Resurgence of Measles in the U.S.: A Public Health Challenge

The United States is confronting a significant resurgence of measles, a disease previously declared eliminated in 2000. As of June 3, 2025, Texas has reported 742 confirmed cases, marking a substantial increase from previous years. (reuters.com)

This alarming rise is largely attributed to declining vaccination rates, influenced by increasing vaccine hesitancy and insufficient public health funding. In response, researchers have implemented wastewater surveillance to monitor the presence of the measles virus, aiming to enhance early detection and response efforts.

Background

Measles is a highly contagious viral illness that typically begins with fever, cough, runny nose, and conjunctivitis, followed by a characteristic rash. Complications can be severe, including pneumonia, encephalitis, and death. The disease was declared eliminated in the United States in 2000 due to successful vaccination programs.

However, recent years have seen a troubling decline in vaccination rates. A study published in JAMA by researchers from Johns Hopkins University revealed a significant drop in childhood vaccination rates for measles, mumps, and rubella (MMR) across the U.S. since the onset of the COVID-19 pandemic. Analysis of county-level data from 2,066 counties in 33 states showed that 78% experienced reduced MMR vaccination rates, falling from about 94% before the pandemic to approximately 91% after, below the 95% threshold necessary for herd immunity. (time.com)

The Centers for Disease Control and Prevention (CDC) reported 1,088 measles cases as of May 29, 2025, with 96% of cases among the unvaccinated or those with unknown vaccination status. Notably, 2025 has seen 14 measles outbreaks and three measles-related deaths—the first since 2015. (time.com)

Factors Contributing to the Resurgence

The rise in measles cases is attributed to declining vaccination rates, influenced by increasing vaccine hesitancy and insufficient public health funding. Anti-vaccine sentiment has gained political influence in the U.S., with figures like Robert F. Kennedy Jr., now the U.S. Secretary of Health and Human Services, initially promising not to alter vaccination schedules but later launching a commission to evaluate health policies, including vaccination schedules. This shift has led to decreased trust in vaccines and public health institutions, contributing to the current outbreak.

The U.S. public health system is facing severe erosion due to substantial funding cuts and job losses implemented by the Trump administration, including $11 billion in federal support withdrawal and the elimination of 20,000 positions. These cuts have significantly weakened essential services such as vaccination programs, disease surveillance, and outbreak response. (apnews.com)

Innovative Monitoring Strategies

To enhance early detection and response, researchers have implemented wastewater surveillance to monitor the presence of the measles virus. The WastewaterSCAN program, initially developed to track COVID-19, has adapted its methods to detect measles, identifying traces of the virus in wastewater samples from Maryland, California, and Connecticut. (time.com)

Wastewater surveillance offers early detection advantages by identifying viral presence before individuals show symptoms or seek medical care. This method plays a crucial role in managing highly contagious diseases like measles, where one person can infect many others. While the CDC has a broader wastewater monitoring network, it has yet to include measles testing. Continued data collection from wastewater could help identify measles trends and improve targeted public health responses, such as vaccine distribution. (time.com)

Public Health Response

Health officials emphasize the importance of maintaining measles vaccination, which offers nearly lifelong immunity, to control the spread of the disease. Efforts to boost immunization are ongoing, particularly in areas like Gaines County, Texas, where vaccination rates are critically low. Despite these efforts, the outbreak is expected to persist for several more months, and if it extends beyond January, it could compromise the United States’ status of having eliminated measles.

The resurgence of measles underscores the critical need for robust vaccination programs and innovative monitoring strategies to control the spread of this highly contagious disease. The combination of rising measles cases and the adoption of wastewater surveillance highlights the importance of maintaining high vaccination rates and the potential of new technologies in public health monitoring.