2025 Southwest United States measles outbreak

Disease outbreak in the United States

2025 Southern United States measles outbreak

Disease| Measles
Virus strain| Measles morbillivirus
Location| United States (Texas, New Mexico, Oklahoma, Kansas), Mexico (Chihuahua)
First reported| January 17, 2025
Index case| Unidentified
Confirmed cases| 739[a][1][2][3][4]

Deaths

| 3
Vaccinations| Measles vaccine

In January 2025, cases of measles began to break out in Texas and neighboring states in the United States. Two cases linked to international travel were identified in Houston, followed by two more in Lubbock County. Gaines County became the epicenter of the outbreak and by mid-February, the disease had spread to New Mexico and other communities in West Texas including Dallam, Dawson, Ector, Lynn, Terry, and Yoakum. In March, cases linked to the outbreak were announced in Oklahoma, the Mexican state of Chihuahua, and Kansas.

The outbreak is confirmed to have infected hundreds of individuals and is suspected to have infected many more. More than 50 individuals have been hospitalized, and three have died: two children in Lubbock (a six-year-old and an eight-year-old) and an adult in Lea County, New Mexico.

Measles is highly contagious and preventable by the MMR vaccine. Though the United States declared measles eliminated in 2000, waning vaccination rates have led to its resurgence in the country, including the ongoing outbreak. The 2025 outbreak has led to the first measles deaths in the country since 2015, and the three deaths were in unvaccinated individuals.

## Background

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Measles rash shown on child. Rash normally appears after 4 days

In the United States, before the measles vaccination program started in 1963, the Centers for Disease Control and Prevention (CDC) estimated that about three to four million people were infected each year, of which approximately 500,000 were reported, with 400 to 500 people dying and 48,000 being hospitalized.[5] Measles is one of the most contagious viruses, and can be passed through respiratory droplets in the air, with unvaccinated individuals at 90% risk of getting measles if they are exposed.[6] Symptoms usually develop 10–12 days after exposure to an infected person and last 7–10 days.[7][8] Initial symptoms typically include fever, often greater than 40 °C (104 °F), cough, runny nose, and inflamed eyes, with a red, flat rash which usually starts on the face and then spreads to the rest of the body.[9][10]

Graph showing the numbers of reported cases of measles between 1938-2019

The MMR vaccine is a safe and effective preventative measure against measles with the first dose given to children between 12 and 15 months of age and a second dose between 4 and 6 years.[11] Though measles was eliminated in the United States in 2000, falling vaccination rates have contributed to its resurgence.[11] Vaccination rates among children have dropped since the COVID-19 pandemic and most states have dropped below the 95% threshold considered effective to prevent community outbreaks.[11][12]

The high rate of vaccination exemptions in Gaines County, Texas, has been blamed for the outbreak.[13] It has one of the highest rates in the country of vaccine opt-outs among children, with nearly 14% skipping a required vaccine in the prior school year.[14] The outbreak has been concentrated in a Mennonite community known to be under-vaccinated.[11]

## Epidemiology

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As of March 7, 2025, 228 cases have been confirmed.[15] In mid-February, it was reported that of the reported cases 39 were aged between 0–4 years old, 62 were aged 5–17 years old, 18 were aged 18 and older, with five cases not completely age identified.[6] Since there have been two deaths and the fatality rate of measles is estimated to be around one to three deaths per 1000, epidemiologists suspect the number of cases could be much higher.[16] The outbreak came amid sporadic smaller outbreaks across the United States.[17] The majority of cases have been in children who are unvaccinated or of unknown vaccination status, with a hospitalization rate of 17%; the origin of the outbreak is unknown.[17]

### Texas

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On January 17, 2025, the Houston Health Department confirmed two cases of measles, the first reported cases in Houston since 2018. The patients were in the same household and had traveled recently.[18] Two cases in unvaccinated school-age children in Lubbock, Texas, were later confirmed; the last case of measles in Lubbock County was reported in 2004.[19] The first child in Lubbock had contracted the disease after sitting in an emergency room with another child who was sick.[11] The children resided in Gaines County.[20] By February 7, the number of confirmed cases had increased to nine with three probable cases,[21] before reaching fourteen confirmed cases with six probable cases.[22]

