Texas measles outbreak: Here’s why it’s not going away anytime soon

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Over 130 people in rural Texas and New Mexico have been infected with measles ‒ and the nation's largest outbreak in six years is projected to keep surging. 

What began in a tight-knit West Texas Mennonite community, has expanded to other under-vaccinated communities, including across state lines. Experts warn that communities with low immunization rates, such as these, are primed for measles' spread.

“We’re still in free-fall,” Dr. Peter Hotez, co-director of the Texas Children’s Hospital Center for Vaccine Development, told Paste BN. 

“It still has a lot of energy and steam behind it,” he said of the measles outbreak. “And that energy and steam are all the unvaccinated kids.” 

How did measles outbreak start?

The outbreak began less than a month ago when several unvaccinated children in Gaines County, Texas, were identified as having measles.

At this time, it's unclear how the first person was exposed, and there's no indication that any early patients traveled outside the United States, said Lara Anton, a spokesperson for Texas' health department.

As of Tuesday, 124 people were known to be infected, according to the Texas Department of State Health Services, including 18 of whom had been hospitalized. In abutting New Mexico, state health officials suspect their measles outbreak, with nine people identified, is connected to the Texas cases.

Texas health officials announced Monday that more people were likely exposured to the virus after a contagious Gaines County resident traveled to several locations in and around San Antonio, nearly 400 miles away. The person visited two public universities, tourist attractions around San Antonio's famed River Walk, and a Buc-ee's along Texas' Interstate 35, among other locations, officials warned.

Measles is so contagious that, typically, kindergarten vaccination rates have to reach 95% for a community to remain protected against outbreaks. If vaccinated twice in early childhood, adults typically do not need additional protection against measles, according to the CDC.

Six other states, from Alaska to New York, have also recently seen separate, isolated cases of measles, according to Centers for Disease Control and Prevention data.

Last year there were 285 measles cases nationwide ‒ a record number since the start of the COVID-19 pandemic, CDC data showed. In 2019 there was a large outbreak among unvaccinated Orthodox Jewish communities in New York. In 2022 there were 121 measles cases reported nationwide and last year, an outbreak in a Chicago migrant shelter ended up infecting 57 people.

Since vaccines became widely available in the 1960s, cases have declined precipitously. In 2000, measles was declared eliminated. However, outbreaks have resurfaced with declines in vaccination rates, due in part to vaccine hesitancy and skepticism.

Most measles cases in the U.S. are brought by international travelers and then spread, largely among unvaccinated Americans.

Rural, under-vaccinated community at center of outbreak 

In Gaines County, the epicenter of Texas' outbreak, 80 cases have been identified by state health officials so far. Just over 20,000 people live in Gaines, a rural county that touts itself as a leader in peanuts, cotton, oil and natural gas. 

A week ago, Anton had said the outbreak was concentrated in a close-knit, under-vaccinated Mennonite community, where many opted to homeschool children or send them to private schools.  

In an email Saturday, she said the biggest factor in measles’ spread was among people who are “under-vaccinated.” The region is very rural, with people having to travel at least 30 to 40 miles to get preventative care, including vaccinations, she said. 

“We’d like to draw attention to how the virus spreads and why that makes it particularly difficult to contain if people are not vaccinated,” Anton said. 

Last school year, state data showed vaccination coverage for students in Gaines was among the lowest in Texas and well below the 95% considered protective.

• Fewer than 82% of kindergartners in Gaines were vaccinated against measles. 

• In the county’s small Loop Independent School District, with about 150 students, only 46% of kindergarten students were vaccinated.  

Eight other Texas counties also have cases, state data shows. Most of those also have vaccination rates below 95%.

“It will spread if it is not at 95%,” Dr. Richard Lampe, a pediatric infectious diseases specialist at Texas Tech University Health Sciences Center, in Lubbock, told Paste BN. “I’ve seen it happen, and it’s happening right now in our area.” 

Close call in Lubbock clinic for highly infectious disease

Two weeks ago, Lampe's clinic saw a family who traveled about 60 miles from Gaines to see a pediatric specialist. While the child was in the room with the doctor, the mother told clinic staff he had had measles the week before. The child was not vaccinated.

Clinic staff was initially worried the boy might have been contagious but his rash had subsided four days earlier, which meant he was no longer infectious.

The measles virus is highly contagious, remaining in a room for up to two hours after an infected person leaves, according to the CDC. Someone who is contagious can infect as many as 18 others.

A challenge with the Gaines outbreak is many people have limited English, speaking the German dialect of the Mennonite community, or a combination of German and Spanish, Lampe said. West Texas and eastern New Mexico have tight-knit communities that travel back and forth across state lines, he said. 

In a German-language Mennonite newspaper community brief dated Jan. 27 — three days before Texas officials announced cases in Gaines County — two people from Seminole, the county's largest city, wrote about measles in their community.

“Oh yes, there are a lot of sick people here,” Johann and Katharina Neustädter said in Die Mennonitische Post. “Many have fever or diarrhea, vomiting or measles. Also headaches and colds. That's not good."

Just across from Gaines County, in eastern New Mexico, nine cases have been identified in Lea County.

Religious affiliation isn’t a factor in New Mexico’s outbreak, David Morgan, a spokesperson for the state health department, said in an email. Of the nine identified cases, Morgan said, all four school-age children weren't vaccinated, while two adults weren't vaccinated and three other adults had no known vaccination status.

What are measles symptoms? 

People can spread measles before they even show symptoms of the viral infection, which can present like other circulating respiratory viruses, such as COVID-19 and flu. But measles is even more contagious.

“It’s probably one of the most infectious diseases that exists,” Dr. Meghan Brett, a hospital epidemiologist at the University of New Mexico, in Albuquerque, told Paste BN.  

In addition to respiratory symptoms, people with measles may also have conjunctivitis, or eye redness. Small white bumps can begin to appear in a person's mouth two to three days after symptom onset, CDC said.

Once a fever subsides, the person develops a rash, the telltale sign of measles, which starts at their head and goes down to their toes. Someone is infectious from before symptoms show, until four days after the rash appears, said Dr. Ari Brown, a pediatrician in Austin. 

About one in five unvaccinated people who catch measles require hospitalization, according to CDC. One in 20 children infected end up with pneumonia, the most common cause of death among children. Around 1 in 1,000 children who contract measles develop encephalitis, or brain inflammation, that can lead to deafness, convulsions or intellectual disabilities.

Between 1 and 3 out of 1,000 children infected die from respiratory or neurologic complications. Unvaccinated women who are pregnant can have babies born prematurely or low birthweight, which can cause long-term issues for a child's development. People with weakened immune systems, such as those in cancer treatment, are also at increased risk of severe illness from measles. 

The measles vaccine, which comes along with protection against mumps and rubella, is 97% effective against measles with two doses. Even one dose can provide 93% protection, and it can be protective even after exposure to the virus.

“Let’s prevent what’s preventable,” Brown said. “And this is a highly preventable infection.” 

Mary Walrath-Holdridge of Paste BN contributed to this report.