Public Health Wake-Up Call: Will the US Lose Measles Elimination Status?

The US faces a critical deadline in January 2026 to prove it has stopped measles transmission and could lose its elimination status if large outbreaks linked to ongoing cases (like those from the Texas outbreak) aren't definitively stopped and a 12-month period of no local spread is achieved. Following a surge in 2025 cases, including linked outbreaks in Texas, Arizona, and South Carolina, health officials are concerned that declining vaccination rates and continued spread might lead to this loss, mirroring Canada's recent loss of status, though countries can regain it.¹

In 2000, the United States achieved a major milestone in public health: measles elimination. This wasn’t the eradication of the virus worldwide — that remains a global challenge — but it meant that within the US, measles was no longer spreading endemically. New cases did occur, but these were linked to international travel and were quickly contained without sustained domestic transmission.² That declaration didn’t mean the virus had vanished from the Earth — far from it — but it signaled that continuous, endemic transmission of measles inside the US had been successfully disrupted. It reflected decades of work by medical laboratory scientists, clinicians, public health agencies, epidemiologists, and communities who embraced the life-saving power of vaccines.

For more than two decades, this status stood as evidence of one of the most successful public health campaigns in modern history. Widespread vaccination, effective surveillance, and rapid outbreak response kept the virus at bay. But in 2025, this achievement is under serious threat. The US is experiencing its largest measles outbreaks in decades—and for the first time since elimination—experts are warning that the country may soon lose its measles elimination status.³

Global and Regional Trends

Measles cases have risen dramatically across the Region of the Americas in 2025, driven by multiple large outbreaks and importations. As of mid-September 2025, over 11,300 confirmed cases and 23 deaths were reported across 10 countries, a roughly 31-fold increase versus the same period in 2024. Canada, Mexico, and the US accounted for the vast majority. Earlier in the year, PAHO reported sharp increases compared with 2024 figures, reflecting ongoing gaps in immunization coverage that are fueling transmission.² WHO has documented rising measles burden worldwide partly due to historical declines in vaccination coverage; tens of millions of children missed routine doses in recent years. While 2023 data showed ~10.3 million global cases, the 2025 landscape remains driven by outbreaks in multiple regions.⁴

United States Trends

As of December 9, 2025, the US has reported 1,912 confirmed measles cases, the highest annual total in over 30 years. Cases have been confirmed in 43 jurisdictions nationwide, with 47 outbreaks documented in 2025. Outbreaks are linked to under vaccinated or unvaccinated communities, and many cases trace back to international importations followed by local transmission. There have been 3 confirmed deaths from measles in the US. in 2025. Unvaccinated individuals account for the overwhelming majority of cases, consistent with patterns earlier in 2025 when ~96% of patients were unvaccinated or had unknown vaccination status.⁵

What Does Measles Elimination Mean?

To understand what’s at stake, it’s critical to define “measles elimination.” In public health terminology:

1. Elimination is distinct from eradication. Eradication means the disease is gone globally (smallpox is the only human disease ever eradicated).
2. Elimination means no continuous transmission of the disease within a particular geographic area for 12 months or more in the presence of a robust surveillance system.

The U.S. eliminated measles in 2000 primarily due to high 2-dose vaccination coverage with the MMR vaccine (measles, mumps, rubella).⁶ The 12-month clock resets any time there is sustained transmission that cannot be quickly stopped. If measles keeps circulating — without interruption — for more than a year, elimination status can be lost.

How Elimination Is Verified

Elimination status is verified by both national authorities like the Centers for Disease Control and Prevention (CDC) and international bodies such as the Pan American Health Organization (PAHO) and World Health Organization (WHO). Countries submit data on cases, genetic strains, and measures taken to interrupt spread. If sustained transmission occurs, the status is reevaluated and can be withdrawn.