By mid February it was reported that the outbreak had spread to nine Texas counties mostly concentrated in the rural South Plains region, with counties including Dallam, Dawson, Ector, Gaines, Lubbock, Lynn, Terry, and Yoakum.[6] It was reported on February 24, that a person with measles had traveled outside of the outbreak area, to visit the campus of University of Texas at San Antonio and other local establishments.[23] By late February more than 20 patients have been hospitalized at Covenant Children's Hospital. Some of them were suffering bacterial pneumonia and were requiring intubation to breathe.[11]

On February 26, an unvaccinated six-year-old girl died of measles in Lubbock, the first death attributed to the outbreak.[24][25] She had been sick for three weeks before being put on a ventilator and succumbing to pneumonia.[25] She was the first measles death in the country since 2015.[26] In a media interview less than a month later, the girl's father commented that "vaccination has stuff we don't trust … We don't like the vaccinations, what they have these days. We heard too much, and we saw too much."[25] Also in the same time period, the girl's father and mother, who are Mennonites, both appeared on video for a video interview by anti-vaccine organisation Children's Health Defense, where the father said that "measles are good for the body", while the mother told other parents regarding the measles, mumps and rubella vaccine: "Don't do the shots", with measles being "not as bad as they’re making it out to be."[27]

Legacy Traditional School, a charter school in Cibolo, near San Antonio, told parents on February 27 that a student was infected with measles.[28] However, the child was actually infected with rubella, a different disease that can also be prevented by the same MMR vaccine.[29] Austin confirmed on February 28 its first measles case since 2019, an unvaccinated infant who contracted the disease while overseas.[30]

On April 3, an eight-year-old girl died of "measles pulmonary failure" in Lubbock, marking the second child death from the outbreak.[31] She was not vaccinated.[32]

### New Mexico

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New Mexico health officials began checking residents for measles on February 3.[33] On March 6, an unvaccinated adult in Lea County died and was later revealed to have contracted measles prior to his death.[34]

### Oklahoma

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The first two cases linked to the outbreak were identified in Oklahoma on March 11.[35]

### Kansas

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By March 28, 23 cases had been confirmed in Kansas; 21 of the cases were in children, and 20 of the total cases were in unvaccinated individuals.[36] Genetic analyses suggest they were related to the Texas outbreak, but the exact exposure is not known.[36]

### Chihuahua

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The Mexican state of Chihuahua, where the vaccination rate is at 75%, identified 15 cases of measles in Cuauhtémoc and one in Namiquipa on March 12.[37] The outbreak has been concentrated in a Mennonite community whose members regularly travel to Texas to visit family and carry out business.[38] There were also 25 cases of whooping cough (pertussis) discovered.[39]

## Responses

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### Federal

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During a cabinet meeting on February 26, Robert F. Kennedy Jr., the United States secretary of health and human services (HHS), stated: "We are following the measles epidemic every day. Incidentally, there have been four measles outbreaks this year. In this country last year there were 16. So, it's not unusual. We have measles outbreaks every year."[40] Kennedy, who is known for his anti-vaccine activism and history of downplaying measles resurgences, also stated incorrectly that there were two deaths and that the hospitalizations were for quarantine purposes.[24][41] Only one death had been recorded at that time,[26] and officials in Lubbock stated that they do not hospitalize patients for quarantine purposes. The officials stated that the children who were admitted were having difficulty breathing (with some requiring intensive care and supplemental oxygen). They added that all of the admitted children were unvaccinated.[40] Senator Bill Cassidy, who chaired the Senate health committee, tweeted that the death was "absolutely devastating" and encouraged parents to vaccinate their children.[42][43]

Infectious disease experts Cameron Wolfe of Duke University, David Higgins of the University of Colorado, and former head of the National Immunization Program Walter Orenstein objected to Kennedy's description of the outbreak as "not unusual" and stated the child's death was fully preventable with proper vaccination.[24][26] Ali S. Khan, the former Director of the Office of Public Health Preparedness and Response at the Centers for Disease Control and Prevention (CDC) called for political officials at all levels to promote vaccination.[44] In contrast to the 2019 New York measles outbreak—when CDC officials and Health Secretary Alex Azar urged vaccination—the CDC and Health Secretary did not release statements or make posts on social media urging vaccination.[42] On March 4, the CDC, which had been providing MMR vaccines and lab support, posted on X that the Epidemic Intelligence Service would be helping the Texas State Department of Health.[45] The organization also began planning a large-scale study of vaccines and autism, though extensive research has shown no connection between the two.[46]

