “Measles Resurgence: Going from Bad to Worse,” because of the alarming increase in measles cases in the U.S. since 2022 attributed to vaccine disinformation promulgated by anti-vaxxers aimed not only at the COVID-19 vaccine but in general at other vaccines as well.
Symptoms. The key symptoms of measles usually include the three Cs: cough; coryza (a stuffy nose); and conjunctivitis (red eyes). Other symptoms include a high fever that may spike to more than 104 degrees Fahrenheit, a red blotchy rash, and Koplick spots (tiny white spots that appear inside the mouth two to three days after symptoms begin).
Severe cases can result in blindness, deafness, pneumonia, or encephalitis (swelling of the brain). Some cases of the illness can be fatal. Before the introduction of the measles vaccine in 1963, the virus claimed an estimated 2.6 million lives each year worldwide.
In the decade before 1963 in the U.S., there were 400 to 500 measles deaths per year. The virus was declared eliminated in the U.S. in 2000, meaning cases were no longer regularly occurring. Cases still happen in unvaccinated travelers entering the country and during outbreaks such as the current one in Texas and New Mexico.
Outbreak in Texas. As I mentioned earlier, on February 21, 2025, the CDC reported 93 measles cases with 11 hospitalizations in an outbreak in rural Texas and nearby New Mexico. On February 25, 2025, the Texas Department of Health reported 34 additional cases in the outbreak centered in the South Plains area in the western part of the state. As of this writing, the total number of cases has risen to approximately 150, including 9 cases in New Mexico. (The link between the Texas cases and those in New Mexico has yet to be established.)
The newest cases include the first of the outbreak in Dallam and Martin counties, pushing Texas’s number of affected counties to nine. Most of the latest measles confirmations are from Gaines County, where the outbreak began in the local Mennonite community.
The majority of cases are in children and teenagers. To date, 18 people have been hospitalized, 5 of whom were vaccinated with the rest either unvaccinated or having an unknown immunization status. On February 25, 2025, the first death was reported in an unvaccinated child. As vaccine expert, Dr. Peter Hotez, co-director of the Texas Children’s Hospital Center, commented, “We’re still in free fall. [This outbreak] still has a lot of energy and steam behind it.”
Vaccination rates. To be fully vaccinated against measles requires two shots. One dose of the vaccine is approximately 93% effective and two doses are 97% effective. Community immunity occurs when 95% or more of a community is vaccinated against measles.
Nine in ten Americans have received at least one of the two shots that normally comprise measles vaccination but only four of the infected people in Texas had done so. And in New Mexico, officials said that seven of their nine patients were definitely unvaccinated, while two “believed that they were vaccinated.”
Gaines County, where the Texas outbreak began, has one of that state’s lowest immunization rates for the MMR vaccine. Just 81% of children at state school kindergartens had vaccination certificates in this school year, far short of the 95% required to keep viral spread in the community at bay.
As mentioned earlier, the measle outbreak in Texas is centered in a closeknit Mennonite community. At the present time, it is unclear what role, if any, religious objections to vaccines played in the Mennonite community at the center of the Texas outbreak. (But see, “Vaccine Hesitancy Among Religious Groups: Reasons Underlying This Phenomenon and Communication Strategies to Rebuild Trust,” Frontiers in Public Health, 2022 where the authors discuss the religious reasons underpinning vaccine hesitancy for many religious groups, including Protestants, Catholics, Jews, Muslims, Amish, Hinduist and Sikhist.)
It is also not known what role, if any, Andrew Wakefield, who falsely linked measles vaccination to autism, played in the Texas measles outbreak. Wakefield, a disgraced British fraudster responsible for the most notorious of all anti-measles vaccination campaigns, has been living in Texas since 2021, and according to a 2018 article in The Guardian was “embraced by Trump’s America.”
A similar concern regarding potential anti-vaxxer influence can be raised regarding Robert F. Kennedy, Jr., America’s new Secretary of Health and Human Services. Kennedy is a notorious anti-vaxxer who has downplayed the Texas outbreak—even after the first death occurred.
Prospects for resolution of the Texas measles outbreak. It’s far too early in the course of the current Texas measles outbreak to forecast when it’s likely to be curtailed. Nonetheless, knowing of the extraordinary dedication and expertise of public health workers, in general, I believe that despite the broadsides to the “tugboat of preventive health,”—vaccines—the Texas Department of Public Health, along with the currently beleaguered CDC, will stem this measles outbreak. And hopefully it will do so sometime soon.
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