The cases in Kansas are likely part of the mushrooming outbreak that began in West Texas in late January. On March 13, Kansas reported a single measles case, the first the state had seen since 2018. The nine cases reported last week had ties to that original case.
Spreading infections and misinformation
On Wednesday, KDHE Communications Director Jill Bronaugh told Ars Technica over email that the department has found a genetic link between the first Kansas case and the cases in West Texas, which has similarly spread swiftly in under-vaccinated communities and also spilled over to New Mexico and Oklahoma.
“While genetic sequencing of the first Kansas case reported is consistent with an epidemiological link to the Texas and New Mexico outbreaks, the source of exposure is still unknown,” Bronaugh told Ars.
Bronaugh added that KDHE, along with local health departments, is continuing to work to track down people who may have been exposed to measles in affected counties.
In Texas, meanwhile, the latest outbreak count has hit 327 across 15 counties, mostly children and almost entirely unvaccinated. Forty cases have been hospitalized, and one death has been reported—a 6-year-old unvaccinated girl who had no underlying health conditions.
On Tuesday, The New York Times reported that as measles continues to spread, parents have continued to eschew vaccines and instead embraced “alternative” treatments, including vitamin A, which has been touted by anti-vaccine advocate and current US Health Secretary Robert F. Kennedy Jr. Vitamin A accumulates in the body and can be toxic with large doses or extended use. Texas doctors told the Times that they’ve now treated a handful of unvaccinated children who had been given so much vitamin A that they had signs of liver damage.
“I had a patient that was only sick a couple of days, four or five days, but had been taking it for like three weeks,” one doctor told the Times.
In New Mexico, cases are up to 43, with two hospitalizations and one death in an unvaccinated adult who did not seek medical care. In Oklahoma, officials have identified nine cases, with no hospitalizations or deaths so far.
On Thursday, the county on the northern border of Stevens, Grant County, also reported three confirmed cases, which were also linked to the first case in Stevens. Grant County is in a much better position to handle the outbreak than its neighbors; its one school district, Ulysses, reported 100 percent vaccination coverage for kindergartners in the 2023–2024 school year.
Outbreak risk
So far, details about the fast-rising cases are scant. The Kansas Department of Health and Environment (KDHE) has not published another press release about the cases since March 13. Ars Technica reached out to KDHE for more information but did not hear back before this story’s publication.
The outlet KWCH 12 News out of Wichita published a story Thursday, when there were just six cases reported in just Grant and Stevens Counties, saying that all six were in unvaccinated people and that no one had been hospitalized. On Friday, KWCH updated the story to note that the case count had increased to 10 and that the health department now considers the situation an outbreak.
Vaccination rates have slipped nationwide, creating pockets that have lost herd immunity and are vulnerable to fast-spreading, difficult-to-stop outbreaks. In the past, strong vaccination rates prevented such spread, and in 2000, the virus was declared eliminated, meaning there was no continuous spread of the virus over a 12-month period. Experts now fear that the US will lose its elimination status, meaning measles will once again be considered endemic to the country.
So far this year, the Centers for Disease Control and Prevention has documented 378 measles cases as of Thursday, March 20. That figure is already out of date.
On Friday, the Texas health department reported 309 cases in its ongoing outbreak. Forty people have been hospitalized, and one unvaccinated child with no underlying medical conditions has died. The outbreak has spilled over to New Mexico and Oklahoma. In New Mexico, officials reported Friday that the case count has risen to 42 cases, with two hospitalizations and one death in an unvaccinated adult. In Oklahoma, the case count stands at four.
Cod liver oil contains high levels of vitamin A, which is sometimes administered to measles patients under a physician’s supervision. But the supplement is mostly a supportive treatment in children with vitamin deficiencies, and taking too much can cause toxicity. Nevertheless, Kennedy has touted the vitamin and falsely claimed that good nutrition protects against the virus, much to the dismay of pediatricians.
“They had a really good, quick recovery,” the mother said of her other four children, attributing their recovery to the unproven treatments.
