Health officials on Monday linked for the first time the measles outbreak that began in Texas with another in Utah and Arizona, a finding that could end America’s status as a nation that has eliminated measles.
The news came in a phone call, a recording of which was obtained by The New York Times, among officials from the Centers for Disease Control and Prevention and state health departments.
The chain of transmission began in January, in a conservative Mennonite group on the western edge of Texas, and spread to Oklahoma and New Mexico.
Countries lose their elimination status after 12 months of sustained transmission. If the outbreak cannot be extinguished by January, the anniversary of the first cases in Texas, the United States will lose what is known as “elimination status” as determined by the World Health Organization, which it has had for 25 years.
“I wouldn’t call the code yet, but I think the patient’s not looking real good,” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
Canada lost its status last week, ending a 27-year run, after failing to control an outbreak that began at a Mennonite gathering in October 2024.
Losing elimination status may not lead to tangible changes, such as travel restrictions. But experts have called the possibility “deeply embarrassing” for a wealthy country with the medical resources of the United States.
A representative from the Health and Human Services Department did not immediately respond to request for comment.
This month, the C.D.C. presented its outbreak information to the Pan American Health Organization. As of Nov. 13, the C.D.C. had confirmed 1,723 measles cases nationwide, 87 percent of which were associated with a record 45 outbreaks so far this year. By contrast, 16 outbreaks were reported in 2024.
About 92 percent of the reported cases this year are among people who are either unvaccinated or of unknown vaccination status.
The subtype of measles that is circulating, identified by the number 9171, first took hold on Jan. 20 in Gaines County, Texas, and “continues, unfortunately uninterrupted, across multiple jurisdictions,” said Dr. David Sugerman, who leads the C.D.C.’s measles response, on the call.
The country’s measles elimination status is “very much still under threat if we see that same sequence transmitting in current outbreaks ongoing through the end of January,” he said, when the outbreak will have been going on for a year.
The C.D.C. is working with health authorities in Canada and Mexico to share best practices and collaborate on decoding the genetic sequences of the measles virus, he added.
The outbreak in Utah and Arizona is currently the largest in the country, with more than 180 cases. Most new infections are among household members of infected individuals, but roughly one in four across both states have an unknown origin, suggesting that officials are missing some sources of exposure. About 7 percent of infections were contracted at congregate events, including weddings and other festivals.
Local public health officials in Utah said efforts to encourage vaccinations in the area have had “limited” impact. While there was an initial spike in vaccination rates when the outbreak first took root, progress has fallen off.
“It would not surprise me in the least if there’s continued spread across these next several months,” said Dr. David Kimberlin, who sits on a panel of experts that analyzes measles data for the United States’ elimination status review.
Another large outbreak in two schools in South Carolina is close to being contained. Rockland County, N.Y., has four reported cases, the first since a massive outbreak in 2018 that lasted 10 months. That outbreak raced through Orthodox Jewish communities, some of which had vaccination rates below 70 percent.
“Overall, the risk of widespread measles transmission in the United States remains low,” Dr. Sugerman said. But the virus may quickly move through close-knit communities where vaccination rates are low, he warned.
The infections in New York this year stem from two people traveling from Israel. In total, the United States has had 152 importations from at least 47 countries, including eight new ones just in the last two weeks.
Apoorva Mandavilli reports on science and global health for The Times, with a focus on infectious diseases and pandemics and the public health agencies that try to manage them.
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