Measles at Home, Retreat Abroad
One year after the West Texas-New Mexico outbreak, the U.S. steps back from the WHO as measles threatens its elimination status.
The Twin Crises: Domestic Outbreak and Global Retreat
It has been about a year since a measles outbreak was first reported in West Texas, which ultimately reached 762 confirmed cases, 99 hospitalizations, and 2 deaths in Texas, plus a linked New Mexico outbreak with 100 cases across nine counties and 1 death. And a year ago today, President Trump signed Executive Order 14155, initiating the United States’ withdrawal from the World Health Organization.
The timing was symbolic and consequential: the nation that helped lead global eradication of smallpox was simultaneously fighting its largest U.S. measles outbreak year since the early 1990s and stepping back from the very system built to contain such threats.
The U.S. could soon lose its measles elimination status, a designation held since 2000 that signified no sustained local transmission for more than 12 months. Losing elimination status would not be merely symbolic. It would confirm that measles is again circulating continuously in the population, creating a much higher risk of outbreaks here at home. It would likely prompt a call for revisiting national vaccination guidance to better protect infants if measles becomes endemic again. And travel guidance may increasingly emphasize ensuring measles immunity for anyone traveling to outbreak-affected areas, including the U.S.
How Measles Spread: From West Texas to a Nationwide Surge
The outbreak that began in Seminole, Texas, spread into neighboring Lea County, New Mexico, and ultimately totaled at least 862 cases across the two states: 762 in Texas and 100 in New Mexico. In Texas, more than two-thirds of cases were in children, 99 people were hospitalized, and two school-aged children died. New Mexico’s outbreak included one death.
From there, measles spread east through domestic travel and church gatherings, igniting clusters in South Carolina, Ohio, and Utah, and propelling the national total above 2,000 cases in 2025, the most since the 1990s.
According to the Centers for Disease Control and Prevention, 2,242 confirmed measles cases were reported to date across the United States in 2025, with 93% of patients unvaccinated or of unknown vaccination status and 11% hospitalized. As of January 13, 2026, an additional 171 cases have already been reported across nine states: Arizona, Florida, Georgia, North Carolina, Ohio, Oregon, South Carolina, Utah, and Virginia.
Hidden Gaps and Rising Vaccine Exemptions
A Nature Health study estimated MMR vaccine coverage for kids under age 5 in each U.S. county. It found that in some counties, coverage may be below 60%. The study’s estimates include babies younger than 6 months, who are too young to get the vaccine. The researchers also found that places with low vaccination often line up closely with recent measles outbreak areas, including parts of Texas and New Mexico.
Meanwhile, a research letter in JAMA found that more parents are skipping school vaccine requirements for personal or religious reasons. The typical county’s non-medical exemption rate rose more than five-fold, from 0.6% in 2010–2011 to 3.1% in 2023–2024, and the increase sped up after 2021. The authors also found wide county-to-county variation, with Utah, Idaho, Oregon, Wisconsin, and Arizona showing the highest exemption levels in 2021-2024. Together, this suggests that national vaccination averages, often based on kindergarten data, can hide serious local pockets where too few young kids are protected, which can allow measles to keep spreading.
The Real Dangers of Measles Infection
The short-term symptoms of measles, including fever, cough, and rash, are only the beginning of its dangers. The virus attacks multiple organs and weakens the body’s immune defenses, leaving children at risk for both direct and delayed complications.
Children under five years old are most at risk for serious illness. About one in five unvaccinated young children with measles needs hospital care, often because of pneumonia or dehydration. Measles can also cause ear infections and diarrhea, and in rare cases, the virus reaches the brain and causes swelling, called encephalitis. About 1 out of every 1,000 children with measles develops encephalitis, which can lead to seizures and may cause deafness, permanent brain damage, or intellectual disability. Very rarely, years after infection, measles can cause a deadly brain disease called subacute sclerosing panencephalitis (SSPE), a deadly brain disease that usually appears 7-10 years after the initial infection. Measles in pregnancy can also cause miscarriage, early delivery, or low birth weight. Overall, nearly 1-3 out of every 1,000 children infected with measles die from lung or neurologic complications.
Even after recovery, the infection continues to take a toll. Measles weakens the immune system for months or even years, a process known as “immune amnesia.” This immune damage erases the body’s memory of how to fight off other germs, making children vulnerable to illnesses like pneumonia and diarrheal disease that might otherwise have been mild. In places where measles remains common, these indirect effects have historically accounted for up to half of all childhood deaths from infectious diseases. For every visible rash, there is an invisible cost: a prolonged period of vulnerability that lingers long after the measles infection seems to have passed.
These risks show that measles is not just a harmless childhood rash. It is a serious disease that can damage many parts of the body and leave lasting health problems even after recovery.
Revisiting the U.S. Vaccine Schedule
In the United States, the MMR vaccine is given in two doses. Kids usually get the first dose at 12-15 months and the second dose at 4-6 years, before starting school.
But during measles outbreaks or when the risk is high, babies can be vaccinated earlier. The CDC says infants 6-11 months can get one early dose of MMR. Because babies this young may not build long-lasting protection from that early dose, it does not count as part of the regular two-dose series. Babies who get an early dose still need two more doses later: one at 12-15 months and another at 4-6 years. That schedule was designed for an era when measles exposure in the United States was extremely rare, after the virus had been declared eliminated in 2000.
If measles starts spreading more often in some U.S. communities, doctors may increasingly consider using this early-dose option to better protect babies who are too young for the routine schedule.
In countries where measles is still endemic or where outbreaks are common, children are often vaccinated much earlier. The World Health Organization recommends that infants in high-risk areas receive their first measles vaccination at 6 months. In those settings, the likelihood of exposure is high, and infants who remain unprotected during their first year of life face substantial risk of severe illness or death.
During the first few months of life, babies still carry maternal antibodies passed through the placenta during pregnancy. Those antibodies help protect against measles infection. By about six months, those antibodies have declined enough that the vaccine can “take,” producing a meaningful immune response.
But because doses given before 12 months may not generate full or durable immunity, the WHO and CDC advise that infants vaccinated at 6-11 months receive the standard two additional MMR doses later, at 12 months and again between ages 4 and 6. The additional early dose is considered a temporary shield during a period of heightened vulnerability, not a replacement for the regular series.
In the context of rising domestic outbreaks, many pediatricians and public health officials are now weighing whether the United States should adopt this same “outbreak dose” approach for infants living in communities where measles transmission persists, effectively treating those regions as temporary high-risk zones.
A New Reporting Rhythm: CDC Moves Measles Updates to Fridays
CDC has also changed how it reports measles numbers. Until now, CDC’s “Measles Cases and Outbreaks” page reflected confirmed cases reported as of 4:00 p.m. on Tuesdays. Starting the week of January 23, 2026, CDC says it will update that page on Fridays instead, shifting the public release of national measles totals to the end of the workweek, when newsrooms are thinner and audiences are turning to the weekend, making it easier for rising measles case counts to get less sustained media attention.