Notes from the Field: Initial Public Health Response to a Measles Outbreak in a Close-Knit West Texas Community — January−February 2025

Carolyn A. Crisp, PhD1,2,; Scott Milton, MD2,; Chelsea S. Lutz, PhD3,4; Kelly Northcott2; Kevin McClaran2; Cynthia Hernandez2; Sadia Almas, MPH2; Zach Holbrooks5; Katherine Wells, DrPH6; Elizabeth Sajewski, PhD3,7; Texas 2025 Measles Outbreak Response Team; CDC Epi-Aid Measles Response Team; Atisha Morrison, MPH2; Casey Schroeder, PhD2; Maria Nolen2; Jennifer Gonzales2; Diana Martinez, PhD2; Saroj Rai, PhD2; Varun Shetty, MD2; Jennifer A. Shuford, MD2 (

Summary

What is already known about this topic?

Measles is a highly contagious respiratory virus that can cause serious illness. A measles outbreak occurred in Texas during January–August 2025.

What is added by this report?

During January 29–February 28, 2025, Texas reported 207 confirmed measles cases, primarily among members of a close-knit west Texas community. Most cases occurred among unvaccinated persons or those with unknown vaccination status. Measles, mumps, and rubella (MMR) vaccine and measles testing clinics were offered; however, community members were hesitant to interact with public health and health care systems, and MMR vaccine acceptance was low. Educational materials on measles and measles prevention were developed and distributed.

What are the implications for public health practice?

In challenging community contexts, public health messaging intended to limit viral transmission and severe health outcomes could supplement standard control measures, including advising persons with suspected measles to avoid contact with other persons to prevent transmission and to seek medical care promptly.

Related Materials

• Article PDF
• Full Issue PDF

Introduction

On January 29, 2025, the South Plains Public Health District (SPPHD) alerted the Texas Department of State Health Services (DSHS) Public Health Region 1 of an unvaccinated school-aged child with measles in Gaines County, a rural county in west Texas bordering New Mexico. Investigations during January 29–February 28, 2025, identified 207 confirmed cases† (144 laboratory confirmed and 63 epidemiologically linked), predominately in a multilingual, close-knit community in Gaines County and eight nearby counties. This report describes barriers to implementing public health interventions during the initial phase of the outbreak. This activity was reviewed by CDC, deemed not research, and conducted consistent with applicable federal law and CDC policy.§

Characteristics of Persons with Measles

Among 207 measles cases in Texas residents reported during January 29–February 28, approximately two thirds (143; 69%) were reported in Gaines County; the remaining 64 (31%) occurred in eight nearby counties (

Vaccination Status of Persons with Measles and Local Vaccination Coverage

Among 207 persons with confirmed measles, 201 (97%) had no documentation of receipt of measles, mumps, and rubella (MMR) vaccine or their vaccination status was unknown; six (3%) had received ≥1 vaccine dose. In the outbreak area, county MMR vaccination coverage among kindergarteners during the 2024–25 school year ranged from 77.3% to 94.6%, compared with 93.2% in Texas overall. To prevent in-school transmission (and be consistent with Texas law), public health professionals recommended that school administrators ask students not to return to school for 21 days after a measles exposure if they did not have documented evidence of immunity (receipt of ≥2 valid MMR vaccine doses, documented prior infection, or positive antimeasles immunoglobulin G titers). Children attending unaccredited private schools or those who were homeschooled would not be included in this policy, potentially leading to ongoing school-based transmission.

Response to Distribution of Measles Information and Prevention Materials

SPPHD and DSHS developed and distributed culturally appropriate and community-informed resources describing measles disease and prevention strategies, including school guidance, information for school nurses and parents, and vaccination and testing clinic locations. CDC helped translate materials into relevant languages. During January 29–February 28, public health education focused on the importance of vaccination and symptom recognition. In counties with evidence of ongoing measles transmission, an early dose of MMR vaccine for infants aged 6–11 months and a second MMR vaccine dose for adults who had received only 1 dose were recommended. Thirty-three MMR vaccination clinics for persons aged ≥6 months and 16 measles testing clinics were held in DSHS Public Health Region 1. Despite these measures, vaccine acceptance was low; approximately 275 MMR vaccine doses were administered. Understanding transmission dynamics in the affected community was difficult because many persons interviewed during case investigations declined to provide enough information to enable follow-up and an exposure assessment (e.g., names of household members [often in large household units], contacts, or exposures).