Tragic misinformation
Most children do recover from measles, regardless of whether they’re given cod liver oil. The fatality rate of measles is nearly 1 to 3 in 1,000 children, who die with respiratory (e.g., pneumonia) or neurological complications from the virus, according to the Centers for Disease Control and Prevention.
Tommey noted that the sibling who died didn’t get the alternative treatments, leading the audience to believe that this could have contributed to her death. She also questioned what was written on the death certificate, noting that the girl’s pneumonia was from a secondary bacterial infection, not the virus directly, a clear effort to falsely suggest measles was not the cause of death and downplay the dangers of the disease. The parents said they hadn’t received the death certificate yet.
Tommey then turned to the MMR vaccine, asking if the mother still felt that it was a dangerous vaccine after her daughter’s death from the disease, prefacing the question by claiming to have seen a lot of “injury” from the vaccine. “Do you still feel the same way about the MMR vaccine versus measles?” she asked.
“Yes, absolutely; we would absolutely not take the MMR. The measles wasn’t that bad, and they got over it pretty quickly,” the mother replied, speaking again of her four living children.
“So,” Tommey continued, “when you see the fearmongering in the press, which is what we want to stop, that is why we want to get the truth out, what do you say to the parents who are rushing out, panicking, to get the MMR for their 6-month-old baby because they think that that child is going to die of measles because of what happened to your daughter?”
With measles declared eliminated from the US in 2000 and national herd immunity strong, health experts have recommended that American children get two doses of the Measles, Mumps, and Rubella (MMR) vaccine—the first between the ages of 12 and 15 months and the second between the ages of 4 and 6 years, before they start school.
Before 12 months, vulnerable infants in the US have been protected in part by maternal antibodies early in infancy as well as the immunity of the people surrounding them. But if they travel to a place where population immunity is unreliable, experts recommend that infants ages 6 to 11 months get an early dose—then follow it up with the standard two doses at the standard times, bringing the total to three doses.
The reason they would need three—and the reason experts typically recommend waiting until 12 months—is because the maternal antibodies infants carry can interfere with the vaccine response, preventing the immune system from mounting long-lasting protection. Still, the early dose provides boosted protection in that 6-to-11-month interval.
In the past, this early, extra dose was recommended for infants traveling internationally—to countries that hadn’t achieved America’s enviable level of herd immunity and were vulnerable to outbreaks. But now, with US vaccination rates slipping, herd immunity becoming spotty, cases rising by the day, and outbreaks simmering in multiple states, the US is no longer different from far-off places that struggle with the extremely infectious virus.
In an article published today in JAMA, prominent health experts—including former Centers for Disease Control and Prevention Director Rochelle Walensky—call for the US to update its MMR recommendations to include the early, extra dose for infants who are not only traveling abroad, but domestically, to any areas where measles is a concern.
“With some local immunization levels inadequate to avert outbreaks and ongoing disease spread in various regions of the country, a dichotomy between domestic and international travel is not appropriate,” the experts write. “For many travel itineraries, there may even be a higher risk of measles exposure at the US point of departure than at the international destinations.”
Vaccinating at-risk infants early is critical to their own health—as well as the people around them, the experts note. “[I]nfants younger than one year face a heightened risk of severe measles-related complications such as pneumonia, encephalitis, and death. Younger infants are also at increased risk of developing subacute sclerosing panencephalitis (SSPE), a rare measles complication that has a high fatality rate and may surface years after initial infection,” according to the experts.
Meanwhile, the Texas health department on Tuesday provided an outbreak update, raising the case count to 223, up 25 from the 198 Texas cases reported Friday. Of the Texas cases, 29 have been hospitalized and one has died—a 6-year-old girl from Gaines County, the outbreak’s epicenter. The girl was unvaccinated and had no known underlying health conditions.
The outbreak continues to be primarily in unvaccinated children. Of the 223 cases, 76 are in ages 0 to 4, and 98 are between ages 5 and 17. Of the cases, 80 are unvaccinated, 138 lack vaccination status, and five are known to have received at least one dose of the Measles, Mumps, and Rubella vaccine.
One dose of MMR is estimated to be 93 percent effective against measles, and two doses offer 98 percent protection. It’s not unexpected to see a small number of breakthrough cases in large, localized outbreaks.