Kennedy published an opinion piece about the outbreak on the Fox News website on March 2.[47] He suggested parents consult with healthcare providers about vaccination, but did not explicitly recommend it, stating the choice was "personal."[48][49] He also promoted vitamin A supplementation and, in later interviews, cod liver oil, neither of which are effective treatments.[50] Infectious disease specialists interviewed by Stat interpreted Kennedy's column as echoing the messages of anti-vaccine activists, who emphasize nutrition, supplementation, and parental choice over vaccination.[51] Kennedy gave an interview to Fox News' Marc Siegel on March 8 in which he made numerous false claims including that it is "almost impossible" for healthy individuals to die from infectious disease and that the child who died may have been malnourished, despite health official's statements that she had no underlying conditions.[25][52] Kennedy's promotion of unproven treatments for measles during the outbreak was cited as one of the reasons for the resignation of Kevin Griffis, the CDC communications director.[53][54]

In April, federal budget cuts led to layoffs of frontline workers and the cancellation of over 50 measles vaccination clinics in Texas, many of which were planned in areas with low vaccination rates.[55][56] After a second child died of measles, Kennedy attended her funeral.[57] He met with the families of both children who died of measles, stated that the CDC would redeploy a team to Texas at the request of governor Greg Abbott, and that HHS would follow the state's lead.[58]

Afterwards Kennedy posted on X that "the most effective way to prevent the spread of measles is the MMR vaccine" but again did not explicitly recommend it.[58] He also praised two doctors (Ben Edwards and Richard Barlett) who had treated children with aerosolized budesonide (a steroid) and clarithromycin (an antibiotic)—which may weaken the immune system—as "extraordinary healers".[58] Edwards had earlier in the outbreak described mass infections as "God's version of measles immunization",[59] and Barlett had inaccurately promoted budesonide as a cure for COVID-19[59] and been disciplined in 2003 by the Texas Medical Board for "unusual use of risk-filled medications".[60][61]

### State and local

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Schools did not order unvaccinated students to stay home as it would require declaring a state of emergency.[62] The Texas Department of State Health Services stated that such a declaration was not necessary since 90% of Texans are vaccinated; they ordered a 21-day quarantine for exposed unvaccinated individuals, but this would not be tracked or enforced.[62] In rural Texas, the challenges of the outbreak were exacerbated by a lack of adequate public health infrastructure, primary care practitioners, and funding as 26 hospitals had closed between 2010 and 2020.[63]

As news of the outbreak spread, health officials reported a rise in families deciding to vaccinate their children. The director of public health in Lubbock county stated that in the last week of February 2025 they had given approximately 100 doses of the MMR vaccine to children who had previously been unvaccinated or whose parents did not believe in vaccines.[64] Vaccine-hesitant parents, including those who had sought exemptions for their children, were also bringing them to receive vaccines.[65] High demand for vaccines caused shortages in some parts of Texas, particularly Austin.[50] State vaccine registry data suggested there was a 10% increase in vaccination rates compared to 2024 in Gaines County.[66] However, some families continued to refuse vaccines and instead opted for vitamin A supplements, cod liver oil, or budesonide—a steroid used for asthma—and supported Kennedy's stances.[67][68][54] Multiple children treated for measles at Covenant Children's Hospital in Lubbock showed signs of liver damage, a symptom of vitamin A toxicity.[54][69]

## See also

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* 2019 Samoa measles outbreak
* Measles resurgence in the United States
* MMR vaccine
* Vaccine hesitancy
* History of public health in the United States

## Notes

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1. ^ As of April 22, 2025, 624 cases in Texas, 65 cases in New Mexico, 37 cases in Kansas and 13 cases in Oklahoma have been confirmed or deemed probable.

