Without action, Spring Break could create The Gulf of Measles

Sixty days into 2025, the U.S. had the highest number of measles cases this early into the year in three decades.

Measles has been reported in eight states, with the largest outbreak in Texas, where there have been at least 159 cases and one unvaccinated child has died. The last previous deaths from measles in the U.S. were in 2015 and 2003.

Because of the highly contagious nature of this virus, spotty and falling vaccination rates and the arrival of spring break and recreational travel to areas with measles, there is great potential for measles to spread across the country without aggressive action now to bridge gulfs in preparedness.

Measles is a vaccine-preventable illness that predominantly affects children and adolescents, with a recent hospitalization rate of about 25 to 40 percent. Ten percent of children with measles may have long-term hearing loss, and one in 1,000 will have severe brain inflammation.

A non-vaccinated individual has a 90 percent chance of contracting measles if they are exposed to a contagious individual. Measles is contagious for four days before the rash appears and then for another four days.

For more than 50 years, we have prevented measles and contained viral spread through vaccination and isolation. If an unvaccinated individual is exposed to measles, vaccination within 72 hours can prevent illness and allow the person to go on with their life. Otherwise, the individual needs to isolate for the 21-day incubation period.

In 2000, measles was declared eliminated in the U.S. through vaccination and public health efforts. And a decade ago, nearly 93 percent of children across the U.S. were vaccinated against measles.

Yet, with the rise of anti-vaccine sentiment and legislated vaccine exemptions, vaccination rates for children entering kindergarten are below the threshold to prevent community spread. Furthermore, in many communities, measles vaccination rates are as low as 50 percent, resulting in pockets of vulnerability.

Public health has taught us that we usually underestimate the potential severity of outbreaks, as we recently saw with COVID-19. Considering the current outbreaks and impending spring break travel, public health strategies need to be implemented now.

First, cases must be reported in real-time at the local, state and national levels. The Texas Department of State Health Services has been updating numbers daily. The Centers for Disease Control and Prevention, however, is updating measles cases weekly. Newsletters and media sources have been providing frequent updates to help fill gaps in CDC reporting over the past month.

Second, we must prepare large-scale measles vaccination events in communities with measles exposures and unvaccinated people. Last year, an outbreak of measles at a Chicago refugee center, to which more than 2,000 people were exposed, was contained through county, state and CDC vaccination efforts, resulting in the vaccination of more than 30,000 individuals.

However, with recent administrative changes and firings, it is unclear whether the CDC can adequately assist states. In an important action, weeks into the outbreak, it was just announced that the CDC would be assisting in the Texas ground response.

Texas is now sending vaccination teams to potential areas of measles exposure. To be effective, these efforts need to be deployed immediately where cases occur. Unfortunately, this may not be possible in Louisiana, which states that the Department of Health will no longer encourage mass vaccination.

Third, state and local Department of Health contact-tracing teams need to expand to prepare for outbreak control. These individuals can help identify those exposed to measles, coordinate vaccination and provide guidance for isolation if an exposed individual is not vaccinated within three days.

Fourth, we need to realize that there will be a large influx of individuals into areas where potential outbreaks occur.

Thousands of individuals travel to the Gulf states during spring break and Mardi Gras. If not vaccinated and exposed to somebody with measles, they are at risk for contracting the illness and spreading it across the country as they return home. In 2020, early cases of COVID-19 in several states could be traced to Mardi Gras in New Orleans and spring break in Florida.

Of immediate concern are reports that an individual with measles traveled to San Antonio. With a 21-day incubation period, measles could easily be in the city as fans visit in early April for the NCAA basketball tournament.

Individuals traveling to areas where there may be future outbreaks must assess their vaccination status. If not vaccinated or unsure, the measles vaccine can be obtained through your local healthcare provider, retail pharmacy or local Department of Health.

We must also recognize that the current Texas measles outbreak began in a Mennonite community. An Anabaptist pastor’s conference took place recently in Sarasota, Fla., and there are planned events during March in Pennsylvania. If unvaccinated individuals from communities with measles attend these events, they could be a super-spreader.

Fifth, we need to acknowledge the importance of community engagement in outbreak control. During the 2019 measles outbreak in Rockland County, N.Y., religious leaders promoted measles vaccination as part of the path out of the outbreak. Without active local engagement in outbreak management, there is the risk of community blame, as reported in Texas.

Finally, we must inform the public about the facts and truth of measles and current cases. The notion that measles outbreaks of this magnitude are “not unusual” or that vitamin A is a treatment or preventative measure against measles in the U.S. is wrong.

We also need to recognize the insidious view of anti-vaccine advocates who blame the vaccine for the outbreak, ignoring fact and reason. Scientifically valid information about measles and the measles vaccine can be found from your health care provider and public health and medical associations, including the American Public Health Association, where one of us serves as executive director, and the American Academy of Pediatrics.

While grappling with new measles cases, our country is seeing the effects of an uncontrolled outbreak of avian flu H5N1. This virus is devastating the poultry industry, affecting the dairy industry and has sickened at least 70 people and caused one death in the U.S.

The consequence of the avian flu is being felt across the country, with the rising prices of eggs. But, if measles takes hold, as it has the potential to do, the human toll will not be seen in the price of eggs, but in our children.

Scott A. Rivkees, MD, is a professor of practice at the Brown University School of Public Health. He is a pediatrician and the former state surgeon general and secretary of Health of Florida. Georges C. Benjamin, MD is the executive director of the American Public Health Association and a former secretary of Health for Maryland.

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