Across the border from Gaines County in Texas sits Lea County, where New Mexico officials have now documented 32 cases, with an additional case reported in neighboring Eddy County, bringing the state’s current total to 33. Of those cases, one person has been hospitalized and one person (not hospitalized) died. The death was an adult who did not seek medical care and tested positive for measles only after death. The cause of their death is under investigation.
Of New Mexico’s 33 cases, 27 were unvaccinated and five did not have a vaccination status, and one had received at least one MMR dose. Eighteen of the 33 cases are in adults, 13 are ages 0 to 17, and two cases have no confirmed age.
On Friday, the Centers for Disease Control and Prevention released a travel alert over the measles outbreak. “With spring and summer travel season approaching in the United States, CDC emphasizes the important role that clinicians and public health officials play in preventing the spread of measles,” the agency said in the alert. It advised clinicians to be vigilant in identifying potential measles cases.
The agency stressed the importance of vaccination, putting in bold: “Measles-mumps-rubella (MMR) vaccination remains the most important tool for preventing measles,” while saying that “all US residents should be up to date on their MMR vaccinations.”
US health secretary and long-time anti-vaccine advocate Robert F. Kennedy Jr, meanwhile, has been emphasizing cod liver oil, which does not prevent measles, and falsely blaming the outbreak on poor nutrition.
Vitamin A is a fat-soluble vitamin that stays in the body. Taking too much over longer periods can cause vomiting, headache, fatigue, joint and bone pain, blurry vision, and skin and hair problems. Further, it can lead to dangerously high pressure inside the skull that pushes on the brain, as well as liver damage, confusion, coma, and other problems, according to the American Academy of Pediatrics.
Nevertheless, in an interview with Fox News this week, Kennedy endorsed an unconventional regimen of a steroid, an antibiotic and cod liver oil, praising two Texas doctors for giving it to patients. One of the doctors Kennedy championed was disciplined by the state medical board in 2003 for “unusual use of risk-filled medications,” according to a report by CNN.
In a yet more worrying sign, Reuters reported Friday afternoon that the CDC is planning to conduct a large study on whether the MMR vaccine is linked to autism. This taxpayer-funded effort would occur despite the fact that decades of research and numerous high-quality studies have already been conducted—and they have consistently disproven or found no connection between the vaccine and autism.
The agency’s move is exactly what Democratic senators feared when Kennedy was confirmed as the country’s top health official. In Senate hearings, Kennedy refused to say that vaccines do not cause autism. Democratic senators quickly warned that his anti-vaccine stance could not only move the country backward in the fight against vaccine-preventable diseases, but also hold back autism research aimed at finding the real cause(s) as well as better treatments.
“When you continue to sow doubt about settled science it makes it impossible for us to move forward,” Senator Maggie Hassan (D-N.H.) said in a Senate hearing. “It’s the relitigating and rehashing … it freezes us in place.”
In an interview with Ars Technica last week, Zach Holbrooks, the executive director of the South Plains Public Health District (SPPHD), which includes Gaines, said that the area has a large religious community that has expressed vaccine hesitancy.
Additional cases likely
Pockets of the county have yet lower vaccination rates than the county-wide averages suggest. For instance, one independent public school district in Loop, in the northeast corner of Gaines, had a vaccination rate of 46 percent in the 2023–2024 school year.
Measles is one of the most infectious diseases known. The measles virus spreads through the air and can linger in the airspace of a room for up to two hours after an infected person has left. Ninety percent of unvaccinated people who are exposed will fall ill with the disease, which is marked by a very high fever and a telltale rash. Typically, 1 in 5 unvaccinated people with measles in the US end up hospitalized, and 1 in 20 develop pneumonia. Between 1 to 3 in 1,000 die of the infection. In rare cases, it can cause a fatal disease of the central nervous system called Subacute sclerosing panencephalitis later in life. Measles can also wipe out immune responses to other infections (a phenomenon known as immune amnesia), making people vulnerable to other infectious diseases.
“Due to the highly contagious nature of this disease, additional cases are likely to occur in Gaines County and the surrounding communities,” the state health department said.
