Measles cases are in 34 states with North Dakota now the focus
The reality of measles may be overcoming vaccine misinformation in some areas, despite the purge of experts from decision-making roles in the Trump administration under Health and Human Services Secretary Robert F. Kennedy Jr. The nation's top vaccine expert resigned under pressure in March.
And on June 11, Kennedy appointed eight new members of an immunization advisory panel - some of whom are vaccine critics - after sacking all 17 members of the group two days earlier. Kennedy called his actions "a major step towards restoring public trust in vaccines."
The University of Minnesota's Center for Infectious Disease Research and Policy, however, called the committee's mass replacement "one of the darkest days in modern public health history." The Infectious Diseases Society of America called the move "reckless, shortsighted and severely harmful," saying Kennedy's criticism of the original 17 committee members is "completely unfounded."
In West Texas, where outbreaks are concentrated, the city of Lubbock hasn't seen a new case in 20 days, said Katherine Wells, public health director for the city. The area is east of the largest Texas outbreaks, which were centered on a Mennonite community with religious objections to vaccination.
Wells attributed the recent success to a combination of more vaccinations, public awareness campaigns and willingness to stay home when sick to avoid transmission.
"I talked to some people who, because there's so much information about the risk of vaccines and the bad side effects, I can see from a parent's perspective, 'Why would I give my child that?'" Wells said. "Now they've seen measles in their community, so now they're thinking, 'OK, now I'm going to get vaccinated.'"
Outbreak moves north
In North Dakota, however, the state's 34 cases give it the highest rate in the nation, followed by New Mexico and Texas, according to the North Dakota Public Health Association, a nonprofit health advocacy group that published an analysis of individual states' data on Facebook. The state's first case since 2011 was reported May 2.
"This is not a result of local public health failure," the organization posted. "This is a result of persons in the community choosing not to have their children vaccinated and resisting local public health recommendations and urgent efforts to increase vaccination uptake."
Dr. Stephen McDonough, a pediatrician and former state health officer in North Dakota, said he hasn't seen signs of improvement in the state. He doubts recent federal moves will do anything but make the situation worse.
"The outbreak in North Dakota is real, has not peaked yet and is expanding," McDonough said in an interview. "It was just a matter of time before North Dakota experienced a measles outbreak due to our low immunization rate."
Middle school band students in Minot, North Dakota, had to cancel trips to a regional band festival and parade in May because of the outbreak. Some 150 unvaccinated children were asked to quarantine for 21 days to avoid further spread.
North Dakota had a 90% vaccination rate among kindergartners for the 2024-25 school year, a number that has declined from about 95% in the 2019-20 school year, according to state records. Vaccination coverage at 95% or above is needed to halt measles transmission.
North Dakota's small population makes its measles rate misleading, said Jenny Galbraith, an immunization manager for the North Dakota Department of Health and Human Services.
However, the state has suffered from low vaccination rates in recent years as more parents have claimed exemptions based on personal philosophy, religion or other reasons as allowed by state law. With about 7% of children exempted, it's almost impossible to reach the goal of 95% vaccination, she said.
One hopeful sign is that North Dakota hasn't seen a new measles case since May 28, Galbraith said. "It's hard to say it's getting better because we're not out of the woods yet," she said.
It's not always possible to overcome vaccine misinformation in the rural areas where it has taken root, said Lori Tremmel Freeman, CEO of the National Association of County and City Health Officials.
Increases in vaccination are generally in "areas where people are already comfortable getting vaccinated," she said, rather than areas such as parts of North Dakota and Oklahoma "that are more leery of vaccines and harder to penetrate because of misinformation." Texas County in Oklahoma has 16 confirmed cases, almost all among unvaccinated people.
But local officials can keep stressing the benefits of vaccination and also the need to stay home when measles symptoms appear, advice that those unwilling to vaccinate may be more likely to heed, Freeman said.
"In this day and age, it's an embarrassment that we've lost three people to measles," she said, referring to the three deaths reported this year.
'Cautiously optimistic' in Texas
According to a federal Centers for Disease Control and Prevention update June 6, there are 1,168 confirmed cases affecting 33 states. Texas reported two more cases June 10, and Navajo County, Arizona, reported the state's first four cases last week.
There have been 17 measles outbreaks, defined as clusters of three or more related cases, this year compared with 16 in all of last year, according to the CDC. Cases are now more than four times higher than they were all of last year. And with less than half the year over, case numbers are closing in on 2019's high of 1,274.
That's still a small number compared with almost 28,000 cases in 1990, when an outbreak centered in California hit low-income areas with low vaccination rates.
While the total case count grows, the number of weekly new infections is dropping since a peak of 116 in late March.
In Texas, outbreaks have slowed as unvaccinated people have either gotten vaccinated or become infected and gained immunity, said Lara Anton, spokesperson for the Texas Department of State Health Services.
"The number of new cases in West Texas has slowed down and we are cautiously optimistic that this trend will continue," Anton said.
The current list of states affected by confirmed measles cases this year: Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Hawaii, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Minnesota, Missouri, Montana, Nebraska, New Jersey, New Mexico, New York, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Dakota, Tennessee, Texas, Vermont, Virginia and Washington.
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