Measles outbreaks have infected more than 2,600 people since the beginning in 2025 with cases in all but six U.S. states.
Outbreaks of the highly contagious virus in the United States have jeopardized thenation's status as a measles-free country. Experts says the potential loss of this designation underscores the challenges of bolstering U.S. public health efforts that have been eroded by funding cuts,declining immunization ratesand vaccine skepticism.
The nation's measles-free status, first declared in 2000, is "very much in doubt," said Chrissie Juliano, executive director of the Big Cities Health Coalition.
"What took decades to build and maintain has been torn down in just a year," Juliano said. While public health officials debate the importance of the designation, one thing is clear, Juliano said.
"It highlights a dangerous trend for the health of our children," Juliano said. "We will continue to see more illness, more hospitalizations, more missed school and work days and less and less time for kids to just be kids."
What is the measles-free designation?
The U.S. was declared measles free in 2000 by the Pan American Health Organization, which is part of the World Health Organization. The designation signifies a nation or region has been free of continuous transmission of measles for a year.
Following outbreaks thatbegan in Gaines County, Texas, in January 2025, the Pan American organization said it will examine the U.S. and Mexico'smeasles elimination statusin April 2026.
In 2025, the U.S. had 2,242 measles cases, the most in more than three decades. Cases surfaced in all but six U.S. states. Three people died, the first U.S. measles deaths in more than a decade, and another 245 people were hospitalized, according to the Centers for Disease Control and Prevention.
In November 2025, the Pan American group declared Canada no longer holds measles elimination status. The change in status followed a review confirming sustained transmission of the same measles virus strain in Canada for more than one year.
What is the status of cases in the United States?
Measles continues to spread in the U.S. this year, with 416 confirmed cases in 14 states as of Jan. 23, the CDC said.
States with cases this year include Arizona, California, Florida, Georgia, Idaho, Kentucky, Minnesota, North Carolina, Ohio, Oregon, South Carolina, Utah, Virginia and Washington.
CDC said 94% of cases in 2026 were among people who were not vaccinated or whose vaccination status was unknown.
Public health officials stressed that measles is a vaccine-preventable disease. Children get the measles, mumps and rubella in two doses as part of routine immunizations. Children get the first MMR dose at 12 to 15 months and the second dose at 4 to 6 years.
Schools typically require proof that a child has been vaccinated by the time they begin kindergarten.
Public health officials said vaccination rates must be at least 95% for a community to remain protected against outbreaks. If a community reaches such a herd immunity threshold, it's typically enough to protect infants and others who can't be immunized because people around them have sufficient protection.
But vaccine rates have declined in recent years. Vaccination coverage among U.S. kindergartners has dropped from 95.2% during the 2019–2020 school year to 92.5% in the 2024–2025 school year, well under the threshold necessary for effective herd immunity,according to the CDC.
Zack Moore, a state epidemiologist with the North Carolina Department of Health and Human Services, said the MMR vaccine is 97% effective when both doses are taken.
"We have the tools," Moore said. "But we know that with vaccination coverage rates waning, it's becoming more and more difficult."
Funding cuts, exemptions challenge immunization efforts
Local public health officials said they are frustrated by vaccination rates dropping among school-age children.
"There's just so much confusion, mixed messages, things that are undermining our efforts to get our community and the kids vaccinated," said Dr. Phil Huang, director of Dallas County Health and Human Services.
Dallas lost more than $4 million in COVID-19 federal funds used to bolster the community's vaccine efforts, including specialized clinics targeting schools with low immunization rates following the West Texas measles outbreak in 2025.
Dallas County canceled more than 50 community outreach efforts and lost 25 staff positions as a result of the funding cuts, Huang said.
He cited other policy decisions have curtailed efforts to bolster childhood immunization. The Texas Legislature passed legislation that made it easier for parents to opt out of required vaccinations for school-age children.
And in the Dallas metro region, raids by Immigration and Customs Enforcement have depressed childhood immunization rates in mostly Hispanic communities, Huang said.
MMR vaccine rates among Dallas County kindergartners dropped below 90% in 2025, Huang said.
"All of these different factors are making our jobs more difficult," Huang said.
In North Carolina, officials are closely monitoring the spillover of cases from anoutbreak centered around Spartanburg County, South Carolina. South Carolina officials reported 700 cases of Jan. 23. Since December, more than a dozen cases have popped up in counties in southwestern part of North Carolina.
Moore said low vaccination rates at some schools in counties bordering South Carolina are "dry tinder" for spread of the virus.
"We have a lot of communities that are very susceptible if a measles case land there," Moore said. "That is unfortunately what we're starting to see."
CDC official downplays potential loss of measles elimination
The nation'santi-vaccine movement has gained momentumduring PresidentDonald Trump's administration.
Trump has suggested the measles, mumps and rubella vaccine be separated into three different shots. Health SecretaryRobert F. Kennedy Jr., who has a history of vaccine skepticism, has sought changes to the childhood immunization schedule. Under Kennedy's watch, the U.S. Department of Health and Human Servicesdowngraded four childhood immunizationsfrom recommended to shared decision-making between parents and health care providers.
Although HHS did not change recommendations for the two-shot MMR vaccine, the American Academy of Pediatrics President Andrew Racine said any changes to the childhood vaccine schedules "will sow further chaos and confusion and erode confidence in immunizations."
During a briefing Jan. 20, a top CDC officialdownplayed the importanceof the U.S. potentially losing its measles-free status. CDC Deputy Director Ralph Abraham said such a change would be the "cost of doing business" due to international travel and "our borders being somewhat porous."
Local public health officials who work to bolster the nation's immunization rates pushed back on Abraham's assessment.
Dr. Michelle Taylor, commissioner of the Baltimore City Health Department, worried mixed messages from federal health officials could introduce "chaos and confusion."
"Most families want to do what is best for their children and for the larger community around them," Taylor said. "But they depend on local public health to have consistent messaging about what should happen to keep them healthiest as possible."
Contributing: Mary Walrath-Holdridge
This article originally appeared on USA TODAY:Measles cases spread amid declining MMR vaccination
