Texas is poised to make measles a nationwide epidemic, public health experts say

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With its measles outbreak spreading to two additional states, Texas is on track to becoming the cause of a national epidemic if it doesn’t start vaccinating more people, according to public health experts.

Measles, a highly contagious disease that was declared eliminated from the U.S. in 2000, has made a resurgence in West Texas communities, jumping hundreds of miles to the northern border of the Panhandle and East Texas, and invading bordering states of New Mexico and Oklahoma.

Based on the rapid spread of cases statewide — more than 200 over 50 days — public health officials predict that it could take Texas a year to contain the spread. With cases continuously rising and the rest of the country’s unvaccinated population at the outbreak’s mercy, Texas must create stricter quarantine requirements, increase the vaccine rate, and improve contact tracing to address this measles epidemic before it becomes a nationwide problem, warn infectious disease experts and officials in other states.

“This demonstrates that this (vaccine exemption) policy puts the community, the county, and surrounding states at risk because of how contagious this disease is,” said Glenn Fennelly, a specialist in pediatric infectious diseases and assistant vice president of global health at Texas Tech Health El Paso. “We are running the risk of threatening global stability.”

The measles outbreak — the largest in the state in 30 years — has spread from two cases in late January to more than 270 cases and now includes 11 counties, most of them in the rural South Plains region.

So far this year, there have been more than 300 cases of measles confirmed across 15 states, as of March 13. The Texas outbreak, which makes up the bulk of those cases, is only linked to cases in New Mexico and Oklahoma, where state officials said this month that someone associated with the Texas outbreak was exposed.

Last month, Texas officials reported that an unvaccinated, otherwise healthy school-aged child died from measles, the first death from the virus in a decade.

This month, New Mexico officials said an unvaccinated adult in Lea County, about 50 miles away from the outbreak’s epicenter of Gaines County, who died had tested positive for measles. Officials are still confirming whether the cause of death was measles, according to the New Mexico Department of Health.

“This is a very multi-jurisdictional outbreak with three states involved and about seven or eight different local health departments, in addition to some areas where the state serves as the local health department. There are a lot of moving parts,” said Katherine Wells, director of public health for the City of Lubbock, during a Tuesday meeting of the Big Cities Health Coalition, a national organization for large metropolitan health departments.

Most of Texas’ measles cases are in unvaccinated school-aged children and are concentrated in the Mennonite community in Gaines County, which traditionally has low vaccination rates.

Wells said efforts to increase the vaccination rates in Gaines County, which is about 70 miles from Lubbock, and the surrounding region have been slow as trust in the government has seemingly reached an all-time low.

“We are seeing, just like the rest of Americans, this community has seen a lot of stories about vaccines causing autism, and that is leading to a lot of this vaccine hesitancy, not religion,” she said.

The COVID-19 pandemic led to the politicization of vaccines and overall weariness to health mandates like quarantines and masks. Public health officials are now battling misinformation and public resistance to measles.

Wells said because the state can’t stop people from traveling, she fully expects this outbreak to last a year, and the surrounding states and the nation should prepare themselves for a potential spread.

“Measles is going to find those pockets of unvaccinated individuals, and with the number of cases and ability for people to travel, there is that risk of it entering other unvaccinated pockets anywhere in the United States right now,” Wells said.

Vaccine hesitancy

Fennelly was working in the New York area in the 1990s during a major outbreak that filled hospitals with infants sickened from measles that were too young to get the measles vaccine, and then during a 2018 outbreak, when pamphlets were circulating in the local Ultra-Orthodox community warning against the unfound dangers of the measles vaccine.

Now, years later, Fennelly is watching the same series of events play out in Texas.

“This could have been predicted. There have been steady rates of increased personal belief exemptions over the last several years leading to pockets of under-vaccination across the state,” he said.

In the West Texas region, misinformation about vaccines, distrust of local public health officials, and fear of government authority overruling family autonomy have reigned supreme, creating the pockets that measles infiltrated this year.

However, this is not just a South Plains problem but a statewide issue as vaccine exemptions continue to grow.

“We have several pockets of population that have high unvaccinated groups. We sent out a letter to public and private school districts with low vaccination rates explaining the situation and asking them to update their children’s shots,” said Phil Huang, director and health authority for Dallas County Health and Human Services, during the Big Cities Health Coalition meeting.

Texas requires children and students to obtain vaccines to attend schools, child care centers, and college. However, individuals can claim they are exempt if they are in the military, have a religious or personal belief that goes against getting immunized, or if a health provider determines it is not safe to do so.

Since 2018, the number of requests to the Texas Department of State Health Services for an exemption form has doubled from 45,900 to more than 93,000 in 2024.

Data suggests that vaccine exemptions and those living in areas with higher vaccine exemption rates for measles and pertussis are at increased risk of contracting these diseases. The authors of this data collection concluded that “geographic pockets of vaccine exemptions pose a risk to the whole community.”

Fennelly said the hurdles to obtaining exemptions are easy to clear, leading to an increasing number of people refusing the vaccine.

State lawmakers this session have filed more than a dozen bills that would strengthen or expand vaccine exemptions.

“We don’t have the capacity in Texas to deal with so many sick children if this continues to spread. We are already at our limit with seasonal influenza and respiratory syncytial virus. Our doctors are at their limit,” Fennelly said.

Simbo Ige, commissioner of the Chicago Department of Public Health, had to deal with a measles outbreak in her city a year ago, with 64 individuals testing positive, 57 of whom were associated with a shelter. She said the quickest way they controlled the outbreak was quickly administering more than 30,000 doses of the measles-mumps-rubella vaccine.

A Chicago Department of Health report projected a high probability of an outbreak of more than 100 cases without the city’s rapid intervention.