Preliminary Conclusions and Actions

Low rates of MMR vaccination and measles testing and reluctance among community members while being interviewed during case investigations presented substantial challenges during the initial weeks of this measles outbreak. SPPHD and DSHS contacted trusted community members to better understand perspectives of the community. Many community members described their lack of trust in outside institutions and their reluctance to engage with public health and health care systems overall, based on an ethos within the community that prioritized maintaining independence from outside institutions and seeking solutions from within the community. This perspective complicated implementation of standard measles control measures and hampered epidemiologic investigations. Therefore, many measles cases likely remained unreported.

Decreases in measles vaccination coverage worldwide have increased the risk for larger measles outbreaks, especially in undervaccinated communities (About Measles | CDC). On August 18, 2025, the Texas measles outbreak was declared over, having comprised 762 confirmed cases, 99 hospitalizations, and a second measles-associated death. Although the source of this outbreak remains unknown, internationally imported cases have been associated with outbreaks among other close-knit U.S. communities with low vaccination coverage (3,4). High population coverage with 2 MMR vaccine doses is the most effective public health intervention for preventing measles (Measles Vaccination | CDC).

This outbreak highlights several challenges associated with encouraging vaccination, testing, education, and other interventions to limit disease severity and spread in certain communities. Early in a measles outbreak response, public health partnerships with trusted community members might help guide the development of culturally appropriate educational materials to support public health interventions. In challenging community contexts, public health messaging intended to limit viral transmission and severe health outcomes could supplement standard control measures, including advising persons with suspected measles to avoid contact with others to prevent transmission and to seek medical care promptly.

Acknowledgments

Texas Department of State Health Services, Austin Laboratory; Bioterrorism Response Laboratory; The Institute of Environmental and Human Health, Texas Tech University; Michaela Agard, Texas Department of State Health Services; Jamie Felberg, South Plains Public Health District.

Texas 2025 Measles Outbreak Response Team

Sandi Arnold, Texas Department of State Health Services; Brooklyn Baker, Texas Department of State Health Services; Samantha Curtis, Texas Department of State Health Services; Thi Dang, Texas Department of State Health Services; Jessica Del Toro, Texas Department of State Health Services; Eric Garza, Texas Department of State Health Services; Paola Gonzalez-Colon, Texas Department of State Health Services; Rebecca Gorman, Texas Department of State Health Services; Jenna Harlan, Texas Department of State Health Services; Elise Huebner, Texas Department of State Health Services; Anita Irving, Texas Department of State Health Services; Lydia Johnson, Texas Department of State Health Services; Michael Jost, Texas Department of State Health Services; Katie Katsounas, Texas Department of State Health Services; Bonny Mayes, Texas Department of State Health Services; Kinjal Mehta, Texas Department of State Health Services; Erica Mendoza, Texas Department of State Health Services; Karen Nunez, Texas Department of State Health Services; Bonnie Oh, Texas Department of State Health Services; Briana O’Sullivan-Kovacs, Texas Department of State Health Services; Elena Penedo, Texas Department of State Health Services; Annette Rodriguez, Texas Department of State Health Services; Daniella Rodriguez, Texas Department of State Health Services; Gretchen Rodriguez, Texas Department of State Health Services; Astrid Romero, Texas Department of State Health Services; Olivia Smith, Texas Department of State Health Services; Yan Sun, Texas Department of State Health Services; Jeff Swanson, Texas Department of State Health Services; Whitney Tillman, Texas Department of State Health Services; Shivangi Vayla, Texas Department of State Health Services; Stephen White, Texas Department of State Health Services; Cynthia Williams, Texas Department of State Health Services; Sarah Work, Texas Department of State Health Services.

CDC Epi-Aid Measles Response Team

Nakia Clemmons, CDC; Thomas Filardo, CDC; Duane Hammond, CDC; Adria Mathis, CDC; Dylan Neu, CDC; Belinda Ostrowsky, CDC; Kelley Raines, CDC; Courtney Rogers, CDC; David Sugerman, CDC; Axel A. Vazquez Deida, CDC; Erika Wallender, CDC; Dennis Wang, CDC; Jonathan Yoder, CDC.

Corresponding authors: Carolyn A. Crisp, ccrisp@cdc.gov; Scott Milton, Scott.Milton@dshs.texas.gov.

