Grim news from multiple publications regarding the ongoing measles outbreak across the United States was published yesterday. After being eliminated in the U.S. for a quarter of a century, measles is making a huge and dangerous comeback, amid rampant disinformation and anti-vaccine voices, including multiple Trump administration officials.
The first was a simulation model, published yesterday in JAMA, that found that if the U.S. continues at the current vaccination rate, in 25 years measles would become an endemic disease with close to one million cases in the next quarter century. A 10% drop in MMR vaccination rates would bring the number of cases up to over 11 million. However, the model also found that all is not lost, if we can increase childhood MMR vaccination rates nationally by 5%, the number of cases would drop to only 5,800. According to the model, other vaccine-preventable diseases (such as polio, rubella, and diphtheria) are unlikely to reestablish endemicity under current levels of vaccination. However, with declining childhood vaccination rates, the increase and size of outbreaks of previously eliminated vaccine-preventable diseases will eventually lead to their return to endemic levels. Based on the estimates from the simulation model, the timing and critical thresholds are widely different by disease, with measles likely being the first to return to endemic levels due to it's extremely high rate of transmission. And unless vaccination rates and public health response improve, it may even occur under current vaccination levels.
A report published yesterday in the CDC's Morbidity and Mortality Report Weekly (MMRW), details the current measles outbreak in the U.S. with data from January 1 - April 17, 2025. In recent years large measles outbreaks (>50 cases) have been becoming more and more frequent, especially in tight-knit communities with low vaccination rates. During 2001–2023, approximately 90% of U.S. measles outbreaks with 50 or more cases occurred in close-knit communities with low vaccination coverage.
According to the MMWR report, a total of 800 measles cases and 10 outbreaks were reported in the U.S. during the first 16 weeks of 2025. a 180% increase over the 285 cases reported during all of 2024. The majority of cases are associated with the current multi-state outbreak, predominantly among close-knit Mennonite communities with low vaccination rates in Western Texas, New Mexico, and Oklahoma, accounted for 654 (85.5%) cases. An additional 37 cases in Kansas are suspected to be linked to this outbreak; all 208 genotyped specimens obtained from measles patients in Kansas, New Mexico, and Texas were genotype D8 with 94% carrying identical sequences. The source of this outbreak is still unknown.
The United States, Canada, and Mexico are all experiencing large, expanding outbreaks within similar interconnected communities. Such communities tend to have frequent communal gatherings and many have concerns about engaging with public health and health care systems for testing, treatment, and vaccination. Additionally, frequent travel among these communities across various states and countries can facilitate rapid spread of measles. Therefore, public health departments need to consider partnering with trusted community members, including clinicians and religious leaders, on providing culturally competent community engagement, education, and vaccination efforts, as well as identifying acceptable infection control approaches for the community. There also needs to be coordination with health care facilities, early childhood education facilities, schools, and daycares, as well as other congregate settings that surround or serve these communities.
Of the 800 reported cases, 48 (6%) were directly imported from other countries, including 44 among U.S residents who had travelled abroad; 15 (31%) of these imported cases resulted in secondary cases. Imported cases came from the following countries: Canada (10), Vietnam (10), Mexico (7), Pakistan (3), Philippines (2), Saudi Arabia (2), and one case from each Afghanistan, Australia, Guinea, Netherlands, Somalia, Spain, and Uganda. Seven cases could not determine a source country, as they had visited multiple countries during their exposure period. Additionally, a growing outbreak is occurring in Chihuahua, Mexico, after a resident was infected while traveling to Gaines County, Texas in late February.
A joint alert by the WHO, UNICEF, and Gavi (the Vaccine Alliance) during World Immunization Week (April 24-30) offers a stark warning of how immunization efforts are being jeopardized globally due to misinformation, population growth, and humanitarian crises. Large outbreaks of vaccine-preventable diseases are rising globally.
In response, the agencies are calling for urgent and sustained political attention and investment to strengthen immunization programmes and protect significant progress achieved in reducing child mortality over the past 50 years.
The number of children missing routine vaccinations has been increasing in recent years, even as countries make efforts to catch up children missed during the pandemic. In 2023, an estimated 14.5 million children missed all of their routine vaccine doses – up from 13.9 million in 2022 and 12.9 million in 2019. Over half of these children live in countries facing conflict, fragility, or instability, where access to basic health services is often disrupted.
“The global funding crisis is severely limiting our ability to vaccinate over 15 million vulnerable children in fragile and conflict-affected countries against measles,” said UNICEF Executive Director Catherine Russell. “Immunization services, disease surveillance, and the outbreak response in nearly 50 countries are already being disrupted – with setbacks at a similar level to what we saw during COVID-19. We cannot afford to lose ground in the fight against preventable diseases.”
UNICEF, WHO, and Gavi urgently call for parents, the public, and politicians to strengthen support for immunization. The agencies emphasize the need for sustained investment in vaccines and immunization programs and urge countries to honor their commitments to the Immunization Agenda 2030 (IA2030).
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