In 2025 the United States recorded its most measles cases since measles was declared eliminated in 2000. On March 21, 2025, Lubbock Public Health (LPH) in Texas learned of a 3-year-old with measles who attended a local child care facility.
The first case
The child — unvaccinated, with a vaccination exemption on file — had fever from March 15 and a rash from March 20, plus cough, runny nose, pink eye, an ear infection and diarrhea, and hadn't traveled. The child was infectious from about March 16 to 24 and attended the center until March 17. After a strep test at a drive-through clinic and a visit to an emergency department on March 21, a measles test came back positive on March 24; the center heard on March 25.
The facility had 48 staff and 287 children, from infants to prekindergarten — 39 (13.6%) under 12 months old.
The spread
| When | Who |
|---|---|
| March 25–29 | a child in the same classroom (B), and the index child's sibling, exposed at home (C) |
| April 1–15 | four more children at the center, in other classrooms (D–G) |
| April 16 | a 41-year-old man of unknown vaccination status, grandfather of patient D (H) |
All were confirmed by laboratory testing. Of the seven children, three were under 12 months; the index child was hospitalized for a day; a 7-month-old caught measles despite a post-exposure MMR dose given three days before symptoms began. Everyone recovered.
The response
| Measure | What was done |
|---|---|
| Telling families | the director phoned every family on March 25; emails and texts followed; LPH wrote to caregivers on March 28 with measles information and a vaccination offer |
| Checking immunity | 96% of the 248 children 12 months and older had at least one MMR dose; 10 eligible children aged 6 months to 6 years had exemptions and no MMR — three of them got measles. Staff reported being vaccinated (not verified); no staff got measles |
| Post-exposure protection | MMR offered to everyone exposed; immunoglobulin at local hospitals |
| Separating infants | from April 3, six infants under 6 months shared one classroom with its own entrance and two dedicated staff |
| Limiting mixing | children and staff stayed in their classrooms (15–20 children each); the cafeteria and other shared spaces closed |
| Excluding the unvaccinated | unvaccinated children were kept home 21 days after their last exposure; five children from four families stayed home rather than be vaccinated |
| Early doses | on April 7, the Texas Department of State Health Services recommended an early MMR dose for infants 6–11 months in outbreak counties, including Lubbock |
| Sick children | cases could return 4 days after rash onset if well; children with symptoms went home for 21 days unless a test was negative |
| Wider outreach | an April 11 meeting with CDC (including the National Institute for Occupational Safety and Health), LPH and the state on infection control, ventilation and Caring for Our Children standards; television interviews; contact with 117 other child care facilities, none reporting cases |
Why keep the infants in care? LPH worried that if babies under 6 months were barred, families might move them to other centers and spread measles further — so it grouped them instead. It also recognized that home quarantine is hard on families without financial or social safety nets.
Lessons
- Vaccination is the best protection. CDC recommends MMR at 12–15 months and 4–6 years; two doses are 97% effective. Because one person with measles can infect 90% of the non-immune people they contact, community coverage above 95% is needed — and it protects babies too young to vaccinate.
- Exemptions are rising. Among kindergartners, conscientious exemptions rose from 2.14% in Texas and 2.04% in Lubbock County in 2020–21 to 3.95% and 4.49% in 2024–25. In 2024, only 82% of Lubbock County children aged 1–3 and 90% aged 4–5 had at least one MMR dose.
- Partnership and communication — between health departments, child care directors and families — made rapid action possible.
Sources
Based on Ly AN, Shotts A, Torres T, et al., "Measles Outbreak in a Child Care Facility — Lubbock, Texas, March–April 2025," MMWR volume 75, number 21, Centers for Disease Control and Prevention; a work of the United States government in the public domain.
Licence: CC0 1.0 (public domain) · Adapted from www.cdc.gov
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