Two new reports examining recent US measles outbreaks highlight the challenges of containing the spread of the disease in certain communities.
The first report, published last week in Morbidity and Mortality Weekly Report (MMWR) by a Centers for Disease Control and Prevention–led team, examines the 2025 measles outbreak in a close-knit community in West Texas. Published this week in Vaccine, the second report takes a close look at the 2025-26 school-based outbreak in South Carolina.
Both reports conclude that maintaining high measles vaccination coverage is the most effective intervention for preventing measles and limiting disruptions to schools and communities. The two outbreaks were the largest in the country in the past two years, reaching numbers not seen in decades.
West Texas outbreak sickens 762, kills 2
Gaines County sits on the far western edge of Texas along the New Mexico border—a 1.5-hour drive southwest from Lubbock and a 2.5-hour drive southeast from Roswell.
On January 29, 2025, local health officials alerted the Texas Department of State Health Services (DSHS) of an unvaccinated child with measles in the county. The ensuing outbreak eventually sickened 762 people, hospitalized 99, and killed two, according to the MMWR report.
Nearly all identified patients (97%) were unvaccinated or had unknown vaccination status. Just six (3%) had received at least one dose of the measles, mumps, and rubella (MMR) vaccine. Most patients were children, and 18% required hospitalization.
At the time of the outbreak, local kindergarten MMR vaccination rates ranged from 77.3% to 94.6%. The overall coverage rate in Texas is 93.2%.
Many community members described their lack of trust in outside institutions and their reluctance to engage with public health and health care systems overall… Therefore, many measles cases likely remained unreported.”
Health officials launched extensive education and mitigation efforts, including 33 vaccination clinics, 16 testing clinics, and culturally tailored materials translated into multiple languages. But vaccine uptake remained low, with only about 275 MMR doses administered.
And, because of community resistance to outside institutions, researchers suspect the total case count was much higher than 762.
“Many community members described their lack of trust in outside institutions and their reluctance to engage with public health and health care systems overall, based on an ethos within the community that prioritized maintaining independence from outside institutions and seeking solutions from within the community,” the researchers write.
“This perspective complicated implementation of standard measles control measures and hampered epidemiologic investigations,” they added. “Therefore, many measles cases likely remained unreported.”
The findings highlight the complex social and cultural challenges that can stymie vaccination, testing, and education, write the researchers. They conclude that early collaboration with trusted community members could help support more effective public health interventions.
In South Carolina, largest outbreak since measles elimination
Spartanburg County, South Carolina, sits in the north central part of the state, about an hour-and-twenty-minute drive southeast of Asheville, North Carolina. On October 2, 2025, the largest US measles outbreak since the disease was declared eliminated in 2000 began in the county.
From October to April, the disease spread across 32 schools and resulted in 997 confirmed cases. At least 21 people were hospitalized with measles-related complications; no fatalities were reported in the outbreak.
For the Vaccinereport, researchers from Cornell University analyzed school vaccination rates and quarantine orders. They found that schools with repeated quarantines had significantly lower vaccination coverage.
Average two-dose MMR coverage at schools with measles exposures was 82.5%, compared with 91.0% at schools without exposures. Schools that required multiple rounds of quarantine had average vaccination rates of 77%, versus 86% at schools that required only a single quarantine.
Overall, 13 of 32 affected schools (41%) required multiple quarantines—eight with two rounds of 21-day quarantines and five with three rounds.
This pattern of multiple quarantines clustered in low-coverage, highly susceptible schools “demands scrutiny,” write the researchers. They argue that quarantine should be viewed as a temporary strategy that buys time for vaccination efforts rather than its own mitigation strategy.
“Low coverage not only invites exposure but sustains recirculation,” they write, noting that quarantines for school-aged children can come with significant social and educational costs.
Schools weren’t the only exposure site in the outbreak. Twenty-nine cases were connected to a church in Inman, South Carolina. The researchers note that “This pattern in which a faith community with shared vaccine attitudes sustains and amplifies transmission mirrors dynamics observed in other US outbreaks.”
Vaccination gaps leave communities vulnerable
Groups with low trust in outside institutions and that place a high value on finding solutions within their own communities might be best reached by culturally tailored communication strategies, the reports suggest. They also argue that vaccination gaps can leave communities vulnerable to outbreaks.
Both reports conclude that promoting vaccination and supporting high coverage rates is the best prevention strategy.
“Maintaining high vaccination coverage,” write the authors of the South Carolina study, “is not only an infection control measure but a prerequisite for uninterrupted schooling, sustainable public health capacity, and the prevention of severe neurological complications.”
