(PDF) Atypical measles syndrome in adults: Still around

In Rural West Texas, A Measles Outbreak Grows With No End In Sight

SEMINOLE, Texas — 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 Tuesday this week, the number of confirmed cases rose to 58, the state health department said. The majority of those cases are in Gaines County, which borders New Mexico. Four of the patients had been vaccinated. The rest are either unvaccinated or their status isn't known.

Most of the infections are in school-age kids, and 13 have been hospitalized.

Measles 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.

During his confirmation hearings, Kennedy said he was not anti-vaccine. "I am pro-safety," he said. "All of my kids are vaccinated, and I believe vaccines have a critical role in health care."

About 40 people showed up for measles testing this week at a mobile site in Seminole, Texas.NBC News

HHS did not respond to a request for comment from Kennedy about the outbreak.

The Centers for Disease Control and Prevention can send in its experts to assist only if the state requests help. So far, Texas has not done so, the CDC said.

The CDC has sent about 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.

A woman and a young girl from the Mennonite community get tested for measles at a mobile testing site in Seminole, Texas. It takes at least 48 hours for results to come back.NBC News

"We have a high, high number of unvaccinated," said Tonya Guffey, the chief nursing officer at Seminole District Hospital. "It's not that they're not educated. It's just what their belief is."

Guffey noted that many of the unvaccinated people in the area were Mennonite. "We educate, we encourage, we do what we can for the community, but it's their choice," she said.

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.

Young and vulnerable

The growing outbreak is worrisome to Carina Perez and her husband, Ben Ham, who are caring for a foster child they affectionately call "Muffin."

As the measles outbreak spreads in the Lubbock area, Carina Perez and her husband worry for the safety of their foster daughter, who has reactive airway disease, which makes her highly susceptible to any airborne viruses.NBC News

The 18-month-old girl has been eligible for only the first dose of the MMR vaccine so far. She was also born with several health problems, including reactive airway disease, which makes it hard to breathe if she catches any kind of respiratory virus.

Muffin has been admitted to the intensive care unit three times in her young life so far because of respiratory syncytial virus (RSV) and even the common cold.

"The smallest triggers get her pretty sick," Perez said. "We have to be very cautious about being out in public."

Measles Outbreak In West Texas Worsens

Texas health officials have consistently said that vaccination is the best way for people to avoid the highly contagious airborne disease.

AUSTIN, Texas — At least 48 cases of measles — the vast majority of which were among children — have been reported in West Texas, marking an escalation in the recent outbreak.

All but six of the current cases are in Gaines County. The rest are in neighboring Lynn, Terry and Yoakum counties.

All of those with measles so far were either unvaccinated or had an unknown vaccination status, according to state health officials. Of the cases so far, 13 people have been hospitalized. It's the worst outbreak in Texas in nearly 30 years, the Associated Press reported Friday. A health official in West Texas said some of the cases appeared to be connected to private religious schools in the area, the AP also reported.

The new cases come two weeks after Texas health officials reported two Measles cases out of Gaines County, both involving unvaccinated school-aged children. Both children were hospitalized in Lubbock and later discharged. Last week, state health officials said the number of cases had grown to 10. Since then, that figure has continued to increase.

West Texas is not alone in new cases of measles. In January, new measles cases were also reported in Harris County, prompting a health alert from the state and marking the first time Texans were confirmed to have the disease since 2023. The two Harris County cases involved unvaccinated adult residents.

Measles is a highly contagious airborne disease. Symptoms could include a high fever, cough, runny nose and rash that starts on the face but then extends to the rest of the body. The health consequences of getting measles can be serious and sometimes result in death.

Last year, 40% of all the 245 people nationwide who contracted measles were hospitalized, according to the Centers for Disease Control and Prevention. More than half of those hospitalized with measles last year were under the age of five.

The disease's prevalence has accelerated in recent years. According to the CDC, by March 2024 there were more reported measles cases that year than in all of 2023. The rise comes more than two decades after measles was considered eliminated by health agencies in 2000, meaning that there had been no continuous spreading of the disease for 12 months.

The new cases both nationwide and in Texas come as the state's measles vaccination rate among kindergarteners has dropped since the COVID-19 pandemic. The vaccination rate was 97% in the 2019-20 school year and declined to 94.3% for 2023-24. Around the same time, the number of vaccine exemption requests in Texas have doubled from 45,900 in 2018 to 93,000 in 2024.

State lawmakers have filed more than 20 bills so far this legislative session aimed at weakening vaccination mandates. One proposal would even amend the Texas Constitution to preserve a Texans' right to refuse vaccination.

Texas health officials have consistently said that vaccination is the best way for people to steer clear of measles and other preventable diseases. The vaccination process includes two separate doses.

"Children too young to be vaccinated are more likely to have severe complications if they get infected with the measles virus," the Texas health officials wrote in a Jan. 30 release. "However, each MMR dose lowers the risk of infection and the severity of illness if infected."

This article originally appeared in The Texas Tribune.

The Texas Tribune is a nonprofit, nonpartisan media organization that informs Texans — and engages with them — about public policy, politics, government and statewide issues.

Measles Outbreak Hits Town In Texas

A worsening measles outbreak has taken root in Texas, sickening two dozen and hospitalizing nine on the western edge of the state, where childhood vaccination rates have dwindled in recent years.

As of Tuesday, 22 children and two adults had been infected, all of whom were unvaccinated, local health officials said. The outbreak comes as Robert F. Kennedy Jr., a staunch critic of childhood vaccines, has been nominated to be the country's next health secretary, causing public health experts to worry that similar upticks of preventable illnesses will become more frequent.

"There's a feeling this is going to be more and more common," said Dr. Cameron Wolfe, an infectious disease expert at Duke University.

The Texas outbreak has so far been limited to residents of Gaines County, which borders New Mexico and has roughly 20,000 residents. Last year 82 percent of kindergarten students received the measles, mumps and rubella vaccine, according to state data. That figure is roughly 10 percentage points lower than the average vaccination rate in Texas public schools and far below the federal target of 95 percent for measles vaccination.

Vaccination rates have been declining nationwide since the start of the Covid-19 pandemic in 2020 and now sit below 93 percent. An estimated 280,000 kindergartners in the United States do not have documentation of an M.M.R. Vaccine, according to federal data.

Texas public schools require children to have received certain vaccines, including the M.M.R. Shot, but parents can apply for an exemption for "reasons of conscience," including religious beliefs.

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