1Division of State and Local Readiness, Office of Readiness and Response, CDC; 2Texas Department of State Health Services; 3Epidemic Intelligence Service, CDC; 4Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC; 5South Plains Public Health District, Seminole, Texas; 6Lubbock Public Health, Lubbock, Texas; 7Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC.

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Thi Dang reports service on the board of directors of the Association for Professionals in Infection Control, Dallas Fort Worth Chapter. Elise Huebner reports receipt of support from the Council of State and Territorial Epidemiologists (CSTE) to attend their annual conference. Bonnie Oh reports institutional support from the Food and Drug Administration (FDA) and the Association of Public Health Laboratories, and support from FDA to attend the Association of Public Health Laboratories meetings. Casey Schroeder reports institutional support from FDA and the Association of Public Health Laboratories; support from the Association of Public Health Laboratories, the American Society for Microbiology, and the American Society for Clinical Laboratory Sciences for travel to and attendance at meetings; uncompensated work reviewing Clinical Laboratory Sciences Schools & University programs for the National Accrediting Agency for Clinical Laboratory Sciences and service on the planning committee for the Association of Public Health Laboratories ID Lab Conference; and service on the planning committee for the Emerging Laboratory Managers Collaborative Conference. Yan Sun reports institutional support from FDA and the Association of Public Health Laboratories and support from the Association of Public Health Laboratories for travel to and attendance at meetings. Stephen White reports receipt of support from CSTE to attend the 2023 annual conference from the Association of Public Health Laboratories for travel and attendance at the annual conference and service on the Association of Public Health Laboratories advisory board. Saroj Rai reports stocks in Novartis Pharmaceuticals. No other potential conflicts of interest were disclosed.

• These authors contributed equally to this report.

† A confirmed measles case was defined as an acute, febrile rash illness (temperature can be ](https://www.dshs.texas.gov/news-alerts/measles-outbreak-case-definition)). Laboratory-confirmed cases were those among persons who received a positive wild-type measles test result using one of the methods described in the 2025 Texas DSHS Epi Case Criteria Guide.

§ 45 C.F.R. part 46, 21 C.F.R. part 56; 42 U.S.C. Sect. 552a; 44 U.S.C. Sect. 3501 et seq.

References

• Wang D, Rogers C, Lutz C, et al. Characteristics of patients hospitalized with measles during an outbreak—west Texas, January–March 2025. MMWR Morb Mortal Wkly Rep 2026;75:252–7. https://doi.org/10.15585/mmwr.mm7520a1 PMID:42207686
• Mathis AD, Raines K, Filardo TD, et al. Measles update—United States, January 1–April 17, 2025. MMWR Morb Mortal Wkly Rep 2025;74:232–38.  https://doi.org/10.15585/mmwr.mm6819a4 PMID:31095533
• McDonald R, Ruppert PS, Souto M, et al. Notes from the field: measles outbreaks from imported cases in Orthodox Jewish communities—New York and New Jersey, 2018–2019. MMWR Morb Mortal Wkly Rep 2019;68:444–5. https://doi.org/10.15585/mmwr.mm6819a4 PMID:31095533
• CDC. Notes from the field: measles outbreak—Hennepin County, Minnesota, February–March 2011. MMWR Morb Mortal Wkly Rep 2011;60(13):421. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6013a6.htm

• Because each of these counties reported fewer than five cases, they were combined to avoid potential identification of persons.
  † Gestational ages were 29 weeks and 35 weeks.
  § Disaggregating unvaccinated persons from those with unknown vaccination status was not possible because the Texas Immunization Registry requires explicit consent by law (i.e., is an opt-in registry) to enroll. Unknown vaccination status includes persons who reported having received MMR vaccine but whose vaccination status could not be verified and those who could not recall if they had received MMR vaccine. Unvaccinated status includes persons with no documented doses of MMR vaccine >14 days before symptom onset.
  ¶ Review of the available information indicated that these persons received ≥1 age-appropriate dose of MMR vaccine >14 days before symptom onset or best available proxy date (if the date of rash was not available, one of the following dates was used, in this order: symptom onset date, specimen collection date, hospital admission date, or date reported to the region). Measles Outbreak – August 12, 2025 | Texas DSHS

Where this page came from

This page was imported from Centers for Disease Control and Prevention. Material produced by the Centers for Disease Control and Prevention is a work of the United States government and is in the public domain.

Nobody has written it yet — it is the source material at a new address, which is why search engines are asked to skip it and why no one earns from it. It is up for grabs: take it on, and it is yours to rewrite and to earn from.