Measles Outbreak in a Child Care Facility — Lubbock, Texas, March–April 2025

Anh N. Ly, PhD1,2; Amanda Shotts, MPH3; Tiffany Torres, MPH3; Georgina Peacock, MD4; David E. Sugerman, MD5; Carolyn Crisp, PhD6,7; Gretchen Rodriguez, MPH7; Thi Dang, MPH7; Diana Martinez, PhD7; Saroj Rai, PhD7; Varun Shetty, MD7; Ashley Meehan, MPH8; Susan Hocevar Adkins, MD8; Thomas D. Filardo, MD5; Nicole F. Dowling, PhD4; Katherine Wells, DrPH3 (

Summary

What is already known about this topic?

Measles is a highly contagious, vaccine-preventable disease. In recent years, U.S. measles outbreaks have occurred in communities with low vaccination coverage.

What is added by this report?

During March–April 2025, eight confirmed measles cases linked to a child care facility were reported in Lubbock, Texas. The index case occurred in an unvaccinated child aged 3 years. Multiple mitigation measures were implemented, including exclusion of unvaccinated children who had been exposed; separating children too young for measles, mumps, and rubella (MMR) vaccination; minimizing use of shared spaces; encouraging MMR vaccination; home isolation of patients; and communication with the public and child care facilities.

What are the implications for public health practice?

Vaccination, collaboration, and rapid public health actions are needed to prevent measles transmission in congregate settings.

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Abstract

During 2025, the United States recorded the highest number of measles cases since measles elimination was declared in 2000. On March 21, 2025, Lubbock Public Health (LPH) in Texas received a report of a child care attendee aged 3 years, with fever, rash, cough, coryza, conjunctivitis, otitis media, and diarrhea who received a positive test result for measles by real-time reverse transcription–polymerase chain reaction (RT-PCR). Six additional children who attended the same child care facility and the grandfather of one of the children were confirmed by RT-PCR testing to have measles. None of the patients was reported to have traveled. LPH contacted the pediatric patients’ caregivers to conduct case investigations and provided recommendations to the child care facility for home isolation, vaccination, and testing. LPH also communicated with caregivers, other child care facilities in the area, and the public to raise awareness. The child care facility implemented measures to minimize transmission, including separating children who were not yet eligible for the measles, mumps, and rubella vaccine; minimizing the use of shared spaces; and monitoring signs and symptoms. Collaboration between public health and community partners such as child care facilities can facilitate a rapid response and control of infectious disease outbreaks.

Index Case

On March 21, 2025, Lubbock Public Health (LPH) in Texas was notified of a suspected measles case in a child aged 3 years (index patient, patient A) who had fever, rash, cough, coryza, conjunctivitis, otitis media, and diarrhea. The child had fever onset on March 15 and rash onset on March 20; the infectious period was estimated to be March 16–24 (4 days before and 4 days after rash onset). The child had no travel history during the exposure period but attended a child care facility that had 48 employees and 287 enrolled children, ranging from infants to prekindergarten children; 39 (13.6%) of the children were aged Patient A attended the child care facility while infectious until March 17 (2 days after symptom onset and 3 days before rash onset). The child received testing for Streptococcus infection at a drive-through health care clinic on the morning of March 21. Later that same day, the child visited an emergency department and received measles RT-PCR testing. The positive measles laboratory result was available 3 days later (March 24), and the child care facility was informed the next day (March 25).

Additional Cases Associated with the Child Care Facility

During March 25–29, LPH was notified of two additional suspected measles cases (patients B and C); both cases occurred in children who attended the same child care facility as the index patient, including a child in the same classroom as the index patient (patient B) and a sibling of the index patient (patient C) who was exposed at home (

Age and Vaccination Status of Children with Measles

Among the seven total confirmed pediatric measles cases, three occurred among children aged

Notifying Caregivers of Children

Once notified of the first measles case on March 25, 2025, the child care facility director telephoned caregivers of all enrolled children. Communications were sent from the child care facility to all caregivers through email and text message on March 26. Staff members at the child care facility were informed in person and through email and text message. On March 28, 2025, LPH sent a letter to caregivers, providing information about measles, advice for contacting providers if they or their children experienced symptoms, and recommendations for MMR vaccination, available at LPH.

