The U.S. measles outbreak shows no signs of slowing

The death of a second child from measles is raising alarm bells anew that an ongoing outbreak of the highly contagious disease is larger than official numbers suggest. And it comes at a time when the Trump administration’s widespread cuts to public health funding and jobs are gutting the ability to tackle infectious diseases.

The child, who died April 3 from measles pulmonary failure, was unvaccinated and had no underlying health conditions, Texas health officials announced April 6.

As of April 8, the ongoing measles outbreak in Texas’ South Plains region has grown to at least 505 cases since January. Texas health officials announced April 7 that six additional counties are now included in the outbreak area, bringing the total to 10. The outbreak has also spread to New Mexico, where the death of an adult with measles is under investigation. Outbreaks in Oklahoma and Kansas and a case in Pennsylvania also have ties to Texas.

Typically, measles kills about two to three of every 1,000 people it infects, says Peter Hotez, a pediatric vaccine scientist at Baylor College of Medicine and codirector of the Texas Children’s Hospital Center for Vaccine Development in Houston. The deaths in Texas and New Mexico “say to me that this epidemic is pretty large.”

Nationwide as of April 3, 21 states and New York City have reported 607 confirmed measles cases with many others suspected, according to the U.S. Centers for Disease Control and Prevention.

The true count may be 1,000 or more cases. “Plus, it’s still accelerating,” Hotez says. “It’s not winding down anytime soon.”

Local public health agencies also suspect that additional cases are occurring but those who are infected are not seeking testing or medical care, says Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota in Minneapolis. “It’s very likely that the outbreak is larger than it is right now,” Osterholm says, “but how much larger we just don’t know.”

Complicating matters, in late March the Trump administration abruptly terminated funding to support local testing for measles and other infectious diseases and for staff to track outbreaks and give vaccinations.

In addition, jobs at the CDC, which provides expertise for state and local health departments facing such crises, have been cut as part of a massive restructuring plan for the U.S. Department of Health and Human Services.

The agency has deployed teams to Texas to assist with the outbreak. But more broadly, those job losses are an “unrecognized, catastrophic tsunami that’s going to sweep through public health,” Osterholm says. State and local governments have made minimal investments in public health, ceding responsibility to the CDC. “The reliance on federal support has left us highly vulnerable” to measles and other contagious diseases and to future pandemics, he says.

The administration also has ordered a new investigation into possible links between autism and vaccines, including the measles, mumps and rubella vaccine.

That’s “one of the most thoroughly debunked associations in biomedical science,” Hotez says. Yet it has contributed to people being hesitant to vaccinate their children against highly preventable diseases. At the same time, the Trump administration has cut funding to study vaccine hesitancy. That particularly worries Osterholm. “What it takes to have a vaccine become a vaccination is a critical aspect of disease prevention,” he says. Even the safest, most effective vaccine in the world is useless if people don’t take it.

Kennedy did post on X April 6 that vaccination is the most effective way to prevent measles. That admission is the noted vaccine skeptic’s most direct acknowledgement of the importance of vaccines in combatting measles — though it was swiftly criticized by antivaccine activists.

“I’m glad he made the statement, but it’s insufficient,” Hotez says. “He still needs to come out stronger and emphasize how safe the MMR vaccine is; it’s one of the safest vaccines we have. [Kennedy should emphasize] how effective it is.”

Just hours after making the statement about vaccine effectiveness, Kennedy again posted on X praising a pair of doctors who have used unproven treatments for measles patients. He is among those who have touted combinations of antibiotics, steroids, and cod liver oil and other vitamin A–containing supplements as measles preventatives.

Steroids and antibiotics have not been proven to be effective against measles. Measles is caused by a virus. Antibiotics work only against bacteria. Steroids may help calm the immune system after an infection has been cleared but may hinder the body’s ability to fight an infection if given too early. A 2023 study in the Journal of Neurology found no benefit of steroid treatment for brain swelling caused by viral infections, including measles.

While vitamin A has helped treat measles in lower-income countries, it provided no benefit in cases in a higher-income country where malnutrition is not a factor, researchers reported in the Pediatric Infectious Diseases Journal in 2021. “It’s not so great in terms of treatment, but there’s no evidence it works as a preventative,” Hotez says.

Still, there have been several reports from Texas hospitals of vitamin A toxicity among children whose parents gave them high doses to prevent or treat measles. Overdoses of vitamin A can cause nausea, vomiting, blurry vision, bone pain, hair loss, skin changes and headaches. In some cases, it can lead to liver damage or a rare disorder in which pressure builds up in the brain.