West Texas measles outbreak

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When Aganetha Unger pulled up her large, white van to the emergency measles testing site, several of her eight children were coughing.

“We had some sickness in the house, not very bad, but some fever, some cough,” said Unger, who is Mennonite. One child, she said, had a fever of 103 degrees.

Her youngest getting tested was a 2-month-old, wrapped tightly in a pink blanket on her mom’s lap. When the EMS team swabbed her nose, she didn’t cry.

It was Thursday, eight days after the Texas Department of State Health Services first reported a measles outbreak on the rural, western edge of the state.

On Friday, the number of confirmed cases rose to 49, up from 24 earlier in the week, the state health department said. The majority of those cases are in Gaines County, which borders New Mexico.

Most cases are in school-age kids, and 13 have been hospitalized. All are unvaccinated against measles, which is one of the most contagious viruses in the world.

The latest measles case count likely represents a fraction of the true number of infections. Health officials — who are scrambling to get a handle on the vaccine-preventable outbreak — suspect 200 to 300 people in West Texas are infected but untested, and therefore not part of the state’s official tally so far.

The fast-moving outbreak comes as Robert F. Kennedy Jr. takes the helm of the Department of Health and Human Services. Kennedy, a vaccine skeptic, has long sown distrust about childhood vaccines, and in particular, the measles-mumps-rubella (MMR) vaccine, falsely linking it to autism.

The CDC has sent approximately 2,000 doses of the MMR vaccine to Texas health officials at their request. However, most doses so far are being accepted by partially vaccinated kids to boost their immunity, rather than the unvaccinated.

Without widespread vaccination, experts say, the outbreak could go on for months.

Measles epicenter
The city of Seminole is the seat of Gaines County, Texas, and the epicenter of the current measles outbreak. It’s located in a vast, flat region filled with ranchers and peanut and cotton farmers.

There’s also a large Mennonite population, a religious sect that believes in “total separation from the outside world,” according to the Texas State Historical Association. These Mennonites chose to settle in Gaines County, in part, for its lack of regulation on private schools. This includes vaccine mandates.

As of the 2023-24 school year, Gaines County had one of the state’s highest vaccine exemption rates, at nearly 18%, according to health department data.

The pandemic also appears to have driven down vaccination rates.

“We have some outside of that group of people that are unvaccinated, and the Covid vaccine did play a part in that,” Guffey said.

Guffey, who was born and raised in Gaines County, has been in health care for over 30 years and said she’s never seen a measles outbreak before. Still, she wasn’t surprised by the size of the outbreak currently spreading across the county.

“With the large population of unvaccinated that we have,” Guffey said, “it’s not out of the numbers that you would expect.”

‘Hub’ city concerns
Measles cases were limited to rural areas surrounding Lubbock, Texas, the largest city in the region, until Friday afternoon, when Lubbock Public Health confirmed its first case.

The “hub” city, as it’s nicknamed, is where all of the big grocery and big box stores are.

People who live in Gaines County regularly head into Lubbock to shop and do other business. That includes a large number of unvaccinated people who may have been exposed to measles.

“Communities who don’t vaccinate are not necessarily isolated to their area. They commute to Lubbock,” said Dr. Ana Montanez, a pediatrician at Texas Tech Physicians in Lubbock. “By doing that, they’re taking the disease with them.”

Several of Montanez’s young patients were exposed recently, she said, one just by sitting in the same clinic waiting room with another child who was later confirmed to have measles. That child had traveled from another county for care.

Two doses of the MMR vaccine are needed for virtually full protection against the virus. The first is given at around age 1, but the second isn’t given until around age 5. That leaves kids slightly vulnerable for the several years that they are in between doses.

Doctors have the option of giving the second dose early, however, if a child has been exposed to the virus. That’s what Montanez has done for a few of her vulnerable patients. She also continues to counsel families who aren’t vaccinating their children about the benefits of the shots.

As the measles outbreak in Texas keeps spreading, parents who previously chose not to vaccinate their children are now lining up to get their kids the shots needed to protect them from the serious illness.

