In 2023, the United States is grappling with a significant rise in measles cases, reaching alarming levels not seen in recent years. To combat the spread of this contagious disease, a new innovative approach is being introduced: wastewater surveillance. This technique, which gained traction during the Covid-19 pandemic, involves monitoring sewage systems to detect viral particles. This method proved instrumental in providing early warnings about Covid-19 transmission when traditional testing methods were inadequate. WastewaterSCAN is pioneering the first nationwide program aimed specifically at monitoring for measles. This program will soon be deployed in nearly 150 wastewater treatment facilities across 40 states.
As of the latest updates, at least 1,157 measles cases have been reported across the country in 2023, according to a tally compiled by CNN, which aggregates data from diverse state health departments. Central to this outbreak is a significant multi-state incident concentrated largely in West Texas, which has contributed a staggering number of cases. Specifically, Texas has reported 742 cases linked to this outbreak, while neighboring states have also seen increases; New Mexico has recorded 81 cases, Oklahoma has confirmed 18 cases, and Kansas has seen 71 cases potentially associated with the same outbreak. Experts caution that these reported figures likely underestimate the true scope of the crisis, as many cases go unreported. Alarmingly, the nation is only about 120 cases shy of the total number documented in 2019, which at that time was recorded as the highest amount of measles cases since the disease was declared eliminated in the U.S. in 2000.
Among the states impacted by this current outbreak, South Dakota recently registered its first measles case of 2023, bringing the total number of states reporting cases to 33. This particular case, involving an adult, was linked to international travel, illustrating the global nature of disease transmission. In light of these events, the Centers for Disease Control and Prevention (CDC) has updated its guidance regarding measles for travelers, emphasizing that individuals can be at risk of contracting measles in various environments, including airports, public transportation, and crowded events.
Recent reports have surfaced concerning potential exposures to measles, including an adult in Minnesota who was exposed during domestic air travel and warnings from the New Jersey health department regarding potential exposure at Newark airport. The CDC notes that, thus far in 2023, at least 14 outbreaks have occurred in the U.S., accounting for a staggering 90% of reported cases. It is worth mentioning that the overwhelming majority of these cases have arisen among unvaccinated individuals; only about 5% of confirmed cases pertain to those who had received either one or two doses of the measles-mumps-rubella (MMR) vaccine.
Vaccination remains the most effective strategy for prevention, with two doses of the MMR vaccine being 97% effective against measles. The CDC recommends the first dose be administered between the ages of 12 to 15 months and the second dose between 4 to 6 years of age. Unfortunately, childhood vaccination rates have been in decline across the U.S. for several years, with MMR vaccination coverage among kindergartners falling below the recommended 95% threshold for at least four years. A recent study from Johns Hopkins University highlighted this trend, finding that MMR vaccination rates had dropped in over 75% of counties, with an average decline of 2.7% between 2017 and 2024.
However, some regions are witnessing a surge in vaccination rates due to the current outbreaks. For instance, in New Mexico, the number of MMR vaccinations administered this year has almost doubled compared to the same period last year. In Texas, early vaccination rates among infants have seen a remarkable increase, with the rates for 6-month-olds skyrocketing to more than eight times what they were in 2019. The changes in vaccination behavior come amidst urgent calls from health authorities for increased immunization.
As we navigate this public health crisis, it is essential to emphasize that vaccination remains the singular most powerful tool in protecting communities against measles. Already this year, hospitalizations related to measles have exceeded 133 cases, and more tragically, there have been three fatalities linked to the disease—two children from Texas and one adult from New Mexico—all of whom were unvaccinated. Today, comprehensive community awareness and robust vaccination efforts are more crucial than ever to avert further outbreaks and safeguard future generations against preventable diseases like measles.
