# 2025 Southwest United States measles outbreak

In January 2025, cases of measles began to break out in Texas and neighboring states. Two cases linked to international travel were identified in Houston, followed by two more in Lubbock County. By mid-February the disease had spread to New Mexico and communities in West Texas including Dallam, Dawson, Ector, Gaines, Lynn, Terry, and Yoakum. In March, cases linked to the outbreak were announced in Oklahoma and the Mexican state of Chihuahua.
Measles is highly contagious and preventable by the MMR vaccine. The outbreak has infected hundreds of individuals, hospitalized more than 20, and killed two: a six-year-old in Lubbock and an adult in New Mexico, both of whom were unvaccinated. Though the United States declared measles eliminated in 2000, waning vaccination rates have led to its resurgence in the country and the 2025 outbreak led to the first measles deaths since 2015.

## Background

In the United States, before the measles vaccination program started in 1963, the Centers for Disease Control and Prevention (CDC) estimated that about three to four million people were infected each year, of which approximately 500,000 were reported, with 400 to 500 people dying and 48,000 being hospitalized. Measles is one of the most contagious viruses, and can be passed through respiratory droplets in the air, with unvaccinated individuals at 90% risk of getting measles if they are exposed. Symptoms usually develop 10–12 days after exposure to an infected person and last 7–10 days. Initial symptoms typically include fever, often greater than 40 °C (104 °F), cough, runny nose, and inflamed eyes, with a red, flat rash which usually starts on the face and then spreads to the rest of the body.
The MMR vaccine is a safe and effective preventative measure against measles with the first dose given to children between 12 and 15 months of age and a second dose between 4 and 6 years. Though measles was eliminated in the United States in 2000, falling vaccination rates have contributed to its resurgence. Vaccination rates among children have dropped since the COVID-19 pandemic and most states are now below the 95% threshold considered effective to prevent community outbreaks.
The high rate of vaccination exemptions in Gaines County, Texas, has been blamed for the outbreak. It has one of the highest rates in the country of vaccine opt-outs among children, with nearly 14% skipping a required vaccine in the prior school year. The outbreak has been concentrated in a Mennonite community known to be under-vaccinated.

## Epidemiology

As of March 7, 2025, 228 cases have been confirmed. In mid February it was reported that of the reported cases 39 were aged between 0–4 years old, 62 were aged 5–17 years old, 18 were aged 18 and older, with five cases not completely age identified. Since there have been two deaths and the fatality rate of measles is estimated to be around one to three deaths per 1000, epidemiologists suspect the number of cases could be much higher.

### Texas

On January 17, 2025, the Houston Health Department confirmed two cases of measles, the first reported cases in Houston since 2018. The patients were in the same household and had traveled recently. Two cases in unvaccinated school-age children in Lubbock, Texas, were later confirmed; the last case of measles in Lubbock County was reported in 2004. The first child in Lubbock had contracted the disease after sitting in an emergency room with another child who was sick. The children resided in Gaines County. By February 7, the number of confirmed cases had increased to nine with three probable cases, before reaching fourteen confirmed cases with six probable cases.
By mid February it was reported that the outbreak had spread to nine Texas counties mostly concentrated in the rural South Plains region, with counties including Dallam, Dawson, Ector, Gaines, Lubbock, Lynn, Terry, and Yoakum. It was reported on February 24, that a person with measles had traveled outside of the outbreak area, to visit the campus of University of Texas at San Antonio and other local establishments.
By late February more than 20 patients have been hospitalized at Covenant Children's Hospital with some suffering bacterial pneumonia and requiring intubation to breathe. On February 26, an unvaccinated six-year-old girl died of measles in Lubbock, the first death attributed to the outbreak. She had been sick for three weeks before being put on a ventilator and succumbing to pneumonia. She was the first measles death in the country since 2015.
Legacy Traditional School, a charter school in Cibolo, near San Antonio, told parents on February 27 that a student was infected with measles. However, the child was actually infected with rubella, a different disease that can also be prevented by the same MMR vaccine. Austin confirmed on February 28 its first measles case since 2019, an unvaccinated infant who contracted the disease while overseas.