Regional verification works similarly. For example, the Region of the Americas had maintained measles elimination status for years, but in November 2025 that regional status was lost after endemic transmission reemerged, particularly in Canada.⁷

The 2025 Measles Surge in the US

This year, the country has seen an unprecedented surge in measles cases; the highest in more than three decades.³ Multiple outbreaks have been reported, including significant activity in South Carolina, Utah, Arizona, and Texas. Some outbreaks have led to quarantines, hospitalizations, and even deaths. These numbers far exceed typical measles activity in the US after elimination and are far above the benchmark of fewer than 20 cases per one million population used to define a large or disruptive outbreak.⁸

The United States typically records a few dozen to a few hundred measles cases each year. These numbers, while concerning, are manageable for a strong public health system.

But 2025 has been different.

This year, the country has documented the highest number of measles cases in over 30 years, with outbreaks reported in over 40 states. Some states have experienced major transmission events linked to schools, community gatherings, and regions with lower childhood vaccination rates. Many of these outbreaks are genetically connected, which means they are not isolated sparks — they are part of a larger wildfire.

This level of sustained, cross-state transmission is exactly the type of scenario that threatens elimination status.

For over two decades, every time measles entered the US, it hit a “firewall” of vaccinated communities and fizzled out. This year, in too many places, that firewall didn’t hold.

Major Outbreaks Driving Spread

A key feature of 2025 has been linked outbreaks — clusters of measles that are genetically related and have been circulating for many months. A major outbreak that began in West Texas in January 2025 spread to Oklahoma and New Mexico and eventually seeded outbreaks in other states.⁹ Health officials believe this same measles strain (often referred to as subtype 9171) has continued to circulate for more than 10 months without interruption. If this continuous transmission crosses the 12-month threshold — likely around January 2026 — the U.S. would automatically be at risk of losing its elimination status. Again, by definition, continuous circulation of a measles virus strain for a year qualifies as endemic transmission, which undermines elimination.¹⁰

Why Are Measles Cases Rising?

There is no single reason. Instead, we’re facing a perfect storm of factors — scientific, social, structural, and behavioral.

1. Declining Vaccination Rates

The measles virus is one of the most contagious pathogens known. It can linger in the air for up to two hours and infects around 9 out of 10 susceptible people who are exposed to it. To prevent sustained transmission, communities need roughly 95% immunity through two doses of the MMR vaccine.

In recent years, national vaccination rates have dipped. In some local communities, they’ve fallen far below 90%. When vaccination rates decline, measles doesn’t politely stay away. It rushes in to fill the gaps.

In a recent Contagion interview, Ruth Lynfield, MD, discusses an approach clinicians can take in counseling parents who may have concerns about the MMR vaccine as well as other strategies to increase immunization adherence.

2. The Disinformation/Misinformation Epidemic

I’ve spent much of my career on science communication, and I can tell you that disinformation and misinformation spreads faster than microbes. The COVID-19 pandemic accelerated a disinformation ecosystem that continues to undermine vaccine confidence. False claims about vaccines — including long-debunked myths about autism, infertility, and “immune overload” — have found renewed life in online spaces that prioritize engagement over accuracy.¹¹

Learn more about the differences between disinformation and misinformation.
If you want to understand why measles is resurging, start with the corrosive effect of disinformation and misinformation on parental decision-making.

3. Pandemic-Driven Disruptions

During the height of COVID-19, routine childhood vaccinations dropped dramatically. Some families delayed doctor visits. Some clinics were overwhelmed. Some children aged into kindergarten without receiving their complete vaccine series. We’re now seeing the downstream consequences of those disruptions.

4. Under Vaccinated Clusters

Measles does not need an entire state to be under vaccinated. It only needs one cluster—a school, a religious community, a neighborhood—where vaccination coverage is low. Once introduced into such a setting, measles can spread like wildfire and then extend outward into broader regions. The 2025 Texas, Arizona, and South Carolina outbreaks are current examples of this under vaccinated impact.^3,9,10

5. Increased Global Travel

Measles remains endemic in many parts of the world. With global travel rebounding, importations have increased. When those imported cases land in under vaccinated communities, outbreaks spark.

