The return of measles: how a once-vanquished disease is spreading again | MMR

TSouth Carolina’s measles outbreak now stands at 664 cases, more than doubling in just a few weeks, officials announced this week. The highly contagious virus has also spread to North Carolina, Ohio and Washington state, and similar outbreaks are also spreading in Arizona and Utah.

The outbreak, which began in Texas a year ago this week, has spread to most U.S. states — and as the U.S. passes the one-year mark, its measles elimination status will likely end, a symbol pointing to an expected wave of preventable illness throughout the year. The outbreak has been marred by misinformation, with Robert F Kennedy Jr, secretary of the US Department of Health and Human Services and a long-time vaccine critic, portraying measles vaccination as a personal choice and promoting unproven treatments.

The vast majority of those infected are children and most of them have not received the measles, mumps and rubella vaccine (MMR vaccine). Last year, there were 2,242 confirmed cases of measles in 44 states, according to the U.S. Centers for Disease Control and Prevention (CDC). There have already been 171 measles cases reported in nine states in 2026 — and that number doesn’t include the increase in cases South Carolina reported Friday.

“I think it’s just the new normal, unfortunately, that public health departments have to respond to,” said Katherine Wells, public health director in Lubbock, who oversaw the city’s response to the West Texas measles outbreak.

By 2026, measles will likely infiltrate more communities with low vaccination rates and then put pressure on vulnerable children and adults, even in highly vaccinated communities, she said. And measles is not the only fear.

“Measles is the canary in the coal mine,” Wells said. “As vaccination rates decline, we could see an outbreak of rubella, polio or some of these other vaccine-preventable diseases. »

Because it is highly contagious – it can linger in the air of a room for two hours – measles generally spreads more quickly than other infectious diseases. But preventable diseases like polio, tetanus, diphtheria and whooping cough aren’t far behind a measles outbreak.

“Measles is an indicator,” said James Alwine, professor emeritus at the University of Pennsylvania, virologist and member of the Defend Public Health coordinating committee. “This means that your vaccination level is so low that all other vaccine-preventable diseases will appear over time. »

Vaccination rates are declining across the United States as school exemptions increase, according to a new study published in the Journal of the American Medical Association (Jama). Kennedy has been a “key figure” in growing anti-vaccine sentiment for decades, “disparaging vaccines in general, particularly the MMR vaccine, trying to link it to autism when there’s no connection,” said Rob Davidson, an emergency physician in west Michigan and executive director of the Committee to Protect Health Care — adding that the danger had increased now that Kennedy had “the biggest public health megaphone in the country, maybe the world.”

Davidson has been a doctor for 28 years and, like many of his peers, has never seen a case of measles — all thanks to vaccines, he said. Now he’s preparing for the day he might encounter the disease in a patient.

“It’s something we need to think about regularly,” he said. “It’s a punch in the gut. It didn’t have to be this way.”

In South Carolina, 531 people are currently in quarantine and 85 in isolation, and eight people have been hospitalized with measles since the outbreak began.

“We really feel like we’re looking over the edge, knowing that the situation is about to get worse,” Johnathon Elkes, an emergency medicine physician at Prisma Health in Greenville, South Carolina, said Friday.

Helmut Albrecht, an infectious disease specialist at Prisma Health, urged the public to get vaccinated on Friday: “We have the largest outbreak in the United States right now, and it’s going to get worse before it gets better. »

In North Carolina, seven out of eight cases reported in recent weeks were linked to the South Carolina outbreak. At least three children in Ohio and Washington have also been sickened in this spiraling outbreak, which was first detected in Texas nearly a year ago. The virus is also spreading to other states. Arizona has recorded 217 cases and nine hospitalizations in the outbreak that began in August, and Utah has recorded 210 cases since its first case was detected in June.

The Pan American Health Organization (PAHO) announced Friday that it plans to review the elimination status of measles in the United States and Mexico in April, given the ongoing outbreak.

The outbreak began a year ago, on January 20, 2025, when the first child in Texas to test positive for measles developed a rash. When Wells learned that two children had tested positive and needed to be hospitalized, she rightly worried that this was just the tip of the iceberg, since one in five children with measles needed to be hospitalized.

“Our investigation revealed that there were many, many children sick with measles in the field,” Wells said. “We were already facing a real epidemic.”

The Texas cluster officially ended in August after 762 confirmed cases, 99 hospitalizations and the deaths of two young children. But by then, the outbreak had already spread to other states.

The loss of measles elimination status in the United States is a warning, Wells said: “We’re now entering an era where we’re going to see outbreaks in these unvaccinated communities, and I think then those outbreaks will start to put pressure on other, more vaccinated communities.” »

Children under 1 year old or with health conditions are most vulnerable, even in highly vaccinated communities. This is a particular concern in health care settings, where a child undergoing cancer treatment may come into contact with a patient with measles – particularly because the first symptoms of measles are a cough and runny nose; the telltale rash doesn’t set in until later.

During the Texas outbreak, Lubbock Public Health distributed thousands more MMR vaccines than usual, and other parts of the state also mobilized a response as pharmacies saw an increase in demand.

Some Lubbock parents have been vaccinating their infants early: Babies older than six months can receive the vaccine early, as long as they receive a third dose later, and although the second dose is generally recommended at age four, younger children can receive it earlier. School nurses contacted families of students who were behind on vaccinations or who had opted out for non-medical reasons, informing them of the safety and importance of vaccines.

“We’ve had parents come into our clinics who had never vaccinated their children, but seeing the disease and hearing about it on the news, they said, ‘Oh, it’s real. Let me get my child vaccinated,'” Wells said.

But experts are concerned about the recent announcement that the United States will no longer fully recommend several important childhood vaccines, which could create access problems and increase confusion.

“Putting them on a non-recommended list is going to make people think that maybe they’re not important, maybe they’re not needed,” Alwine said. School mandates are also criticized by anti-vaccine advocates, particularly now that several recommendations have changed.

“We need to make sure vaccines are available and that individuals know how vaccines can save lives,” Wells said. “The majority of parents on both political sides believe in vaccines and want their children to be vaccinated. And we need to make sure that these parents, and the people who would really be affected if these vaccination rates start to decline in schools, actually speak out and speak clearly about the situation. [how] it is important that we keep children vaccinated.

The resurgence of preventable diseases is straining an already overburdened health system.

“We’re definitely going to see more meningitis, hepatitis, RSV, rotavirus – all these things they just took out of the catalog. [full] list of recommendations,” Davidson said. The idea of ​​seeing more disease was “eviscerating,” he said.

Local public health departments across the country are now preparing for their own measles cases and other threats. One of Wells’ top tips is to improve community connections.

“We need to have more staff on the ground, working with communities, for all different types of health issues and health issues,” she said. These efforts can go a long way toward identifying cases before they explode into epidemics – and they can lead to important discussions about why these diseases pose such a threat.

“We’ve lived in the golden age of medicine for so long that there are so many people who have never seen these diseases, don’t even think about them, don’t even know they exist anymore,” Alwine said. “Or people think they’ve been eliminated, but that’s not the case. They’re just waiting.”