Outrage of the Month: Continuing Measles Outbreaks in the United States
Health Letter, April 2025
By Robert Steinbrook, M.D.
Director, Public Citizen's Health Research Group
If you’re not outraged,
you’re not paying attention!
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Measles has made a concerning comeback in the United States, the result of distrust in vaccines and declines in routine childhood vaccination rates. As of March 27 there were 483 confirmed measles cases in the United States in 2025, primarily in Texas and New Mexico, as compared to 285 confirmed cases in all of 2024. There has been one confirmed death, the first U.S. death from measles in more than a decade, and a second death is under investigation. Five measles outbreaks (defined as three or more related cases) account for 93% of the cases. Of the confirmed cases, 97% were unvaccinated or had an unknown vaccination status, and 75% were age 19 or younger.
As the measles outbreaks continue, it is distressing that some people are relying on unproven remedies endorsed by Robert. F. Kennedy Jr., the Health and Human Services (HHS) secretary, such as cod liver oil and vitamins, and postponing medical visits until the illness is more severe. Kennedy has also undercut decades of effective public health messaging about the importance and safety of the measles vaccine with his own muddled messaging. Kennedy has described vaccination as a personal choice and suggested that measles vaccines are less safe than they actually are.
Measles is one of the most contagious of all infectious diseases; up to 9 out of 10 susceptible people in close contact with a measles patient will develop the disease. Just 25 years ago, measles was declared to be eliminated in the United States, the result of widespread use of the measles vaccine, which is now delivered as part of the MMR (measles, mumps, rubella) vaccine. One dose of MMR is 93% effective at preventing measles; two doses are 97% effective. Two-dose MMR vaccination rates of 95% or higher are associated with herd immunity. Many U.S. counties, however, are below the 95% vaccination benchmark, and average coverage among children younger than 5 years may have dropped below 70% in the South.
At present, the United States recommends two lifetime doses of the MMR vaccine for most people, the first dose at age 12 to 15 months and the second dose between 4 and 6 years. In the first six months of life, infants receive some protection against measles from antibodies obtained from their mothers during pregnancy, leaving them with a vulnerable gap between 6 and 11 months. When measles was eliminated in the United States, this gap was not a substantial issue. As measles exposure has increased, however, the measles risk to infants younger than 1 year has increased as well, in part because infants are more vulnerable to severe complications from measles, such as pneumonia, encephalitis and death. Dr. Rochelle Walensky, a director of the Centers for Disease Control and Prevention during the Biden Administration, and her colleagues have proposed updating U.S. guidelines to recommend an additional MMR dose for infants between the ages of 6 and 12 months who are living in or traveling to any region with increased probability of measles exposure, whether domestic or international.
It is outrageous that the United States has continuing measles outbreaks a quarter of a century after measles was effectively eliminated in the country. Some are predicting that the outbreak in West Texas will last for a year until the virus finishes burning through the community. Unfortunately, until two-dose MMR vaccination rates return to levels that have been achieved in the past throughout the country, continuing outbreaks are inevitable. As HHS secretary, Kennedy could be part of the solution, not part of the problem. Kennedy should use his bully pulpit to advocate for increased vaccination rates and keep his opinions about cod liver oil and other dubious treatments to himself.