## References

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1. ^ "Measles Outbreak". dshs.texas.gov. Texas Health and Human Services. Retrieved March 13, 2025.
2. ^ "2025 Measles Outbreak Guidance". nmhealth.org. New Mexico Health. Retrieved March 13, 2025.
3. ^ "Measles". oklahoma.gov/health. Oklahoma State Department of Health. Retrieved March 19, 2025.
4. ^ "Measles Data". kdhe.ks.gov. Kansas Department of Health and Environment. Retrieved March 29, 2025.
5. ^ "Measles Frequently Asked Questions about Measles in U.S". U.S. Centers for Disease Control and Prevention (CDC). August 28, 2018.
6. ^ a b c Simpson, Stephen; Langford, Terri; Klibanoff, Eleanor (February 19, 2025). "West Texas measles cases rise to 124. Here is what you need to know". The Texas Tribune. Retrieved February 27, 2025.
7. ^ "Measles Fact sheet N°286". World Health Organization. November 2014. Archived from the original on February 3, 2015. Retrieved February 4, 2015.
8. ^ Bope, Edward T.; Kellerman, Rick D. (2014). Conn's Current Therapy 2015. Elsevier Health Sciences. p. 153\. ISBN 978-0-323-31956-0. Archived from the original on September 8, 2017.
9. ^ "Measles (Rubeola) Signs and Symptoms". Centers for Disease Control and Prevention. November 3, 2014. Archived from the original on February 2, 2015. Retrieved February 5, 2015.
10. ^ Caserta, MT, ed. (September 2013). "Measles". Merck Manual Professional. Merck Sharp & Dohme Corp. Archived from the original on March 23, 2014. Retrieved March 23, 2014.
11. ^ a b c d e f Shastri, Devi; Seitz, Amanda (February 26, 2025). "A Texas child who was not vaccinated has died of measles, a first for the US in a decade". AP News. Retrieved February 27, 2025.
12. ^ Stobbe, Mike (October 2, 2024). "US school-entry vaccination rates fall as exemptions keep rising". AP News. Retrieved February 27, 2025.
13. ^ Moniuszko, Sara; Higgins, David (February 12, 2025). "Measles outbreak in Texas was "completely preventable," infectious disease expert says". CBS News. Retrieved February 26, 2025.
14. ^ Smith, Peter (February 26, 2025). "Who are the Mennonites in a Texas community where measles is spreading?". AP News. Retrieved February 27, 2025.
15. ^ Edwards, Erika (April 5, 2025). "Second measles death reported in Texas amid fast-growing outbreak". NBC. Retrieved April 5, 2025.
16. ^ Joseph, Andrew (March 12, 2025). "Why health experts fear the West Texas measles outbreak may be much larger than reported". STAT. Retrieved March 12, 2025.
17. ^ a b "United States of America". World Health Organization (WHO). January 1, 1900. Retrieved March 28, 2025.
18. ^ Zuvanich, Adam (January 17, 2025). "Houston Health Department reports city's first measles cases in seven years". KUHF. Retrieved February 26, 2025.
19. ^ Simpson, Stephen; Carter, Jayme (January 30, 2025). "Measles cases reported in Texas as vaccine rate against the disease has fallen". The Texas Tribune. Retrieved February 26, 2025.
20. ^ Brindley, Emily (January 30, 2025). "Texas officials identify 2 measles cases in unvaccinated school-age children". The Dallas Morning News. Retrieved February 26, 2025.
21. ^ Mole, Beth (February 7, 2025). "Measles outbreak erupts in one of Texas' least-vaccinated counties". Ars Technica. Retrieved February 26, 2025.
22. ^ McPhillips, Deidre (February 7, 2025). "Measles outbreak expands in West Texas around county with low vaccination rate". CNN. Retrieved February 26, 2025.
23. ^ Edwards, Erika (February 26, 2025). "As Texas measles outbreak grows, parents are choosing to vaccinate kids". www.aol.com. Retrieved February 27, 2025.
24. ^ a b c Levenson, Michael; Rosenbluth, Teddy; Mandavilli, Apoorva (February 26, 2025). "Unvaccinated Child Dies of Measles in Texas, Officials Say". The New York Times. Retrieved February 26, 2025.