Reviewing Vaccination Status of Children and Staff Members and Offering Postexposure Prophylaxis

The child care facility reviewed the vaccination status of all enrolled children and reported 96% vaccination coverage with ≥1 MMR vaccine dose each among the 248 children aged ≥12 months. Ten children aged 6 months–6 years at the facility who were eligible for MMR vaccination had vaccine exemption forms on file with the child care facility and had not received any MMR vaccine dose; three of these children had measles during this outbreak. All staff members reported that they had received MMR vaccine; however, their vaccination status was not verified. No measles cases occurred among staff members. LPH offered MMR vaccine as postexposure prophylaxis to all persons who were exposed to measles at the child care facility. Immunoglobulin was offered as postexposure prophylaxis at local hospital facilities.

Ongoing Monitoring, Quarantine, and Return to the Child Care Facility

The child care facility instructed caregivers to keep children who received positive measles RT-PCR results at home; they were allowed to return to the child care facility after 4 days had elapsed since rash onset, if no other signs or symptoms (e.g., fever, vomiting, or diarrhea) were present. The facility continued to monitor children in attendance for fever, cough, coryza, and conjunctivitis. Children with symptoms were sent home immediately and required to remain home for 21 days or provide a negative RT-PCR test result to return. No staff members reported symptoms.

Increasing Community Awareness of the Outbreak

On April 11, 2025, a meeting with CDC (including members from the National Institute for Occupational Safety and Health), LPH, and DSHS was held to discuss potential approaches to continue to reduce transmission within the child care facility. CDC shared guidance on topics such as preventing infection in education settings, national standards on health and safety from Caring for Our Children (2), a set of voluntary safety standards for early care and education programs, and facility ventilation guidelines. A representative from LPH and the child care facility administrator were interviewed on television to inform the community about the outbreak. LPH also contacted 117 child care facilities in the area. None of these facilities reported measles cases.

Discussion

The response to a measles outbreak in this child care facility highlights the importance of vaccination and rapid response in accordance with public health guidance. CDC recommends 1 routinely administered MMR vaccine dose for children aged 12–15 months and a second dose at age 4–6 years (3). In 2024, coverage with ≥1 MMR vaccine dose among children aged 1–3 years and 4–5 years in Lubbock County was 82% and 90%, respectively. In child care settings, Texas law requires receipt of ≥1 MMR vaccine dose by age 16 months or serologic evidence of immunity from previous infection unless the child has a documented vaccination exemption for medical reasons or reasons of conscience (4). The proportion of children with a conscientious exemption has been increasing in Texas and Lubbock County. During the 2024–25 school year, 3.95% of kindergarten children in Texas and 4.49% in Lubbock County had a conscientious exemption, compared with 2.14% in Texas and 2.04% in Lubbock County during the 2020–21 school year (5). Because a person with measles can infect 90% of nonimmune persons with whom they come into contact, maintaining community vaccination coverage of >95% is the most effective means for preventing measles transmission (6). Two doses of MMR vaccine are 97% effective in preventing measles (3). In addition, herd immunity, achieved through high community vaccination coverage, protects children who are not yet eligible for MMR vaccination and other persons who cannot receive the vaccine for medical reasons.

During this outbreak, the child care facility followed guidance from state and local health departments regarding MMR vaccination and child care attendance. According to state guidance, children who are unvaccinated and do not receive an MMR vaccine dose within 72 hours of exposure to measles, including those with medical or other exemptions, should not return to school for 21 days after their last exposure. However, LPH recognized that asking families to quarantine their children at home is disruptive, especially in families lacking financial or social safety nets who might not have the means to keep their children at home.

