Nearly two months after the Texas measles outbreak was declared over, the virus continues to make a comeback across the US.
On August 18, Texas officials declared the measles outbreak over after the state recorded 762 cases and two fatalities in eight months.
Nationwide, the CDC has registered 1,563 measles cases this year, the highest tally since 1992 when there were 2,126 cases. However, many experts believe the true toll could be much higher.
Leading vaccine expert Dr Paul Offit warned: ‘If you talk to people on the ground… they all say the same thing, which is the numbers are much worse than that. Probably closer to 5,000.’
Currently, public health officials are tracking two major outbreaks across three states, with infections mostly in unvaccinated individuals, while two other states have also recorded measles cases within the last week.
In South Carolina, more than 150 unvaccinated children at two schools are now in 21-day quarantines after being exposed to the virus in classrooms, with officials confirming eight cases to date.
In the Utah-Arizona outbreak, a total of 118 cases have now been recorded across both states, including six hospitalizations, with experts saying this outbreak has only just begun and that more cases are likely.
There were also two new cases reported in Minnesota last week, taking the state’s tally to 20 infections, and one in a schoolchild in Ohio, raising concerns that other children in the state could be infected.
Measles was officially declared eliminated in the US in 2000, after the country went 12 months without any local transmission of the disease, only reporting cases in travelers to the US.
But experts fear that amid falling vaccination rates, this status is under threat. Measles can be prevented by the MMR vaccine, which slashes the risk of infection by 97 percent after two doses administered at the age of 12 to 15 months and four to six years.
For the 2024-2025 school year, 92.5 percent of kindergarteners got the measles, mumps and rubella (MMR) vaccine, below the 95 percent in 2019-2020 and the 95 percent experts say is needed to prevent an outbreak.
Health and Human Services Secretary Robert F Kennedy Junior came under pressure this year during the West Texas measles outbreak after he said vaccination was a ‘personal choice’ and promoted alternative treatments such as vitamins and cod liver oil.
In an editorial for the Wall Street Journal last month, however, he praised the CDC’s handling of the outbreak and said it showed ‘what a focused’ agency ‘can achieve’.
South Carolina has recorded 11 measles cases so far this year, including eight linked to the current outbreak that began on September 25, well above the single case that was recorded in 2024 and the last measles outbreak in the state in 2018 when six cases were detected.
It is not clear how many patients are unvaccinated, although the first patient was a schoolchild.
In the current outbreak, concerns were sparked by the latest case recorded in Greenville County last week, in the state’s upstate area, which has not been linked to others in neighboring Spartanburg County.
Dr Linda Bell, the state’s epidemiologist, warned at a press conference last week, reports NPR: ‘What this new case tells us is that there is active, unrecognized community transmission of measles occurring.’
She urged all residents to ensure they were vaccinated against measles, with the vaccine slashing the risk of infection with the disease.
In Utah, the state declared an outbreak of measles in September, and has recorded 55 cases to date and three hospitalizations, mostly in the southwestern part of the state. The case tally marks the state’s biggest recorded outbreak since 1996.
Only one of these patients was vaccinated against measles, with the first patient being an unvaccinated adult who was diagnosed with the disease without leaving Utah.
State epidemiologist Dr Leisha Nolen warned to CNN that the outbreak was also only likely to continue to grow.
‘Unfortunately, I think we still have quite a while to go with infections,’ she said.
‘We know that most of our infections have been localized down towards the southern end of our state, but I think we are starting to see now people get infected even at the very north end of our state.
‘So, I do think that this is going to continue to bop around and spread in different communities. I suspect we are in the middle of it.’
In Arizona, an outbreak was declared in September after cases spilled over its northern border from Utah.
It has detected 63 infections and three hospitalizations with measles to date, mostly in the Colorado City area, which has a low vaccination rate. It is not clear what proportion of patients are vaccinated. The case tally is the highest in the state since 1991.
Two cases were detected in Minnesota last week, in what state epidemiologist Dr Jessica Hancock-Allen warned in a press release was ‘more than we would like to see in Minnesota’.
And last week, Ohio reported a case of measles in a student in Columbus, in the center of the state, who was unvaccinated and had recently traveled out of state.
Measles is the most infectious disease, with one infected person able to infect nine out of 10 unvaccinated individuals with the disease.
In the early stages, patients suffer from a flu-like illness with a high fever, cough, runny nose and red and watery eyes.
But three to five days after infection, the characteristic painful red rash appears on the skin, starting on the face before spreading downward across the body.
Children, pregnant women and those with a weakened immune system are most at risk from a measles infection.
The CDC estimates that among unvaccinated individuals, about one in 5 are hospitalized, while one in 20 unvaccinated children get pneumonia and about one to three out of every 1,000 infected unvaccinated children die from the disease.
After two doses of the vaccine, the recommended dose, the risk of being infected is slashed by more than 97 percent.