What Losing Measles Elimination Would Mean

Some may ask: “Why does elimination status matter? Isn’t it just a label?” No! It’s far more than that. If the US loses its measles elimination status, the following dominoes will fall:

1. A Warning Signal About Public Health Stability

Losing elimination would indicate that our vaccination rates and public health systems have weakened to the point where measles is once again establishing sustained chains of transmission. It would be a barometer of national vulnerability—not just to measles, but to other vaccine-preventable diseases as well.

2. Increased Illness, Hospitalizations, and Deaths

Measles is not a harmless childhood disease.

It can cause:

• Severe pneumonia
• Encephalitis (brain swelling)
• Blindness
• Long-term immune suppression
• Hospitalization
• Death

The idea that measles is “mild” is one of the most harmful myths circulating today.⁹

3. Economic and Societal Costs

Containing measles outbreaks requires enormous resources:

• Contact tracing
• Isolation and quarantine
• Emergency vaccination clinics
• School closures
• Lost productivity
• Hospital costs.

A single outbreak can cost millions of dollars.

4. Setbacks in Other Public Health Areas

When measles surges, it drains resources from other critical health efforts — including chronic disease management, maternal health, emergency preparedness, and other infectious disease threats.

5. Loss of Regional Progress

The Region of the Americas held measles elimination for years. Losing that status — already in motion after Canada’s struggles — signals a continent-wide regression.¹

What Needs to Happen Now

The good news, and yes, there is good news, is that measles is entirely preventable. We know exactly how to stop it. We have decades of experience doing so.

Here’s what we must prioritize:

1. Rebuild Trust in Vaccination

Science communication has never been more important. Health professionals, clinicians, scientists, educators, journalists, and community leaders must:

• Speak clearly and compassionately
• Avoid jargon
• Address fears and misinformation
• Serve as trusted voices in their communities.

Vaccination is not simply a scientific act — it is a social act grounded in trust.¹²

2. Increase MMR Vaccination Coverage⁹

This means:

• Ensuring children receive 2 doses on schedule
• Making vaccines accessible and affordable
• Working directly with communities that have low coverage
• Reducing barriers to school-entry vaccination requirements.

The MMR vaccine is often considered one of the gold standards in immunizations. The efficacy for protection against each of the three diseases is well over 86% after completion of the 2-dose series; specifically for measles, it is ~97% effective.⁹

3. Strengthen Public Health and Medical Laboratory Infrastructure^13-14

The pandemic exposed major weaknesses in surveillance, staffing, laboratory capacity, and coordination. To maintain elimination, we need:

• Stronger funding for state and local health departments
• Support for the clinical, medical laboratory, and public health laboratory workforce
• Faster outbreak detection
• Better communication channels between agencies and the public.

4. Improve School and Community Outreach

Schools, childcare centers, and community organizations are powerful amplifiers of public health messaging. They should:

• Reinforce evidence-based vaccine requirements
• Provide clear communication to parents
• Partner with local health departments during outbreaks.

5. Prioritize Global Cooperation

Measles anywhere is a threat everywhere. Supporting global vaccination campaigns reduces the number of importations into the U.S.

The Bigger Picture: What the Measles Crisis Reveals

This moment is about measles — but it’s also about much more.

It reveals:

• The fragility of public health gains
• The consequences of misinformation
• The reality is that infectious diseases don’t care about political boundaries, ethnicity, race, geography, and similar human biases.
• How quickly vaccine-preventable diseases can reemerge
• The interconnectedness of medical laboratory science, public health, and community behavior.

Measles is not a failure of science. It is a failure of communication, trust, and societal alignment.

A Call to Action

As a lifelong advocate for public health and laboratory medicine, I believe we are at a crossroads. We can allow measles to reestablish itself, quietly undoing decades of progress — or we can act now to rebuild the vaccination confidence and public health systems that kept this virus at bay for so long.

Losing elimination status isn’t inevitable. But preventing that loss requires partnerships — between parents and physicians, scientists and journalists, public health agencies and policymakers, schools and families.

If we want to preserve our elimination status—and more importantly, protect our children and communities—now is the time to double down on science, trust, and collective responsibility. The history of measles elimination in the US shows what we can accomplish when we work together.

Now, the future of our collective global public One Health community is in our hands. And the world is watching.