Because of concerns that some families might seek out other facilities for child care, LPH determined that not allowing children aged Effective communication was vital during this response. Proactive engagement between public health staff members and community partners, such as child care administrators and caregivers, was important for implementing timely public health measures. To maintain readiness for potential future outbreaks, public health departments need to draw on staff member expertise to implement rapid, clear, and tailored infection prevention and control measures and raise community awareness. Vaccination remains the most effective public health intervention to prevent measles and measles outbreaks. Few measles outbreaks in child care settings have been recently reported (7,8). This report highlights the challenges and lessons learned to guide future measles outbreak responses in these settings.

Acknowledgments

Staff members at the child care facility; Chad Dowell, Duane Hammond, the Institute of Environmental and Human Health, Bioterrorism Response Laboratory, Texas Tech University; Gabrielle Franco, Paola Gonzalez-Colon, Jenna Harlan, Texas Department of State Health Services measles team.

Corresponding author: Nicole F. Dowling, ncd5@cdc.gov.

1Global Immunization Division, Global Health Center, CDC; 2Epidemic Intelligence Service, CDC; 3Lubbock Public Health, Lubbock, Texas; 4Immunization Service Division, National Center for Immunization and Respiratory Diseases, CDC; 5Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC; 6Division of State and Local Readiness, Office of Readiness and Response, CDC; 7Texas Department of State Health Services; 8Division of Readiness and Response Science, Office of Readiness and Response, CDC.

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

• 45 C.F.R. part 46, 21 C.F.R. part 56; 42 U.S.C. Sect. 241(d); 5 U.S.C. Sect. 552a; 44 U.S.C. Sect. 3501 et seq.

† Infants aged

References

• Texas Department of State Health Services. School communicable disease chart: recommendations for the prevention and control of communicable diseases in a group-care setting. Austin, TX: Texas Health and Human Services, Texas Department of State Health Services; 2026. https://www.dshs.texas.gov/disease-surveillance-epidemiology-section/school-communicable-disease-chart
• Child Care Technical Assistance Network. Caring for our children basics home. Washington, DC: US Department of Health and Human Services, Child Care Technical Assistance Network; 2025. https://childcareta.acf.hhs.gov/cfoc
• CDC. Measles (rubeola): measles vaccine recommendations. Atlanta, GA: US Department of Health and Human Services, CDC; 2026. https://www.cdc.gov/measles/hcp/vaccine-considerations/index.html
• Texas Department of State Health Services. School and childcare vaccine requirements. Austin, TX: Texas Health and Human Services, Texas Department of State Health Services; 2026. https://www.dshs.texas.gov/immunizations/school
• Texas Department of State Health Services. Conscientious exemptions data. Austin, TX: Texas Health and Human Services, Texas Department of State Health Services; 2026. https://www.dshs.texas.gov/immunizations/data/school/conscientious-exemptions
• CDC. Measles (rubeola): how measles spreads. Atlanta, GA: US Department of Health and Human Services, CDC; 2024. https://www.cdc.gov/measles/causes/index.html
• Meyer D, Trotochaud M, Ferguson L, Vines J, Barlow R, Nuzzo JB. A US metropolitan county health department’s response to a measles outbreak in a childcare facility—challenges faced and lessons learned. Perspect Public Health 2022;142:42–5. https://doi.org/10.1177/1757913920955201 PMID:33200687
• Clegg WJ, Linchangco PC, Arwady MA, et al. Measles outbreak in a child care center, Cook County, Illinois, 2015. J Pediatric Infect Dis Soc 2017;6:239–44 https://doi.org/10.1093/jpids/piw011 PMID:27012274

• The epidemiologic link indicates potential contacts or relationships with another patient with measles. Patients A–G were enrolled at the child care facility.
  † Patients B and D received the age-appropriate first dose of MMR vaccine.
  § Patient F received 1 dose of MMR vaccine as postexposure prophylaxis 3 days before symptom onset.
  ¶ Patient G was considered unvaccinated at the time of the outbreak. On April 7, 2025, Lubbock was added to the list of outbreak areas in Texas, and an early dose of MMR vaccine was recommended for infants aged 6–11 months.

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