US Faces One-Year Measles Outbreak: CDC Official Labels Surging Cases as 'Cost of Doing Business

WASHINGTON (The Hill) – On Tuesday, the United States encountered a significant milestone that could threaten its longstanding measles elimination status, a title it has held for over 25 years. This development comes amid a year into the second term of the Trump administration, which has been critiqued for not prioritizing infectious disease management.

The Pan American Health Organization (PAHO), which serves as the World Health Organization’s (WHO) regional branch for the Americas, has identified January 20, 2025, as the date that marks the beginning of continuous measles transmission in the U.S.

In contrast, the Centers for Disease Control and Prevention (CDC) maintains that it is premature to officially conclude that the U.S. has lost its measles elimination status, a status it first attained in the year 2000.

According to established guidelines, a nation is considered to have lost its measles elimination status if the disease is transmitted consistently for a period of 12 months. Canada, the U.S.’s northern neighbor, met this unfortunate benchmark late last year, potentially foreshadowing similar challenges for the United States.

Ralph Abraham, a former Louisiana surgeon general who was sworn in as the CDC’s principal deputy director last month, said the exact chain of transmission needs to be determined before the status is official.

He said it’s unclear whether the West Texas outbreak in January is related to the ongoing spread in states such as South Carolina, which has reported more than 600 cases since October.

“The United States would lose the elimination status when a chain of transmission — and those are important words too — last for 12 months or more. Now, what is the chain of transmission? It’s defined as all cases linked to a common source through an epidemic linkage. So those things matter,” Abraham said.

When asked if he believes the U.S. losing its elimination status would be a “significant loss,” Abraham said, “Not really,” calling it the “cost of doing business” for maintaining borders friendly to international business and travel as well as respecting the “personal freedom” of communities who decide not to vaccinate.

Last year was the worst for measles in the U.S. in recent history, with major outbreaks in Texas, Utah and Arizona among other states. There were 49 outbreaks in 2025 and more than 2,200 confirmed cases.

Last year also saw the first U.S. measles deaths in a decade, with three confirmed deaths due to infections. All three deaths occurred in unvaccinated individuals, two children and one adult.

PAHO has invited the U.S. and Mexico to a meeting in April to go over their respective measles elimination statuses. Mexico is set to lose its own measles elimination status on Feb. 1.

A CDC official who joined Abraham at Tuesday’s briefing said the U.S. is still in contact with PAHO, though the Trump administration moved to withdraw from the WHO last year. They did not say whether the U.S. would attend the April meeting, citing the need to gather more data.

“We’re working with PAHO to figure out optimal timing to ensure that the data that we have is comprehensive before those meetings,” the official said in a briefing Tuesday.

“What we need to do is reach out to states for that epidemiologic data as well as samples and specimens for testing. Some of those specimens are not at the state health lab. They’re actually in commercial laboratories. And then we would do that comprehensive analysis.”

Both infectious disease experts and federal officials have said that the likely loss of measles elimination status is the result of years of growing vaccine hesitancy predating the current Trump administration.

But critics are quick to note that it comes less than a year after Health and Human Services Secretary Robert F. Kennedy Jr., who spent decades as a leading vaccine skeptic, was confirmed. And while he isn’t the only cause, they argue he has worsened an already bad situation.

William Schaffner, professor of medicine at Vanderbilt University Medical Center and a former officer with the CDC’s U.S. Public Health Service, said the policies of the Trump administration have “accelerated” and “reinforced” vaccine hesitancy.

“If you do not promote the notion that this vaccine is safe and effective, when you don’t do those positive things very, very vigorously, then obviously confidence in vaccines will diminish,” said Schaffner.

Infectious disease experts warn that one year of sustained measles transmission is a harbinger of worse developments to come.

“Elimination status certification includes assessment of the health of the public health system. Can we identify and respond to cases to limit the size of outbreaks? Is our immunization program empowered to increase vaccine coverage to better than 95 percent?” said Demetre Daskalakis, a former senior CDC official, in a briefing, referring to the ideal vaccination coverage recommended to prevent widespread outbreaks.

The U.S. has been slipping further from this standard in recent years, with 92.5 percent of kindergarteners vaccinated during the 2024-2025 school year.

Daskalakis will begin his new role as chief medical officer at Callen-Lorde Community Health Center in New York City next month.

“I fear to say that the actions of the secretary of Health so far have already damaged our public health system, potentially beyond repair, and we do not have the capability to actually control measles, whether or not this is demonstrated through continuous measles transmission for 12 months,” Daskalakis added. “So, I’m going to say that that elimination is already lost, frankly, no matter what any other body says based on what we’re seeing domestically.”

Schaffner said this latest development in measles is only the “point of the spear” for the country, noting how the CDC’s vaccine advisory panel has overhauled the childhood vaccine schedule and withdrawn recommendations for multiple shots.

“And I think in time we will see an increase in other vaccine-preventable diseases, because this will spur hesitancy and skepticism among parents will choose to have their children withheld from vaccines completely, or will delay their vaccination,” he said.

Abraham said on Tuesday that both he and Kennedy endorse the measles, mumps and rubella (MMR) vaccine as a way of combatting measles spread. The MMR vaccine is among those that remained on the childhood immunization schedule following the CDC’s reduction in recommended shots — though both Trump and interim CDC Director Jim O’Neill have suggested splitting it into separate shots.

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