While Gaines is remarkable for its low vaccination rate, vaccination coverage nationwide has slipped in recent years as vaccine misinformation and hesitancy have taken root. Overall, vaccination rates among US kindergartners have fallen from 95 percent in the 2019–2020 school year into the 92 percent range in the 2023–2024 school year. Vaccine exemptions, meanwhile, have hit an all-time high. Health experts expect to see more vaccine-preventable outbreaks, like the one in Gaines, as the trend continues.
Measles, whopping cough, polio, tetanus—devastating and sometimes deadly diseases await comebacks in the US as more and more parents are declining routine childhood vaccines that have proved safe and effective.
The vaccination rates among kindergartners have fallen once again, dipping into the range of 92 percent in the 2023–2024 school year, down from about 93 percent the previous school year and 95 percent in 2019–2020. That’s according to an analysis of the latest vaccination data published today by the Centers for Disease Control and Prevention.
The analysis also found that vaccination exemptions rose to an all-time high of 3.3 percent, up from 3 percent in the previous school year. The rise in exemptions is nearly entirely driven by non-medical exemptions—in other words, religious or philosophical exemptions. Only 0.2 percent of all vaccination exemptions are medically justified.
The new stats mean that more parents are choosing to decline lifesaving vaccines and, for the fourth consecutive year, the US has remained below the 95 percent vaccination target that would keep vaccine-preventable diseases from spreading within communities. In fact, the country continues to slip further away from that target.
Based on data from 49 states plus the District of Columbia (Montana did not report data), 80 percent of jurisdictions saw declines in vaccinations of all four key vaccines assessed: MMR, against measles, mumps, and rubella; DTaP, against diphtheria, tetanus, and pertussis (whooping cough); VAR, against chickenpox; and polio.
Vulnerable kids
Coverage for MMR fell to 92.7 percent in 2023–2024, down from 93.1 percent in the previous school year. That means that about 280,000 (7.3 percent) kindergartners in the US are at risk of measles, mumps, and rubella infections. Likewise, DTaP coverage fell to 92.3 percent, down from 92.7 percent. Polio vaccination fell to 92.6 percent from 93.1 percent, and VAR was down to 92.4 percent from 92.9 percent.
Enlarge/ A US child infected with measles during a 2024 outbreak. The child’s cheek shows the characteristic rash associated with this viral infection.
With one of the highest vaccine exemption rates in the country, Oregon is experiencing its largest measles outbreak in decades. This year’s count is now higher than anything seen since 2000, when the Centers for Disease Control and Prevention declared the highly contagious virus eliminated from the US.
Last month, when the outbreak tally was still in the 20s, health officials noted that it was nearing a state record set in 2019. There were 28 cases that year, which were linked to a large outbreak across the border in Washington state. But, with that record now surpassed, the state is in pre-elimination territory.
“Before 2019, you have to go all the way back to the early 1990s to see case counts this high,” Paul Cieslak, medical director for communicable diseases and immunization at Oregon Health Authority, said in a statement. “The reason is, we maintained very high vaccination rates and very high population levels of immunity. Unfortunately, we’ve seen an erosion in the percentage of people who are getting vaccinated against measles.”
Vaccination decline
In 2000, when measles was declared officially eliminated, only about 1 percent of kindergarteners in the state had exemptions from childhood vaccines, such as measles. But in the years since, Oregon has become one of the states with the highest exemption rates in the country. In the 2022–2023 school year, 8.2 percent of Oregon kindergarteners had exemptions from vaccinations, according to a CDC analysis published in November. Only Idaho had a higher rate, with 12.1 percent of kindergarteners exempt. Utah was a close third, with 8.1 percent, followed by Arizona (7.4 percent) and Wisconsin (7.2 percent).
Oregon’s exemption rate has risen since then, with the exemption rate now at 8.8 percent, according to the Oregon Health Authority. Any exemption rate above 5 percent is concerning. At that threshold, even if every non-exempt child is vaccinated, a state will not be able to achieve the target of 95 percent vaccine coverage expected to prevent sustained transmission of infectious diseases.
