The 2019 U.S. Measles outbreaks: A public health crisis

December 20, 2019

Video: The Immunization Project at Texas Children's Hospital 

As 2019 comes to a close and I reflect on the year, many notable events occurred, both personally and professionally. On a personal level, I celebrated 15 years of marriage, my 7-year-old daughter learned to ride a bike (finally!), my 9-year-old daughter got braces, and my 2-year-old … well, he just grew more energetic and mischievous this year. In my professional life, the year was consumed by a single overwhelming issue – measles.

This year, the U.S. experienced the largest measles outbreak since 1992. Between Jan. 1 and Nov. 7, 2019, 1,261 cases of measles were reported across 31 states. Globally, measles cases have also surged in the last decade. Just this week, the World Health Organization and U.S. Centers for Disease Control and Prevention reported that a devastating 140,000 deaths from measles occurred in 2018.

In recent decades, many public health experts warned that the widespread protection from vaccine-preventable diseases we achieved in the U.S. was under threat. As parental vaccine hesitancy increased and unvaccinated individuals clustered geographically, experts believed these trends were creating an untenable situation in the U.S. which would eventually result in the reemergence of vaccine-preventable diseases.

This is precisely what occurred this year – 89% of the measles cases in 2019 were in individuals who were unvaccinated or had unknown vaccine status. Sadly, as a result, we as a nation lost the critical protection afforded to us through herd immunity – the protection that occurs when enough of a community is vaccinated to interrupt disease transmission. Herd immunity is especially important for measles, a disease so highly contagious that the virus can live for up to two hours in an airspace where an infected individual was and for which vaccination levels must remain extremely high.

As the Centers for Disease Control and Prevention and public health departments across the U.S. fought to get measles under control and prevent the U.S. from losing its measles elimination status, we at Texas Children’s Hospital knew we had a job to do. We needed to make parents aware of the risk measles poses to the U.S. After all, most parents, myself included, have never experienced measles. We have no memory of its painful reality. As a result, some parents fail to understand and appreciate the impact measles can have on our children and communities. Such complacency and failure to vaccinate allowed measles to take a foothold in our country and it could do so again if we don’t learn from our mistakes and ensure we vaccinate our children, on time, every time.

Need a vaccine? Click here to find your nearest Texas Children's Pediatrics 

In an effort to increase parental understanding, this fall I met with several families who were profoundly impacted by this year’s measles outbreaks. Families just like mine – busy and loving, but also human. These families courageously shared their stories with me hoping other parents will learn from their mistakes. As I listened to their stories, met the children who were affected by measles and saw the photos they took when they were sick, I was struck with disbelief.

Measles – a disease that was declared eliminated in the U.S. in 2000. A disease that myself and everyone born after 1963 have not encountered because we were vaccinated. A disease that parents have not had to worry about for three generations. This disease was now a frightening reality in our country.

Yet, here were young families who, although not vaccine-hesitant, made the easy mistake of losing track of their children’s shots. While some parents intentionally delay or refuse the vaccine for measles (the combination measles-mumps-rubella, or MMR, vaccine), other parents simply fail to stay diligent about their child’s vaccines, an easy thing to do in the chaos and busyness of life with kids. Sadly, there are enough unvaccinated children in the U.S. that these families could no longer rely on herd immunity for even a brief delay in vaccines. Instead, the loss of collective immunity in their community led to their children contracting measles.

I’m honored to bring their stories directly to you. This video shares the stories of Diodato Fierro and Nikolai Ingles, two of the six measles cases that occurred in El Paso, Texas during the summer of 2019. Diodato was just over 1 year old when he contracted measles, his parents accidentally missed his 1-year old vaccines which would have included MMR. The Ingles, an active-duty military family, simply lost track of 3-year-old Nikolai’s vaccine status.

I hope you will be as moved as I was by their message.


Learn more about measles 

Measles: Here’s what you need to know

Measles 101: Commonly Asked Questions

Post by:

Rachel M. Cunningham, MPH