A growing outbreak of more than 120 measles cases that began in a West Texas community has health officials in Houston and across the state on alert for the dangerous and highly contagious disease to continue its spread among unvaccinated children and adults.
On Wednesday the measles outbreak’s first death was announced by state health officials: A school age child who was unvaccinated. So far, 18 people have been hospitalized because of the ongoing outbreak..
The potential for this outbreak to quickly jump between cities was made clear this week when officials warned that a person from the outbreak area – who later was diagnosed with measles – had traveled for a weekend trip to the San Marcos and San Antonio areas.
The virus, transmitted when an infected person breathes, coughs or sneezes, can linger in a room’s air for up to two hours. During the West Texas resident’s three-day trip, Feb. 14-16, the person toured two universities, visited popular tourist attractions and restaurants, and they also made a stop at a busy Buc-ee’s convenience store located along Interstate 35 in New Braunfels and frequented by other travelers.
It’s unclear yet whether anyone became infected because of the lag time between exposure to the measles virus and the development of symptoms. Meanwhile, the spring break travel season is fast approaching, bringing with it even more opportunities for the outbreak to take root in other communities where people are not fully vaccinated.
Will measles cases spread to the Houston area? Here’s what health authorities say you need to know about measles, the current outbreak and how to protect against this serious disease that in 2000 had been declared eliminated in the United States.
Measles is a dangerous disease that spreads easily
“What people need to understand about measles is that it is so highly contagious that if you are unvaccinated, you’re very likely to get it,” Lara Anton, a spokesperson for the Texas Department of State Health Services, told Houston Landing.
For those who lack immunity, all it takes is exposure to someone who is infected with measles.
“And here’s the kicker,” Anton said. “People are infectious before they have symptoms, so they don’t know that they are spreading measles. And just the cherry on top of all of that is that it can linger in the air for two hours after the infectious person leaves.”
While two doses of measles vaccine is 97 percent effective in preventing the disease, she said those who aren’t vaccinated can become infected just by walking into a room where someone who didn’t even know they were infected had just been.
Infected people can spread the virus through the air when they breathe, cough or sneeze.
It can take about 13-16 days from exposure to the virus until an infected person starts developing the hallmark measles rash on their head and body, with some non-specific symptoms like fever, cough, runny nose and red eyes beginning a few days earlier, according to the CDC.
Many who are sickened require hospitalization and babies and children are at particular risk of complications.
“It can cause severe illness,” said Dr. Ericka Brown, local health authority with Harris County Public Health. “One in four cases are hospitalized, and unfortunately, it can cause death.”
Pneumonia, a dangerous lung infection, is a frequent and potentially deadly complication for children infected with measles, according to the CDC. Another dangerous measles complication is encephalitis, a condition where the brain swells putting the person at risk of convulsions, deafness or intellectual disability. For every 1,000 children infected with measles, about one to three of them will die, the CDC says.
For pregnant women, measles can also cause premature birth and low-birth-weight babies, the agency says.
Deadly Texas measles outbreak began in January
The current outbreak of measles was first detected in late January in Gaines County, near the New Mexico border.
Among the outbreak’s first confirmed cases were two school-age children from the county were hospitalized in Lubbock for treatment of the disease. Neither child was vaccinated against measles, state health officials said.
Many of the early cases involved people who were part of a large Mennonite community in Gaines County, Anton said, but officials have not been able to determine where or how the initial people became infected.
By Feb. 5, six measles cases had been identified in the county, all among unvaccinated children. And as of this week, the number of people infected in the outbreak had grown to at least 124 in Texas with 18 people hospitalized.
On Wednesday, health officials announced the outbreak’s first death.The school-aged child, who was not vaccinated, had been hospitalized in Lubbock last week.
All but five of the people sickened with measles have been either unvaccinated or their vaccination status is unknown, according to the state health department.
