Is Measles Here To Stay?

The United States is on the verge of losing it's measles elimination status What this means for you based on when you were vaccinated.

For 25 years the United States has maintained its measles elimination status. To maintain this status there must be absence of continuous spread of disease for 12 consecutive months. Cases for 2025 have exceeded 607 reported cases (as of April 9th, 2025) and local health officials in West Texas have indicated it may take a year to control the outbreak meaning loss of measles elimination status is likely.

Amid the backdrop of slashing CDC employee numbers including eliminating the jobs of people who aid in response and containment of disease outbreaks. Another example of how chaotic the mass firings have been inside of Health and Human Services (which oversees the CDC. FDA, and NIH), just today it was reported that the FDA is again allowing telecommuting due to basic operations being threatened by layoffs.

Federal funds that supported vaccine distribution and free vaccine clinics, including measles vaccine distribution in Texas were abruptly shut down on Tuesday March 25th.

The measles outbreak in West Texas is likely underreported. Typical death rates among unvaccinated populations are about 3 in 1000. In West Texas and the associated New Mexico outbreak three people have died but only a combined 561 cases as of April 4th have been reported. To match well established death rates among unvaccinated people, it would mean that there have been nearly 500 unreported cases in the area.

It should be noted that cases of measles have been reported in numerous states in the United States this year, per the CDC:

As of April 3, 2025, a total of 607 confirmed* measles cases were reported by 22 jurisdictions: Alaska, California, Colorado, Florida, Georgia, Kansas, Kentucky, Maryland, Michigan, Minnesota, New Jersey, New Mexico, New York City, New York State, Ohio, Oklahoma, Pennsylvania, Rhode Island, Tennessee, Texas, Vermont, and Washington.

Given the long-standing anti-vaccine stance of the current HHS director as well as numerous recent appointees, it unlikely that federal resources will be directed to controlling the current outbreak. RFK Jr. recently claimed that the infection curve was flattening, but the data doesn’t agree.

It should be expected that this dismantling of public health will lead to more unnecessary deaths from measles and possibly the loss of elimination status in the United States.

Are Vaccine Updates Needed for Adults?

Every health organization around the world recommends the measles vaccine in childhood. Despite this vaccination rates began to fall globally during the SARS-CoV-2 pandemic and have not recovered. Outbreaks around the world have started in earnest with Canada and Mexico both combatting their own outbreaks due to a drop in vaccination rates. The current Ontario, CA outbreak is so large that New York Health officials have begun warning travelers.

Measles vaccination began in the United States in 1963 and both formulations and vaccine recommendations have been updated to ensure the best possible vaccine coverage, which has led to elimination of the disease in the United States being declared in 2000. Measles, until recently, had become so rare in the United States that most new doctors had never seen a case of what was once a common and deadly childhood disease.

Figure from: “154 million lives and counting: 5 charts reveal the power of vaccines”

Erosion of herd immunity will undoubtedly lead to increased measles exposure and it is recommended that people without presumptive immunity get the measles vaccine.

The CDC’s definition of presumptive immunity can be found here.

Additionally, the CDC recommends that adults who were vaccinated between 1963 and 1967 who received the less effective heat-killed virus vaccine get revaccinated.

Once the live-attenuated measles vaccine was introduced, children vaccinated with a single dose. However, this did not provide sufficient coverage as evidenced by several outbreaks and and a two-vaccine schedule was adopted in 1989, leading to measles elimination.

Currently, there is no recommendation for a catch-up program among adults for a second dose of MMR. However, people who are at high risk of exposure or have high-risk people in their lives can have their antibody titers checked and if they are found to be insufficient your physician may recommend a dose of the MMR vaccine.

Summary

• People vaccinated between 1963-67 are recommended to get another measles vaccine

• People vaccinated between 1967-1989 have only received a single dose of the measles vaccine and may want to check their antibody titers or get re-vaccinated especially if they have high risk of exposure and/or may expose someone else who is part of a vulnerable population.

• The CDC and local health departments have begun to recommend accelerated (single shot at 6 months) vaccine schedules for infants in areas where outbreaks are ongoing.

Personally, I hope that we are able to get these outbreaks under control and we do not lose measles elimination status in the United States. But realistically, it is unlikely without federal support for long-standing proven health interventions, which does not seem to be forthcoming.