### New Mexico

New Mexico health officials began checking residents for measles on February 3. On March 6, an unvaccinated adult in Lea County died and was later revealed to have contracted measles prior to his death.

### Oklahoma

Two cases linked to the outbreak were identified in Oklahoma on March 11.

### Chihuahua

The Mexican state of Chihuahua, where the vaccination rate is at 75%, identified 15 cases of measles in Cuauhtémoc and one in Namiquipa on March 12. The outbreak has been concentrated in a Mennonite community whose members regularly travel to Texas to visit family and carry out business. There were also 25 cases of whooping cough (pertussis) discovered.

## Responses
### Federal

During a cabinet meeting on February 26, Robert F. Kennedy Jr., the United States secretary of health and human services, stated: "We are following the measles epidemic every day. Incidentally, there have been four measles outbreaks this year. In this country last year there were 16. So, it's not unusual. We have measles outbreaks every year." Kennedy, who is known for his anti-vaccine activism and history of downplaying measles resurgences, also stated incorrectly that there were two deaths and that the hospitalizations were for quarantine purposes. Only one death had been recorded at that time, and officials in Lubbock stated that they do not hospitalize patients for quarantine purposes and that the children who were admitted were having difficulty breathing (with some requiring intensive care and supplemental oxygen). They added that all of the admitted children were unvaccinated. Senator Bill Cassidy, who chaired the Senate health committee, tweeted that the death was "absolutely devastating" and encouraged parents to vaccinate their children.
Infectious disease experts Cameron Wolfe of Duke University, David Higgins of the University of Colorado, and former head of the National Immunization Program Walter Orenstein objected to Kennedy's description of the outbreak as "not unusual" and stated the child's death was fully preventable with proper vaccination. Ali S. Khan, the former Director of the Office of Public Health Preparedness and Response at the Centers for Disease Control and Prevention (CDC) called for political officials at all levels to promote vaccination. In contrast to the 2019 New York measles outbreak—when CDC officials and Health Secretary Alex Azar urged vaccination—the CDC and Health Secretary did not release statements or make posts on social media urging vaccination. On March 4, the CDC, which had been providing MMR vaccines and lab support, posted on X that the Epidemic Intelligence Service would be helping the Texas State Department of Health. The organization also began planning a large-scale study of vaccines and autism, though extensive research has shown no connection between the two.
Kennedy published an opinion piece about the outbreak on the Fox News website on March 2. He suggested parents consult with healthcare providers about vaccination, but did not explicitly recommend it, stating the choice was "personal." He also promoted vitamin A supplementation and, in later interviews, cod liver oil, neither of which are effective treatments. Infectious disease specialists interviewed by Stat interpreted Kennedy's column as echoing the messages of anti-vaccine activists, who emphasize nutrition, supplementation, and parental choice over vaccination. Kennedy gave an interview to Fox News' Marc Siegel on March 8 in which he made numerous false claims including that it is "almost impossible" for healthy individuals to die from infectious disease and that the child who died may have been malnourished, despite health official's statements that she had no underlying conditions.

### State and local

Schools have not ordered unvaccinated students to stay home as this would require declaring a state of emergency. The Texas Department of State Health Services stated that such a declaration was not necessary since 90% of Texans are vaccinated; they ordered a 21-day quarantine for exposed unvaccinated individuals, but this would not be tracked or enforced. In rural Texas, the challenges of the outbreak were exacerbated by a lack of adequate public health infrastructure, primary care practitioners, and funding as 26 hospitals had closed between 2010 and 2020.
As news of the outbreak spread, health officials reported a rise in families deciding to vaccinate their children. The director of public health in Lubbock county stated that in the last week of February 2025 they had given approximately 100 doses of the MMR vaccine to children who had previously been unvaccinated or whose parents did not believe in vaccines. Vaccine-hesitant parents, including those who had sought exemptions for their children, were also bringing them to receive vaccines. High demand for vaccines caused shortages in some parts of Texas, particularly Austin. In Gaines County, some families continued to refuse vaccines and instead opted for vitamin A supplements, cod liver oil, or budesonide—a steroid used for asthma—and supported Kennedy's stances.