“People are more and more nervous” as they watch the highly contagious virus spread in their communities, mostly among children, said Katherine Wells, director of public health for Lubbock's health department. “We’ve vaccinated multiple kids that have never been vaccinated before, some from families that didn’t believe in vaccines.”

About half of the approximately 100 doses of measles-mumps-rubella vaccine (MMR) given at the health department last week were to kids who were unvaccinated, Wells said.

On Tuesday, the Texas Department of State Health Services reported that 124 cases of measles have been confirmed since late January, mostly in counties in West Texas, near the New Mexico border. So far, 18 patients have been hospitalized, often because they were having trouble breathing.

Of the 124 cases identified, 101 are babies, school-age kids or teenagers.

Nearly all were either unvaccinated or hadn’t received their second MMR shot, which is usually given around age 5. That dose, plus one given around a child’s first birthday, are 97% effective at preventing measles, according to the Centers for Disease Control and Prevention.

While that level of protection is extremely high, it’s not 100%. Five of the 124 people with measles in Texas said they’d had at least one dose of the MMR shot.

Measles is considered one of the most contagious viruses in the world. It’s spread through tiny respiratory particles that can live in the air or on surfaces for up to two hours after an infected person was there.

That’s why a mobile health care unit offering measles testing and vaccines for people who are not sick enough to be hospitalized has set up shop in emergency department parking lots in Lubbock and surrounding areas.

“We’re using the bus to keep them out of the hospital because measles is so contagious and airborne,” Chad Curry, training chief for the University Medical Center EMS, who is overseeing the mobile unit’s operations during the outbreak, said in an interview Tuesday. “We’re trying to lessen the blow.”

Starting Wednesday, Curry’s crew will offer immunoglobulin shots or infusions to people who’ve had a confirmed measles exposure and who may be at risk for complications.

Immunoglobulin, or IG, is an antibody that helps the immune system fight off infections. It can be given up to six days after a person was exposed to measles.

Growing worries
The fast-moving outbreak is certain to expand, health authorities said.

On Monday, the Texas Department of State Health Services alerted the public that a person infected with measles had traveled outside of the outbreak area to other parts of the state.

The person visited the University of Texas at San Antonio campus and a variety of restaurants and convenience stores like Buc-ee’s in other areas near the city.

Measles symptoms in the outbreak have been “textbook,” Wells said. Patients have had fevers up to 104 degrees, coughing, runny nose and red, irritated eyes. After that, they develop a rash that starts near the scalp and spreads down the body.

Symptoms may not appear until two weeks after a person is exposed.

It’s up to health officials now to do what’s called contact tracing. That means painstakingly tracking down anyone who was in those public spaces at the same time — or several hours afterward — to tell them about the exposure and give guidance on what they should do.
That’s on top of the ongoing investigations in the outbreak’s epicenter.

“My biggest concern right now is the manpower needed to do all of the contact tracing,” said Dr. Ronald Cook, chief health officer at the Texas Tech University Health Sciences Center in Lubbock and health authority for the city.

As a measles outbreak sweeps through Texas, officially sickening 124 people, mostly unvaccinated children, and hospitalizing 18, anti-vaccine groups are pushing a familiar and false theory: The highly contagious virus is being caused by the vaccine itself.

“The narrative is that it’s a failure to vaccinate when we know it is a failing vaccine,” said Sayer Ji, a self-described natural health and wellness thought leader who is not a doctor. He outlined his theory Monday during an interview on the internet morning show from Children’s Health Defense, an anti-vaccine nonprofit formerly led by Robert F. Kennedy Jr., who resigned after being chosen by President Donald Trump to run the Department of Health and Human Services.

Ji’s discussion with Children’s Health Defense’s director of programming, Polly Tommey, comes as Texas health authorities work to contain an outbreak of one of the world’s most contagious diseases, in part through a campaign to vaccinate residents. The measles, mumps and rubella (MMR) shot is remarkably safe and effective, experts said, and the mild reaction that some people experience after receiving it is unlikely to be confused with measles.

But that has not stopped Ji, Tommey and a growing chorus of state “health freedom” groups and conspiracy theory websites from pushing the false claims. They’ve also argued the U.S. Centers for Disease Control and Prevention should be testing to determine the difference between these theorized vaccine-caused cases and naturally occurring wild-type measles. And they’ve suggested the tests weren’t being done as part of a wider conspiracy or “psychological operation” against Kennedy.