References

1. Public Health Agency of Canada. Statement from the Public Health Agency of Canada on Canada’s Measles Elimination Status.Published November 10, 2025. Accessed December 12, 2025. https://www.canada.ca/en/public-health/news/2025/11/statement-from-the-public-health-agency-of-canada-on-canadas-measles-elimination-status.html

2. Centers for Disease Control and Prevention [CDC]. Measles [Rubeola]: Measles Cases and Outbreaks. Published December 10, 2025. Accessed December 12, 2025.https://www.cdc.gov/measles/data-research/index.html?utm_source=chatgpt.com

3. Devi Shastri. Associate Press [AP News]. Hundreds are quarantined in South Carolina as measles spreads in 2 US outbreaks.Published December 11, 2025. Accessed December 12, 2025. https://apnews.com/article/measles-outbreak-south-carolina-utah-arizona-3bfc561ecc16d8e80175effdae0791d4

4. Pan American Health Organization [PAHO]. PAHO intensifies call to strengthen vaccination in light of rising measles cases in the Americas. Published September 19, 2025. Accessed December 12, 2025.https://www.paho.org/en/news/19-9-2025-paho-intensifies-call-strengthen-vaccination-light-rising-measles-cases-americas?utm_source=chatgpt.com

5. World Health Organization [WHO]. Measles cases surge worldwide, infecting 10.3 million people in 2023.Published November 14, 2025. Accessed December 12, 2025. https://www.who.int/news/item/14-11-2024-measles-cases-surge-worldwide--infecting-10.3-million-people-in-2023?utm_source=chatgpt.com

6. Mathis AD, Raines K, Filardo TD, et al. Measles Update — United States, January 1–April 17, 2025. MMWR Morb Mortal Wkly Rep 2025;74:232–238. DOI: http://dx.doi.org/10.15585/mmwr.mm7414a1

7. PAHO. PAHO calls for regional action as the Americas lose measles elimination status. https://www.paho.org/en/news/10-11-2025-paho-calls-regional-action-americas-lose-measles-elimination-status?utm_source=chatgpt.com Published November 10, 2025. Accessed December 12, 2025.

8. WHO. Measles deaths down 88% since 2000, but cases surge. https://www.who.int/news/item/28-11-2025-measles-deaths-down-88--since-2000--but-cases-surgePublished November 28, 2025. Accessed December 12, 2025.

9. Rohde R.E. McNamara R. Measles: An Old Foe Has Returned. Contagion Live. March 10, 2025. Accessed December 12, 2025.
https://www.contagionlive.com/view/measles-an-old-foe-has-returned

10. Mole, Beth. CDC data confirms US is 2 months away from losing measles elimination status. Ars Technica. Published November 18, 2025. Accessed December 12, 2025.
https://arstechnica.com/health/2025/11/cdc-data-confirms-us-is-2-months-away-from-losing-measles-elimination-status/?utm_source=chatgpt.com

11. Phelps, R., Rohde, R.E. (2024). COVID-19 and Uncertain Times. In: McClellan, S. (eds) Data, Security, and Trust in Smart Cities. Signals and Communication Technology. Springer, Cham.Accessed December 12, 2025.
https://doi.org/10.1007/978-3-031-61117-9_8

12. Rohde R.E. Professional Visibility: Be the Expert! ASCLS Today Volume 36 Number 2 | April 2022. Accessed December 12, 2025.
https://ascls.org/professional-visibility-be-the-expert/

13. Robinson A.T., Rohde R.E. Workforce in the Shadow of Healthcare –An Update on the Survival Status of Laboratory Medicine and Public Health. Biomed J Sci & Tech Res 54(5)-2024. BJSTR. MS.ID.008604.Accessed December 12, 2025.
https://biomedres.us/pdfs/BJSTR.MS.ID.008604.pdf

14. Rohde R.E. 5 Strategies for Leading Young Laboratory Scientists in Uncertain Times. Today’s Clinical Lab. February 17, 2025. Accessed December 12, 2025. https://www.clinicallab.com/5-strategies-for-leading-young-laboratory-scientists-in-uncertain-times-28181