Like other states, to prevent the spread of diseases Texas has vaccination requirements – which include immunization against measles – for children attending schools and daycare. But as is common across the country, Texas also allows parents to exempt their children from the vaccination requirements for reasons that include certain medical reasons or “reasons of conscience,” such as a religious or personal belief against immunization.
About 4 percent of kindergartners across Texas had an exemption from at least one vaccine, according research published in a CDC journal. But statewide numbers have the potential to obscure localized clusters of undervaccinated people, health officials said.
While Gaines County currently remains the epicenter of the outbreak with 80 cases, the outbreak had spread to eight other Texas counties as of Feb. 25, according to state data.
The outbreak has also spread into a bordering county in New Mexico, where at least nine confirmed cases of measles had been detected as of earlier this week. Four are younger than 18 and were unvaccinated; five are adults and two of them were unvaccinated and three had unknown vaccination status, said David Morgan, a spokesperson for the New Mexico Department of Health.
“Our agency is urging New Mexicans to check their vaccination records to ensure they have been vaccinated for measles,” Morgan said.
To avoid further spreading the disease, Texas health officials have urged people to isolate themselves if they think they have been exposed to measles or if they are experiencing symptoms. People who suspect they may have measles should contact their healthcare provider to determine the best way to get tested that limits the exposure of others.
Spring break and other travel raise measles concerns
Earlier this week state and local officials issued a health alert warning that people may have been exposed to measles at multiple public locations in the San Marcos and San Antonio areas because of a recent trip to the area by a Gaines County resident before they knew they were infected. Gaines County is near the New Mexico border, about 80 miles southwest of Lubbock.
Because the virus can linger in the air for two hours after an infected person leaves, the state health department has published a detailed list of multiple locations, dates and time blocks where unsuspecting people may have come into contact with the virus. The list, state officials said, will allow unvaccinated people to monitor themselves for symptoms and contact health providers for testing..
According to the Texas Department of State Health Services, those at risk of of infection with measles include people who visited certain restaurants and convenience stores in San Marcos, Wall and Live Oak, as well as who were at:
- Texas State University in San Marcos from 3 p.m. to 7 p.m. on Feb. 14. County health officials posted a map of the campus locations the infected person visited as they toured the university.
- University of Texas at San Antonio Main Campus from 10 a.m. to 4 p.m. on Feb. 15. The infected person toured the campus during UTSA Day, according to an email university health officials sent to the campus community on Sunday. UTSA Day is a large open house event where prospective students can participate in activities such as tours, presentations and workshops to learn more about academic programs, financial aid and the admissions process. University health officials said in their campus email they “believe the individual’s infectious window was likely after their date of visit” but were issuing the notification “out of an abundance of caution.”
- Louis Tussaud’s Waxworks, Ripley’s Believe It or Not!, and Ripley’s Illusion Lab in San Antonio, from 2:30 p.m. to 7:30 p.m. on Feb. 15.
- Buc-ee’s convenience store near Interstate 35 in New Braunfels, from 9 a.m. to noon on Feb. 16.
Because of the lag time between when someone is exposed and when they start getting sick, if anyone became infected at these locations, those cases will start appearing in the coming days. It can take seven to 14 days for the first measles symptoms to appear, according to the CDC.
With more travel expected in the coming weeks as schools let out for spring break, it increases the risk of the outbreak spreading.
“Obviously we’re, we’re concerned, because anytime there is an outbreak, you know, there’s the potential for somebody to spread it to a new community when they travel,” Anton said.
Beyond the current Texas outbreak, measles cases in the United States are often the result of unvaccinated international travelers and the CDC recommends people traveling abroad be sure they are vaccinated against measles two weeks before departure.
CDC recommends international travelers be sure they are up to date with measles vaccinations and lists dozens of countries where measles risks are considered elevated. .
Areas with lower vaccination rates are at increased risk
When more than 95 percent of people in a community are vaccinated against measles, it makes it difficult for the disease to spread because of what’s called herd immunity, according to the CDC.