“It is no coincidence in my mind that Bobby gets confirmed to be secretary of HHS, and immediately we have a measles outbreak,” said Tommey, who is the mother of an adult child whom she says was injured by the MMR vaccine. “Parent to parent, do not go anywhere near that vaccine.”

n fact, the Texas Department of State Health Services is genotype testing measles samples for surveillance purposes. All samples tested in the outbreak have come back as genotype D8, a known strain of the wild measles viruses — not the vaccine, said Lara Anton, senior press officer at the department.

Testing “helps us determine if cases are related” to each other, Anton said. “It also helps us know whether a positive measles test for someone who was recently immunized is due to an actual infection or to a reaction to the vaccine.”

While an MMR vaccine can sometimes induce mild and temporary reactions such as a low-grade fever and rash, actual measles infections are more severe and can be deadly — they often come with high fevers, a full-body rash, ear infections, dehydration and pneumonia — and are linked to direct exposure, not the vaccine. It’s unlikely for the two to be confused, Washam said.

“This is a completely different phenomena,” Washam said. “It’s the body’s immune response to the vaccine. It’s not wild-type measles infection. Most importantly, it’s not transmissible to others, and it’s not a cause of an outbreak.”

There has never been a documented case of the MMR vaccine causing a measles infection that spread to others, Washam said, adding, “It’s an extremely great vaccine.”

Though the symptoms for measles can sound mild, complications can be dangerous and even deadly. Out of every 1,000 cases, around 200 children require hospitalization, 50 develop pneumonia, one experiences brain swelling that can lead to deafness or disability, and between one and three die.

The theories espoused about Texas echo Kennedy’s false statements about the measles outbreak in Samoa in 2019. That fall, as young children were hospitalized and dying from measles infections, Kennedy wrote to the Pacific Island nation’s prime minister, warning about the possible danger of the vaccine campaign. “Nobody died in Samoa from measles,” he told an interviewer last August. “They were dying from a bad vaccine.”

Kennedy has not commented on the Texas outbreak since being confirmed as HHS secretary this month, but some of his early moves — including the shelving of planned ads for the flu vaccine and the postponement of a meeting of a vaccine advisory panel — have concerned public health experts.

For years, activists like Kennedy have suggested that the tens of thousands of children who were hospitalized and the hundreds who died each year from measles before vaccines were available are inconsequential when compared to the countless individuals who they claim — without evidence — have been harmed by the MMR vaccine. But when outbreaks occur, the narrative often shifts from minimizing measles to reviving the persistent anti-vaccine myth: that the MMR vaccine can shed and cause outbreaks.

Kennedy’s 2019 letter to Samoa’s leader referenced another outbreak, which started in California’s Disneyland in 2015 and spread to seven U.S. states, Mexico and Canada and sickened over 100 people. Kennedy claimed the outbreak was likely caused by vaccines — contrary to evidence that showed low vaccination rates as the culprit. The false theory seems to stem from a misreading of a California Department of Public Health report that mentioned cases of a vaccine-induced rash, not vaccine-induced measles.

HHS and the CDC did not respond to requests for comment. Tommey did not respond to requests for comment.

In an email, Ji disputed the experts’ opinions, calling them “an oversimplification that lacks conclusive scientific verification in the absence of proper genotyping,” and suggested a reporter consult a different report on vaccine shedding published by an anti-vaccine organization.

To Washam, the difference between measles and the MMR vaccine is the risk one is willing to take — especially for young children — to get immunity from measles.

For now, the conspiracy theory appears confined to the internet and hasn’t yet taken root in the communities where measles is spreading, according to Dr. Ana Montanez, a pediatrician at Texas Tech Physicians in Lubbock who has treated several exposed families. Montanez said vaccine hesitancy there is currently driven by limited education, cultural isolation in the Mennonite community and a perceived lack of necessity.

“A lot of our parents are actually really open to asking questions,” she said. “It’s not misinformation about the vaccine causing outbreaks that’s the issue here. It’s more about, ‘Why should we vaccinate if we’ve never seen this disease?’”