“It required a lot of education and messaging because people wanted the answer to why I need to get vaccinated. We started listing out the reasons — parents won’t be able to go to work, kids can’t go to school, and even worse, kids can get sick and die,” Ige said. “It’s 2025. We shouldn’t be having children dying from measles in this day and age. We have the tools. We just have to amplify the message.”

New Mexico’s public health officials started spreading awareness of vaccinations immediately after they learned Texas had its first measles case and before New Mexico got its first case.

“We started setting up clinics and getting the ball rolling,” Jimmy Masters, the southeast region director for the New Mexico Department of Health, said. “Let's see what we can do to get people in the doors and vaccinated beforehand.”

Nearly 9,000 New Mexicans have received measles, mumps, and rubella vaccine shots between Feb. 1 and March 10. During that same time period last year, officials vaccinated 5,342 people.

Texas has held multiple vaccination clinics in the outbreak area, but according to the Texas Department of State Health Services, only 350 doses have been administered.

New Mexico has also emphasized its Vaxview website that keeps track of residents' immunizations, allowing concerned people to check within seconds if they need a shot. Texas has a vaccine tracking program known as ImmTrac2, but it’s an opt-in program that doesn’t have most adult records. If someone doesn’t opt in by age 26, their records will not be retained.

“We told people to contact us to ensure their vaccine status is up to date,” Masters said. “If they aren’t sure, just call the health office so we can find out for them. And if they don’t have their records updated for the vaccine, then we can ask them to come in and take advantage of the clinics or come in as walk-ins.”

Because of this, most of Lea County is considered immunized, Masters said, so public health officials in New Mexico don’t view the outbreak as rapidly evolving.

Back in Texas, the opposite is playing out. Advice from public health officials is seemingly ignored, and vaccine efforts are struggling.

“We need to have a consistent message from all levels. We need to reinforce the message that vaccines are safe and vaccines are how you prevent this, and we have concerns when other messages dilute this message,” Huang said.

Texas Department of State Health Services officials are also encouraging people to vaccinate, but whether people will listen is out of the agency’s control.

“The only way to stop the virus from spreading is to get more people immunized. We are …providing education about the severe complications associated with measles infection, and directing them to locations where they can get vaccinated,” said Lara Anton, spokesperson for the state health agency.

Fennelly said the main difference between Lea County and Gaines County is the public acceptance of the vaccine and public health in general. He said if Texas wants to improve, there should be studies on why people are so hesitant to accept vaccines.

“We need to be asking why Gaines County? What are the concerns, and how do we, the health profession and public health officials, most effectively confront and allay those fears,” he said. “People shouldn’t be more afraid of the vaccine than the disease.”

Obstacles to quarantining and contact tracing 

A person with measles visits a friend, another visits kids at a college, and the other has friends over. Public health departments in West Texas are trying to trace the spread of measles, since other than strongly suggesting people quarantine, there’s nothing more local officials can do to prevent infected individuals from traveling.

“We shouldn’t be surprised in this kind of environment that we will have more cases,” said David Lakey, the vice chancellor for health affairs and the chief medical officer at the University of Texas System. “I think we need to work with individuals to ensure they stay home during an event like this.”

State lawmakers have stripped control from cities and counties from implementing mandates, such as closing businesses and schools. While some of these laws apply only to COVID-19, public health experts say it has created an environment where state health officials can only offer suggestions to Texans with little enforcement, allowing measles to continue to spread.

“The state of Texas is taking it seriously and trying to balance how they approach this while respecting the laws of the state and also people’s freedoms,” Lakey said. “They are doing it while also making sure that we are doing everything it can to identify people, provide vaccines, isolate individuals, and take all the other steps to address an event like this.”

With young children particularly vulnerable to the disease, Lakey said hospitals must screen people entering hospitals.

Wells said there have been a couple of women who gave birth at a Lubbock hospital who were infected with measles or were recently exposed to it, and babies six months old or younger have needed treatment with immunoglobulin because of exposure.

“That’s really why measles is so scary. It’s so communicable, and it’s so easy to enter some of the very vulnerable areas where babies don’t have those vaccinations yet,” she said. “That’s going to be day cares, schools, hospitals, pediatricians offices, and we’re seeing those cases more and more as this outbreak continues.”

This potential spread makes contact tracing necessary, but Wells said it is one of their region's most significant challenges besides testing. While a laboratory set up in Lubbock has cut down wait times for tests results from 72 hours to one day, Wells said rural Texas doesn’t have the staff to track the travel of more than 270 people.

“This is going to be a large outbreak, and we are still on the side where we are increasing the number of cases, both because we’re still seeing spread and also because we have increased testing capacity, so more people are getting tested,” she said.

New Mexico has a lead investigator for contact tracing who interviews the patients, gathers medical records, establishes a point of contact, and organizes vaccinations for those who were potentially exposed to prevent spread.

While West Texas officials try to follow the same policies, the health care system is decentralized, meaning the contact tracing is done by the local health authority first, and then, if necessary, the state gets involved and possibly, assistance from the CDC.

Chris Van Deusen, spokesperson for the Texas Department of State Health Services, said while the state is not necessarily struggling to contact trace, he acknowledges the extra manpower it requires.

“That also depends on the individuals talking with us and sharing that information. So that can be difficult, particularly when dealing with a more insular community. It can be difficult to make inroads, and that is why the local process is important,” Van Deusen said.

Experts say that as travel season ramps up and if Texas can’t seem to stop the spread, states nationwide should prepare themselves for what may come.

“The message to health departments is be ready, and schools need to think about this and government officials because this really does have the potential to grow beyond these three states,” Wells said.

Disclosure: Texas Tech University and University of Texas System have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.

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