By Daniel Pastula, Professor of Neurology, Medicine (Infectious Diseases), and Epidemiology, University of Colorado Anschutz Medical Campus
On Feb. 26, 2025, Texas health officials announced the death of a child in a measles outbreak – the first measles death in the United States since 2015. The outbreak was first identified in early February in Gaines County, Texas, where just 82% of kindergartners are vaccinated against measles, compared with 93% on average across the country. As of Feb. 27, there were at least 124 confirmed cases in Texas and nearby towns in New Mexico.
In an interview with The Conversation U.S. associate health editor Alla Katsnelson, neurologist and medical epidemiologist Daniel Pastula explains why measles is so dangerous and how people and communities can protect themselves from the virus.
(The CONVERSATION) What is measles, and where does it come from?
Measles is an ancient disease caused by a virus that probably evolved in cattle and jumped into humans around 500 B.C. One of the first written accounts of it comes from a Persian physician named Rhazes in the ninth century C.E., and measles epidemics were described in medieval Europe and western Asia regularly beginning around 1100-1200. The virus got brought over to the Americas in the 1500s, and it wiped out large populations of native people as Europeans colonized the continent.
By the 1950s in the United States, there were 500,000 reported cases of measles each year – though the true number was probably closer to 4 million . It was so contagious, every kid was thought to have gotten measles by age 15. At that time, measles caused close to 50,000 hospitalizations annually and about 500 deaths, usually in children. It also caused over 1,000 cases of severe brain inflammation every year.
The first measles vaccine became available in 1963, and scientists improved it over the following decades, causing the number of cases to plummet. In 2000, measles was declared eliminated from the U.S.
Since then, there have been occasional minor flare-ups, usually brought in by international travelers, but by and large, measles outbreaks have been rare. No one had died of it in the United States in nearly a decade.
Today, measles infections in the U.S. are almost completely preventable with vaccination.
How does measles spread?
Measles is one of the most contagious infectious diseases on the planet. The virus is so infectious that if you are in a room with an infected person and you are not vaccinated and have never had measles before, you have a 90% chance of becoming infected.
The measles virus is transmitted by droplets released into the air by infected people when they cough, sneeze or simply breathe. Virus particles can survive suspended in the air or on indoor surfaces for up to two hours, so people can get infected by touching a surface carrying virus particles and then touching their face.
Who should get the measles vaccine, and how effective is it?
The vaccine for measles has historically been called the MMR vaccine because it has been bundled with vaccines for two other diseases – mumps and rubella. Most children in the U.S. receive it as a two-dose regimen, which is 97% effective against measles.
Children generally get the first dose of the vaccine at 12-15 months old and the second dose when they are 4-6 years old. Infants who haven’t reached their first birthday generally do not receive it since their immune system is not yet fully developed and they do not develop quite as robust of an immune response. In an emergency, though, babies as young as 6 to 9 months old can be vaccinated. If an infant’s mother previously received the MMR vaccine or had been infected herself as a child, her transferred antibodies probably offer some protection, but this wanes in the months after birth.
People born before 1957 are considered immune without getting the vaccine because measles was so widespread at that time that everyone was presumed to have been infected. However, certain people in this age group, such as some health care workers, may wish to discuss vaccination with their providers. And some people who had the original version of the vaccine in the 1960s may need to get revaccinated, as the original vaccine was not as effective as the later versions.
What measures can protect communities from measles outbreaks?
Vaccination is the best way to protect individuals and communities from measles. It’s also the most effective way to curb an ongoing outbreak.
High rates of vaccination are important because of a phenomenon called herd immunity. When people who are vaccinated do not get infected, it essentially stops the spread of the virus, thereby protecting those who are most susceptible to getting sick. When herd immunity wanes, the risk of infection rises for everyone – and especially for the most vulnerable, such as young children and people who are immunocompromised.
Because measles is so contagious, estimates suggest that 95% of the population must be vaccinated to achieve herd immunity. Once vaccine coverage falls below that percentage, outbreaks are possible. (The CONVERSATION)