25. ^ a b c d Bartlett, Tom (March 11, 2025). "His Daughter Was America's First Measles Death in a Decade". The Atlantic. Retrieved March 12, 2025.
26. ^ a b c Branswell, Helen (February 26, 2025). "Texas measles outbreak marks first fatality as more cases reported". STAT. Retrieved February 27, 2025.
27. ^ Zadrozny, Brandy (March 21, 2025). "How the anti-vaccine movement weaponized a 6-year-old's measles death". NBC News. Retrieved March 22, 2025.
28. ^ Whitney, Luke; Lynch, David (February 27, 2025). "DSHS says no confirmed measles case in San Antonio area school, despite Legacy Traditional School's notice: The Cibolo school told KENS 5 earlier in the afternoon there was a "confirmation of a measles case." The state says they haven't heard that". KENS channel 5 TV. Retrieved February 28, 2025.
29. ^ Phillips, Camille (February 27, 2025). "San Antonio-area charter school now says they have a case of rubella, not measles". Texas Public Radio. Retrieved February 28, 2025.
30. ^ Shastri, Devi; Press, Associated (March 1, 2025). "Texas measles outbreak rises to 146 cases spanning more than 9 counties". PBS News. Retrieved March 2, 2025.
31. ^ Rosenbluth, Teddy (April 6, 2025). "A Second Child Dies of Measles in Texas". The New York Times. Retrieved April 6, 2025.
32. ^ Salhotra, Pooja (April 6, 2025). "A second Texas child has died from measles, RFK Jr. to visit state, report says". The Texas Tribune. Retrieved April 6, 2025.
33. ^ Prokop, Danielle (February 3, 2025). "Texas measles outbreak puts New Mexico health officials on alert". Source NM. Retrieved February 26, 2025.
34. ^ Shastri, Devi (March 6, 2025). "New Mexico adult dies with measles, though cause of death isn't yet confirmed". Independent.co.uk. Retrieved March 6, 2025.
35. ^ "West Texas measles outbreak spreads into Oklahoma". NBC News. March 11, 2025. Retrieved March 12, 2025.
36. ^ a b Mukherjee, Neha; McPhillips, Deidre (March 28, 2025). "Multistate measles outbreak crosses 450 cases, with possible international spread". CNN. Retrieved March 28, 2025.
37. ^ "Texas measles outbreak spreads to Chihuahua". Mexico News Daily. March 14, 2025. Retrieved March 15, 2025.
38. ^ Resendiz, Julian (March 12, 2025). "El Paso, Juarez vigilant as 16 measles cases reported in Chihuahua". BorderReport. Retrieved March 15, 2025.
39. ^ Diario, Ismael Carrillo / El (March 13, 2025). "Registran 25 casos de tosferina y 18 casos de sarampión". El Diario de Chihuahua (in Spanish). Retrieved March 15, 2025.
40. ^ a b Edwards, Erika (February 26, 2025). "First measles death reported in Texas as Kennedy downplays the outbreak". NBC News. Retrieved February 26, 2025.
41. ^ Dervisevic, Hanan (February 27, 2025). "RFK Jr says US measles outbreak is 'not unusual' after first death in a decade". ABC News. Retrieved February 27, 2025.
42. ^ a b Joseph, Andrew (February 27, 2025). "On measles outbreak, the Trump administration's messaging strikes some as off-key". STAT. Retrieved February 28, 2025.
43. ^ @SenBillCassidy (February 26, 2025). "Absolutely devastating news. Encouraging parents to make sure their child is up-to-date on their vaccines. The measles vaccine is safe and effective" (Tweet) - via Twitter.
44. ^ Julie Steenhuysen, Chad Terhune (February 27, 2025). "Measles death in Texas puts Kennedy's vaccine views to the test". Reuters. Retrieved February 27, 2025.
45. ^ Mukherjee, Neha (March 4, 2025). "CDC says it's on the ground in Texas as measles outbreak grows to 159 cases". CNN. Retrieved March 13, 2025.
46. ^ Dan Levine, Leah Douglas (March 8, 2025). "Exclusive: US CDC plans study into vaccines and autism, sources say". Reuters. Retrieved March 9, 2025.
47. ^ Kennedy, Robert (March 2, 2025). "ROBERT F. KENNEDY JR.: Measles outbreak is call to action for all of us". Fox News. Retrieved March 3, 2025.
