The United States is about to lose its measles-free status next year. If this happens, it will enter a new stage in which outbreaks will become common again.
More girls and boys will be hospitalized due to this preventable disease. Some will lose their hearing. Some will die.
Measles is also expensive. A new research Estimates not yet published in a scientific journal estimate that public health responses to multi-case outbreaks cost about $244,000.
When a person requires inpatient care, the average cost per case is $58,600. The study estimates that an outbreak like the one that occurred earlier this year in West Texas, with 762 cases and 99 hospitalizations, would cost about $12.6 million.
The United States' status depends on whether this year's major outbreaks are driven by the large outbreak in West Texas that officially began on Jan. 20. If these outbreaks are linked and continue beyond January 20 of the following year, the country will no longer be considered measles-free.
“Many people have worked very hard for a long time to achieve elimination: years of work to make vaccines available, to achieve good vaccination coverage and to respond quickly to outbreaks to limit their spread,” said Paul Rota, a microbiologist who recently retired after a nearly 40-year career at the Centers for Disease Control and Prevention (CDC).
But instead of acting quickly to prevent the return of measles, Robert F. Kennedy Jr., a lawyer who founded an anti-vaccine organization before leading the Department of Health and Human Services (HHS), weakened the ability of public health authorities to prevent and contain outbreaks, eroding confidence in vaccines.
The measles vaccine is safe and effective: only 4% of more than 1800 cases The country's confirmed case this year was in people who received two recommended doses.
Kennedy shot to experts on the CDC's Vaccine Advisory Committee and without any evidence said that vaccines can cause autism, brain inflammation and death.
On November 19, scientific information about vaccines and autism on the CDC website was replaced with false statements. Kennedy told New York Times that he ordered a replacement.
“Do we want to go back to the pre-vaccination era, when 500 children died a year from measles?” asked Demetre Daskalakis, the former director of the CDC's National Immunization Center who resigned in August in protest of Kennedy's actions.
Daskalakis and other scientists say the Trump administration appears more interested in minimizing a resurgence of the measles outbreak than in containing it.
HHS spokesman Andrew Nixon said in a statement that vaccination remains the most effective tool for preventing measles and that “CDC and state and local health agencies continue to work together to assess transmission patterns and ensure an effective public health response.”
Looking for connections
CDC scientists are tracking measles along with researchers from health departments and universities.
To find out whether outbreaks are related, the genomes of the measles virus, which contain all of its genetic information, are analyzed. These tests can help identify the cause of outbreaks and their true extent, as well as alert about undetected infections.
Scientists have been conducting genetic analyzes of HIV, flu and Covid for years, but this is new for measles because the virus has been a minor problem in the country for decades, explained Samuel Scarpino, a public health specialist at Northeastern University in Boston. “It is important to create a surveillance network that can be quickly scaled up if necessary,” he said.
“We're working with the CDC and other states to determine whether what we're seeing is one large outbreak that continues to spread from state to state,” said Kelly Oakson, a genomics researcher with the Utah Department of Health and Human Services.
At first glance, the ongoing outbreak in Utah th Arizona258 cases as of December 1 appear to be linked to the Texas case because it was caused by the same strain of the virus, D8-9171. But the strain is also circulating in Canada and Mexico, meaning the outbreaks may have started separately from people infected abroad.
If this were the case, this technical difference could prevent the United States from losing its status, Rota said. Being a measles-free country means that the virus does not circulate continuously throughout the year.
Canada lost its status in November because authorities could not prove that multiple outbreaks caused by the D8-9171 strain were unrelated, explained Daniel Salas, executive director of the Pan American Health Organization's (PAHO) integrated immunization program.
The organization, part of the World Health Organization (WHO), includes health officials from North America, Central America, South America and the Caribbean and determines the status of measles elimination based on scientific reports from member countries.
PAHO will hear from US scientists early next year. If its analysis shows that measles is continuously spreading in the country throughout the year, the director of the organization can revoke the country's measles-free status.
