A second unvaccinated child has died of measles amid an outbreak in the South Plains region of Texas, state health officials announced. It is the third measles-related death in the U.S. this year, and AAP President Susan J. Kressly, M.D., FAAP, is calling for urgent action to protect children.
The Texas Department of State Health Services (DSHS) said the school-age child tested positive for measles and was hospitalized in Lubbock. The child died April 3 from what doctors described as “measles pulmonary failure.” The child was not vaccinated and had no reported underlying conditions.
“A family and community are in mourning again, and we join them in that heartache,” Dr. Kressly said. “This death could have been prevented. This child’s life could have been saved by having access to and confidence in the measles vaccine.”
It is the second measles-related death in Texas, where DSHS has reported 481 confirmed cases. The majority of those cases are unvaccinated people living in west Texas near the New Mexico border. Gaines County has reported 315 cases.
In late February, DSHS reported the first death related to the measles outbreak — an unvaccinated school-age child who died in Lubbock. The child had no underlying conditions, according to DSHS. It was the first measles-attributed death in the U.S. in a decade.
In March, the New Mexico Department of Health (NMDOH) announced the death of a Lea County resident who tested positive for measles after dying. The NMDOH said the person did not seek medical care. Lea County, which borders Gaines County, has reported 52 measles cases this year.
The AAP and Centers for Disease Control and Prevention (CDC) recommend children receive the measles-mumps-rubella (MMR) vaccine at 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. One dose of MMR is 93% effective against measles, and two doses are 97% effective. Families should contact their pediatrician for more information about vaccination.
The deaths come as hundreds of people have become infected with measles throughout the country. The CDC reported 607 confirmed measles cases as of April 3, 97% of whom are unvaccinated or have an unknown vaccination status. Seventy-four of the cases have been hospitalized, including 42 children under 5 years and 19 children ages 5-19 years.
“This is a rapidly expanding outbreak and what we need right now is urgent assistance from the federal government to support immunization and strengthen vaccine delivery,” Dr. Kressly said. “Instead, our elected officials are promoting dangerous misinformation about ineffective remedies while also simultaneously eliminating expertise, resources, policies and programs that our nation’s children need.”
The CDC reported six measles outbreaks, defined as three or more related cases. Of the 607 confirmed cases, 93% are outbreak-associated, according to the CDC.
Measles cases have been confirmed in Alaska, California, Colorado, Florida, Georgia, Kansas, Kentucky, Maryland, Michigan, Minnesota, New Jersey, New Mexico, New York City, New York state, Ohio, Oklahoma, Pennsylvania, Rhode Island, Tennessee, Texas, Vermont and Washington.
Webinar addresses diagnosis, prevention, treatment
In response to the outbreak, the AAP Red Book hosted the webinar "Hot Topics Live: Measles." Several infectious disease experts discussed infection control measures, diagnosis, treatment, common complications and prevention strategies. They also hosted a Q&A session.
Among those participating in the webinar were Tammy M. Camp, M.D., FAAP, pediatrics residency director and a professor of pediatrics at Texas Tech University Health Sciences Center. She said she is asking families who are pro-vaccine to contact their legislators about the importance of strong vaccine laws.
"So, trying to help turn our parents into being advocates with us, I think, is important in this," she said.
It can be discouraging when parents and families downplay the seriousness of measles, Dr. Camp said. But many parents are asking her about MMR vaccination and seeking advice to keep their children safe, including those who are too young to get the vaccine.
"Today, I saw three newborns in my clinic," she said. "The question from all three of those parents were 'How do I keep my child safe in the community right now?'"
Combating misinformation, lack of resources
Thousands of U.S. Department of Health and Human Services (HHS) employees, including pediatricians, were laid off and $12 billion in funding for public health programs was cut. In addition, HHS recently hired a discredited anti-vaccine activist, and HHS Sec. Robert F. Kennedy Jr. promoted unproven measles treatments during a visit to the Texas outbreak region.
"We call on our elected officials to lead with science, restore expertise in their decision-making and promote vaccines," Dr. Kressly said. "That is the only way we can stop this outbreak. This is the only way to strengthen the health of America."
In a social media posts, Kennedy called the MMR vaccine the "most effective way" to prevent the spread of measles. He also used social media to suggest that doctors in Texas have had success using aerosolized budesonide and clarithromycin to treat children with measles.
Sean T. O’Leary, M.D., M.P.H., FAAP, chair of the AAP Committee on Infectious Diseases, called these messages dangerous.
“There is no evidence to support the use of either aerosolized budesonide or clarithromycin for treatment of children with measles," Dr. O'Leary said. "Promoting unproven medications for measles treatment puts children at unnecessary risk, and the only way to prevent measles is by vaccination with the measles-mumps-rubella vaccine."
Vaccination rates dropping
According to an October 2024 CDC report, MMR vaccination coverage among U.S. kindergartners dipped to 92.7% in the 2023-’24 school year; that figure was 95.2% in 2019-’20. Herd immunity is achieved when more than 95% of people in a community are vaccinated.
Truveta, a collective of 30 U.S. health systems, analyzed electronic health record data from 685,604 children. It found that 68.5% received at least one measles vaccine dose by 15 months in 2024, down from 77.2% in 2020.
Measles was officially eliminated from the United States in 2000, and 85 measles cases were reported that year. However, declining vaccination rates have led to multiple outbreaks in recent years. In 2024, 285 cases were reported, and 1,274 cases were reported in 2019, the most reported in the last 25 years. The country will lose its measles elimination status if endemic measles virus transmission continues in a defined geographic area for 12 months or more.
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.
Resources
- AAP Red Bookchapter on measles
- Measles FAQs
- AAP Fact Checked articles on measles vaccine safety and effectiveness and how vitamin A does not prevent measles
- CDC clinical overview of 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