Health officials are directly linking the rise of non-medical exemptions to the current measles outbreak, which is centered in Clackamas, Marion, and Multnomah counties. All three are in the northwestern corner of the state, with Clackamas and Multnomah in the Portland area.
“In Clackamas County, as in other Oregon counties, pockets of unvaccinated people raise risk of infection in communities where they live,” Clackamas County Health Officer Sarah Present said. “That’s why the counties reach out to every case that’s been identified and try to determine exactly where they’ve been while infectious.”
Notorious virus
Measles is among the most infectious viruses known. It is notorious for its ability to stay aloft in indoor air for up to two hours after an infected person has been present. For unvaccinated people who are exposed, up to 9 out of 10 will end up falling ill. Those who become infected are contagious from about four days before developing the tell-tale rash and four days after it erupts. Other common symptoms of the infection include high fever, runny nose, cough, and conjunctivitis (pink eye). Many children become severely ill, requiring hospitalization.
In a small percentage of cases, measles can lead to severe complications, including pneumonia, encephalitis, and a progressive neurological disorder (subacute sclerosing panencephalitis), which develops five to 10 years after an initial infection. Additionally, measles is known to cause “immune amnesia.” That is, being infected with measles virus wipes out existing antibodies and immune responses to other germs, leaving people more vulnerable to other diseases.
So far this year, the US has logged 236 measles cases. Of those, 40 percent were in children under the age of 5, while 30 percent were in children and teens between the ages 5 and 19. Eighty-seven percent were either unvaccinated or had an unknown vaccination status. Forty-four percent (103 of 236) were hospitalized.
This year’s tally is already well ahead of the total for 2023, which reached just 59 cases. It is still significantly lower than the 1,274 cases seen in 2019, when the US nearly lost its elimination status.
Enlarge/ Florida Surgeon General Dr. Joseph Ladapo speaks during a press conference at Neo City Academy in Kissimmee, Florida.
Paul Hennessy/SOPA Images/LightRocket via Getty Images
A sixth student at Florida’s Manatee Bay Elementary School outside of Fort Lauderdale has a confirmed case of measles, health officials announced late Tuesday. However, health officials are not telling unvaccinated students who were potentially exposed to quarantine.
The letter, signed by Ladapo, noted that people with measles can be contagious from four days before the rash develops through four days after the rash appears. And while symptoms often develop between 8 to 14 days after exposure, the disease can take 21 days to appear. As such, the normal quarantine period for exposed and unvaccinated people, who are highly susceptible to measles, is 21 days.
“Because of the high likelihood of infection, it is normally recommended that children stay home until the end of the infectious period, which is currently March 7, 2024,” Ladapo’s letter states, adding that the date could change as the situation develops. “However, due to the high immunity rate in the community, as well as the burden on families and educational costs of healthy children missing school, [the health department] is deferring to parents or guardians to make decisions about school attendance.”
Local media outlets reported that, on Tuesday, more than 200 of the school’s 1,067 students were absent.
The measles cluster began Friday when a third grader, who had not recently traveled, was diagnosed with the vaccine-preventable illness. Over the weekend, three additional cases were identified, leading the local health department to release a health advisory. Two additional cases were identified this week. It’s unclear if all six children are unvaccinated.
According to a county vaccine study, only 89.31 percent of the school’s students were vaccinated in the 2023/2024 school year, suggesting that around 114 students are susceptible due to their vaccination status.
The measles virus spreads easily through respiratory transmission and can linger in air space for up to two hours after an infected person has been in an area. Among people susceptible to the virus—those who are unvaccinated or have compromised immune systems—up to 90 percent will become infected upon exposure. People who are fully vaccinated, meanwhile, are considered protected. Two doses of the Measles, Mumps, and Rubella (MMR) vaccine are 97 percent effective at preventing the disease.
Measles symptoms include high fever, runny nose, red and watery eyes, and a cough, as well as a telltale rash that develops after initial symptoms. About 1 in 5 unvaccinated people with measles are hospitalized, according to the Centers for Disease Control and Prevention, while 1 in 20 infected children develop pneumonia and up to 3 in 1,000 children die of the infection.