“We hope that countries are transparent about the information they have,” Salas said. “We're going to ask questions like, 'How did you reach your conclusions and did you consider other possibilities?'
In preparation for this assessment, Oxon and other researchers are studying how similar the D8-9171 strains found in Utah are to each other.
Instead of analyzing just a fragment of the genome that identifies a strain, they examine the entire genome of the measles virus, which has about 16,000 genetic letters. Mutations occur naturally over time, and the accumulation of small changes acts like a clock that tells how much time has passed between outbreaks. “This shows us the evolutionary history of the specimens,” Oxon explained.
For example, if one child directly infects another, both will have identical viruses. But the viruses in people infected early in a major outbreak will be slightly different from the viruses circulating months later.
Although the outbreaks in Texas and Utah were caused by the same strain, Owson said “the finer details lead us to believe they are not very closely related.” To find out how different they are from each other, scientists compare them with measles virus genomes from other states and countries.
Ideally, genetic studies would be complemented by field studies of how each outbreak began. However, many of these investigations went unanswered because the first infected people did not seek medical attention or notify health authorities.
Like West Texas, the outbreak in Utah and Arizona is concentrated in highly closed communities with low vaccination rates and mistrust of government and traditional medicine.
Researchers are also trying to figure out how many cases of measles have gone undetected. “Confirmed cases require testing, and in some communities there are costs associated with traveling to the hospital: gas, finding child care, missing work,” explained Andrew Pavia, an infectious disease physician at the University of Utah. “If your child has measles rash but is not very sick, why worry?”
subtle observation
Pavia is part national outbreak surveillance network led by the CDC. An easy way to gauge the size of an outbreak is to conduct surveys, but this is difficult to do in communities that don't trust public health personnel.
“As part of the collaboration, we could fill out questionnaires asking if anyone in the family has had a rash or other symptoms of measles,” Pavia said. “But the same factors that make it difficult for people to get vaccinated or quarantine also make it difficult.”
That's why Pavia and other researchers are analyzing genomes. Large genetic variations suggest the outbreak spread for weeks or months before being detected, infecting many more people than is known.
A less invasive form of monitoring is wastewater analysis. This year, the CDC and state health departments began testing wastewater from homes and buildings for the measles virus shed by infected people.
A Texas study found it could serve as an early warning system, allowing outbreaks to be detected before people reach the hospital.
The quiet work of CDC scientists contrasts with the agency's lack of public relations.
Since President Donald Trump took office, the CDC has not held a single press conference on measles, and in its latest bulletin about it Weekly Morbidity and Mortality Report This was in April.
Instead of acting quickly to contain the outbreak in Texas, the Trump administration hampered CDC's ability quickly contact the authorities of that state and delivery of federal funds was delayed emergency, according to a KFF Health News investigation. Meanwhile, Kennedy spread confusing messages about vaccines and propaganda untested treatments.
Daskalakis said that as the outbreak in Texas worsened, his team at the Centers for Disease Control and Prevention (CDC) received no response when he asked to brief Kennedy and other HHS officials.
“Objectively, they haven't helped control the outbreak in Texas, so if we lose eradication status, maybe they'll say, 'So what?' Daskalakis said.
Nixon, the HHS spokesman, said Kennedy responded decisively to the outbreak in Texas, ordering the Centers for Disease Control and Prevention to provide measles vaccines and medications to communities, speed up testing and provide guidance to doctors and health officials. He added that the United States maintains its status because there is no evidence of continuous transmission of the virus for 12 months.
“Preliminary genomic analysis indicates that the cases in Utah and Arizona are not directly linked to the cases in Texas.” wrote on social networks Acting CDC Director and HHS Deputy Secretary Jim O'Neill.
Given Kennedy's history of misrepresenting vitamin Aparacetamol (Tylenol) And autismDaskalakis fears the Trump administration will insist that the outbreaks are unrelated or that PAHO is wrong.
“If he becomes health secretary the year we lose the elimination status, it will be a huge stain on the Kennedy regime,” he said. “I think they will do everything they can to question scientific findings, even if that means blaming scientists.”