48. ^ Kounang, Nadia (March 3, 2025). "As measles outbreak grows, HHS secretary says vaccination is a personal decision that can protect individuals and communities". CNN. Retrieved March 3, 2025.
49. ^ Rosenbluth, Teddy (March 2, 2025). "Federal Officials Underplaying Measles Vaccination, Experts Say". The New York Times. Retrieved March 3, 2025.
50. ^ a b Schreiber, Melody (March 8, 2025). "Texas cities run short of MMR vaccine as measles outbreak drives demand". the Guardian. Retrieved March 9, 2025.
51. ^ Branswell, Helen (March 4, 2025). "As RFK Jr. delivers his message on measles, public health experts hear a familiar tune". STAT. Retrieved March 10, 2025.
52. ^ Rosenbluth, Teddy (March 10, 2025). "Kennedy Links Measles Outbreak to Poor Diet and Health, Citing Fringe Theories". The New York Times. Retrieved March 13, 2025.
53. ^ Griffis, Kevin (March 25, 2025). "When the government becomes a health misinformation superspreader". The Washington Post. Retrieved March 26, 2025.
54. ^ a b c Rosenbluth, Teddy (March 25, 2025). "For Some Measles Patients, Vitamin A Remedy Supported by RFK Jr. Leaves Them More Ill". The New York Times. Retrieved March 26, 2025.
55. ^ "Texas measles outbreak hits 422 cases; vaccine clinics canceled due to federal cuts". CBS Texas. April 1, 2025. Retrieved April 1, 2025.
56. ^ "Dozens of free measles vaccine clinics close in Texas as federal funding is cut". NBC News. April 1, 2025. Retrieved April 1, 2025.
57. ^ Vargas, Ramon Antonio (April 6, 2025). "Second child reportedly dies of measles in Texas amid growing outbreak". the Guardian. Retrieved April 6, 2025.
58. ^ a b c Payne, Daniel (April 6, 2025). "'Most effective way' to prevent measles is vaccination, RFK Jr. says, in most direct remarks yet". STAT. Retrieved April 8, 2025.
59. ^ a b Melnick, Kyle; Nirappil, Fenit; Sun, Lena H. (April 6, 2025). "RFK Jr. visits Texas after second child dies of measles amid outbreak". The Washington Post. Retrieved April 9, 2025.
60. ^ Jarvis, Lisa (April 8, 2025). "RFK Jr.'s Measles Message Is Too Little, Too Late". Bloomberg.com. Retrieved April 9, 2025.
61. ^ Goodman, Brenda; Mukherjee, Neha (March 6, 2025). "Kennedy touts unconventional therapies for measles linked to disciplined Texas doctor". CNN. Retrieved April 9, 2025.
62. ^ a b Klibanoff, Eleanor; Salhotra, Pooja; Langford, Terri; Carver, Jayme Lozano (February 28, 2025). "Texas leaders quiet amid the biggest measles outbreak in decades". The Texas Tribune. Retrieved February 28, 2025.
63. ^ Salhotra, Pooja (March 10, 2025). "With crumbling public health infrastructure, rural Texas scrambles to respond to measles". The Texas Tribune. Retrieved March 10, 2025.
64. ^ "As Texas measles outbreak grows, parents are choosing to vaccinate kids". NBC News. February 25, 2025. Retrieved March 2, 2025.
65. ^ Mole, Beth; Technica, Ars (March 1, 2025). "Texas Official Warns Against 'Measles Parties' Amid Growing Outbreak". WIRED. Retrieved March 2, 2025.
66. ^ Florko, Nicholas (March 28, 2025). "Texas Never Wanted RFK Jr.'s Unproven Measles Treatment". The Atlantic. Retrieved March 28, 2025.
67. ^ "In West Texas' measles outbreak, families forgo conventional medicine along with vaccines". NBC News. March 10, 2025. Retrieved March 13, 2025.
68. ^ Reddy, Sumathi (March 10, 2025). "In Rural Texas, a Measles Outbreak Hasn't Swayed Vaccine Skeptics". WSJ. Retrieved March 13, 2025.
69. ^ Davies, David Martin (March 28, 2025). "West Texas children treated for vitamin A toxicity as medical disinformation spreads alongside measles outbreak". TPR. Retrieved March 28, 2025.

## External links

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* Malenfant, Marley (February 11, 2025). "Measles outbreak in Texas affecting children. Here are symptoms parents should watch for". Austin American-Statesman. Retrieved February 26, 2025.