An unvaccinated school-aged child has died after testing positive for measles amid an outbreak in west Texas, health officials confirmed Wednesday.
The Texas Department of State Health Services (DSHS) said the child was hospitalized last week in Lubbock and is the first known death related to the outbreak.
“As a pediatrician, I’m heartbroken to learn that a child has died from measles,” AAP President Susan J. Kressly, M.D., FAAP, said in a statement. “This is a tragic and devastating loss, and our thoughts are with the family and community affected. One death from a preventable disease is one too many.”
As of Feb. 25, 124 cases of measles have been confirmed in Texas since the outbreak began in late January. Most of the cases are unvaccinated children, and 18 people have been hospitalized.
Thirty-nine cases involve children ages 0-3 years, while 62 cases have been reported in children ages 5-17 years. Eighteen cases involve people 18 years of age or older, while five cases are of an unknown age.
During a press briefing Wednesday, Lara W. Johnson, M.D., FAAP, chief medical officer at Covenant Children’s Hospital in Lubbock, Texas, said about 20 patients have been hospitalized with measles. Many received supplemental oxygen to help them breathe, she said.
“Measles is a very severe illness that has a mortality rate of about 3%,” Dr. Johnson said. “Knowing we have a large outbreak, unfortunately, statistically, there’s a significant risk of having a death. I hope we don’t see anymore, but we’re fairly early in this outbreak. We’ve seen the numbers increasing pretty dramatically with each update.”
While respiratory issues are a key concern among those hospitalized, Dr. Johnson said neurological issues can occur with the measles virus and may show up years after initial infection.
Gaines County has the most reported measles cases with 80. The county had a nearly 18% vaccine exemption rate among kindergartners for the 2023-’24 school year, according to DSHS statistics. Additional cases have been reported in Terry (21), Dawson (seven), Yoakum (five), Dallam (four), Martin (three), Ector (two), Lubbock (one) and Lynn (one) counties.
The AAP and the Centers for Disease Control and Prevention (CDC) recommend children receive the measles-mumps-rubella (MMR) vaccine at age 12-15 months and again at 4-6 years. Children can receive the second dose earlier if it is at least 28 days after the first dose. Each dose of MMR lowers the risk of infection and severity of illness, if infected. Families should contact their pediatricians for more information about vaccination.
“The reason many parents in the U.S. have not had to worry about measles in decades is because of widespread immunization with this safe and effective vaccine,” Dr. Kressly said. “However, when immunization rates drop in a community, the disease can spread, putting our most vulnerable — especially young children — at risk.”
In large outbreaks in the U.S. in the late-1980s and early 1990s, there were more than 150 deaths, said Sean T. O'Leary, M.D., M.P.H., FAAP, chair of the AAP Committee on Infectious Diseases.
“Prior to widespread vaccination in the U.S., there were 400 to 500 deaths per year (and that was among a smaller U.S. population),” he said. “Worldwide, in recent years, there are more than 100,000 deaths per year, and prior to widespread vaccination, there were over a million deaths per year worldwide.”
The Houston Health Department identified two confirmed cases of measles in adults associated with recent international travel. Both individuals reside in the same household and were not vaccinated. These are the first reported measles cases in Houston since 2018.
The New Mexico Department of Health reported nine measles cases have been identified in Lea County, which borders Gaines County, Texas. Of those, four cases involve children ages 5-17 years, while five cases involve adults ages 18 and older.
In an update Monday, DSHS said one person from the outbreak area in west Texas visited several locations in the San Marcos and San Antonio area the weekend of Feb. 14-16 while contagious, including Texas State University in San Marcos and the University of Texas at San Antonio main campus. Due to the highly contagious nature of measles, additional cases are likely to occur in the affected communities.
The measles virus is transmitted by contact with infectious droplets or by airborne spread when an infected person breathes, coughs or sneezes. Measles virus can remain infectious in the air up to two hours after an infected person leaves an area.
Illness onset (high fever, cough, runny nose and red, watery eyes) begins a week or two after someone is exposed. A few days later, a rash breaks out as flat, red spots on the face and then spreads down the neck and trunk to the rest of the body. A person is contagious about four days before the rash appears to four days after.
Other measles symptoms may include small spots in the cheek area inside the mouth, diarrhea and ear infection. Measles can lead to pneumonia, swelling of the brain, deafness, intellectual disability and death.
Most children who get measles are not up to date on recommended vaccines or are not old enough to get measles vaccine.
The CDC measles website, which is expected to be updated weekly, reports 93 measles cases as of Feb. 20 across eight jurisdictions (Alaska, California, Georgia, New Jersey, New Mexico, New York City, Rhode Island and Texas).
The CDC has reported three outbreaks (defined as three or more related cases) in 2025, and 92% of cases (86 of 93) are outbreak-associated. Last year, 285 measles cases (16 outbreaks) were reported by 33 jurisdictions across the United States. For comparison, 59 measles cases (four outbreaks) were reported in 2023.
Resources
- AAP resource Think Measles: Recognizing and Addressing Measles in Pediatric Practice
- Red Book Online on-demand webinar “Identifying Measles in the Pediatric Setting”
- AAP Red Book chapter on measles
- Information for health care providers from the CDC on measles
- Information for families from HealthyChildren.org on how to protect children during a measles outbreak
- FAQs on how to protect babies from a measles outbreak from HealthyChildren.org
