Rise in Measles Cases Raises Concerns Over U.S. Elimination Status

This year, the U.S. has seen more measles cases in the first half than in any complete year since 1992. This increase has raised alarms about the potential loss of the country’s measles elimination status, a significant public health achievement that has stood for 25 years, coinciding with a dip in vaccination rates.

But what does this risk actually entail? And just how imminent is it?

The World Health Organization specifies that to maintain elimination status, a country must endure at least 12 months without ongoing domestic transmission of the virus. New outbreaks during this time can only arise from cases imported from abroad.

According to epidemiologists, the U.S. has until January to eliminate current outbreaks, which began domestically in Texas. Failing to do so could mean losing this hard-won elimination status.

“It could be more serious than many Americans realize, given how long we’ve maintained this elimination status,” noted Brittany Kmush, a public health expert at Syracuse University, in a conversation with HuffPost.

She pointed out potential consequences, such as travel restrictions for Americans wishing to visit certain countries due to fears of measles reintroduction. “It could also affect the ability of visitors from abroad to enter the U.S.,” she added, mentioning that other countries could demand proof of vaccination.

Additionally, there might be stricter quarantine measures and economic repercussions as a result, she explained.

The highly contagious nature of the virus poses a risk, as it can infect up to 90% of those nearby who aren’t vaccinated if just one person carries the virus. This is according to the CDC.

“It’s really a matter of when an infectious person might enter a community and trigger an outbreak,” stated William Moss, executive director of Johns Hopkins’ International Vaccine Access Center.

Kmush emphasized that measles is not merely a benign illness—it can lead to severe complications like pneumonia and, on rare occasions, even death. Young children, particularly those under five, are especially susceptible to these serious health issues.

Fortunately, there’s still time this year to combat these outbreaks. Moss reassured that the challenge is built into the system—achieving global eradication is incredibly difficult. As long as the measles virus circulates elsewhere in the world, cases will inevitably find their way into the U.S.

“As long as measles exists somewhere globally, there will always be the risk of importation,” he said. “It would be tough to maintain that elimination status if any new case resulted in its automatic loss.”

Yet, the question of whether these outbreaks can be curbed before the deadline remains open.

Measles cases have been declining since a peak in March, which could signal an end to the outbreaks. But the persistently low vaccination rates leave communities at risk for reinfection.

“It’s really a question of whether a person carrying the virus enters a low-vaccine area,” Moss commented. “In places with high vaccination rates, the risk remains low. But in communities with poor coverage, that’s where new outbreaks could emerge.”

With less than six months left in the year, Moss believes it may still be premature to panic. Even if the elimination status were to be revoked, he suggested that the case levels would unlikely mirror the early 1990s since vaccination levels remain reasonably high.

On the other hand, Kmush voiced concern about the possibility of maintaining the elimination status. She drew attention to the near miss in 2019, when, amidst fewer cases, there were still fears about losing that status. Increased vaccination efforts and public health initiatives helped avert that outcome.

“We successfully managed to vaccinate and implement quarantines,” she recalled. “However, it’s disheartening that the current vaccination rates are even lower than in 2019, with most cases being among the unvaccinated.”

Both experts highlighted that regaining elimination status after losing it is no small feat. A country must demonstrate zero domestic transmission for 36 months and have an effective surveillance system in place, which the U.S. does possess.

As for immediate actions, Kmush advocated for heightened vaccination efforts. She labeled it “the most effective tool” for reducing cases and safeguarding those who cannot be vaccinated, such as very young infants or immunocompromised individuals.

“It’s possible to do quarantines, similar to responses with COVID,” she noted. “But measles spreads more easily than COVID, which means we really need everyone who can to get vaccinated.”

She also called for federal health officials to take stronger action against vaccine hesitancy and skepticism, arguing that certain public figures contribute to a climate of doubt.

“The rhetoric and policies surrounding vaccine hesitancy are potentially dangerous,” she said. “It can make individuals who are unsure feel even more hesitant when they really shouldn’t be.”

The spokesperson for Health and Human Services emphasized that the CDC continues to promote MMR vaccines as the best defense against measles, while urging personal decision-making regarding vaccination based on discussions with healthcare providers.

“It’s crucial for individuals to understand their vaccination options and be aware of the associated risks and benefits,” the representative stated.