While overall immunization rates across the country generally remain high, they’ve been dropping in recent years resulting in pockets of undervaccinated communities across the country that are at increased risk for outbreaks.
Health officials use school vaccination data to gauge vaccination coverage. Nationwide vaccination coverage for measles among kindergarten students – which for many years was at 95 percent – dropped to less than 93 percent during the 2023-2024 school year, according research published in a CDC journal.
In Houston and across Texas, about 94 percent of kindergartners were vaccinated against measles during the 2023-2024 school year, the research estimated.
But vaccination rates can vary significantly in localized communities, Texas school vaccination data show. In Gaines County, where the current outbreak began, only 82 percent of kindergarten students were vaccinated against measles.
Rates are even lower in Foard, Childress, Hall and Throckmorton counties where just 67 percent to 73 percent of kindergarten students are protected against measles, state data show.
The risk of measles outbreaks has been growing because of a combination of factors in the United States and around the world, experts say. They include a growing number of people who oppose or are hesitant to get vaccinated and disruption in normal childhood vaccination appointments during the COVID-19 pandemic.
A national survey of parents in 2024 found that while most parents support vaccination requirements for attendance in school and daycare, more than 8 percent disagreed that such requirements are important and necessary.
Although Texas has the largest outbreak in the country right now, other U.S. states reporting measles cases so far this year are Alaska, California, Georgia, New Jersey, New Mexico, New York City and Rhode Island.
During 2024, there were 285 cases of measles reported across 32 states and the District of Columbia. Forty percent of these measles cases were hospitalized for isolation or management of measles complications, the CDC says. Most of last year’s were associated with 16 outbreaks across the country, according to the CDC. Nearly 90 percent of those who got measles were unvaccinated or had unknown vaccination status; 7 percent had one dose of measles vaccine and 4 percent had two doses.
Two measles cases reported in Houston in January
In January, the Houston Health Department issued an alert that they had identified two cases of measles in the city. It was the first time measles had been reported in the city since 2018, officials said.
The Houston measles cases in January involved two adults who live in the same household, one of them required hospitalization. Neither of the two people were vaccinated against measles, which they apparently were exposed to during recent international travel, the department said.
But before the two people were diagnosed with the highly contagious disease, they had visited several public locations in Houston during late December and early January, potentially exposing others at a grocery store, mobile phone store, a church, restaurants and two urgent medical care facilities.
At the time, Houston health officials urged anyone who might have been exposed at the locations to be sure they were up to date on their measles vaccination, to get the vaccine if they weren’t and to meanwhile monitor themselves for symptoms.
Nobody apparently became infected from these two Houston measles cases. No additional cases were identified, the Houston Health Department told the Landing. And state officials have said there is no connection between the Houston cases and the Gaines County outbreak.
It’s unclear why the two Houston cases didn’t cause more infections locally. But the Houston Health Department said factors that might have prevented onward spread of the virus included higher vaccination rates in the area and quick follow-up actions by public health officials addressing the risks of people who had been exposed.
“We were able to talk about the exposure, help people understand their risk, and follow up on if they were protected (vaccinated),” city health department officials said in an emailed response to the Landing’s questions.
“For people who couldn’t confirm their vaccinations, we or their medical providers could test for immunity with a simple blood draw. We had a person who didn’t want to be tested and couldn’t confirm their vaccination history; that person agreed to quarantine and stay away from others until their risk of becoming ill was over,” the department said.
Outside of the city of Houston, the last time measles cases were reported in Harris County was in early 2019. The county had four cases: two boys younger than 5, and an adult woman and man, the county health department told the Landing.
Vaccination prevents measles
The people most at risk of measles are those who aren’t vaccinated, said Dr. Ericka Brown, health authority for Harris County Public Health.
“I do want people to be vigilant about measles. It is in our surrounding communities, and unfortunately, continues to spread,” Brown said.
She encouraged people who are not fully vaccinated to talk with their health care providers. “Ask questions,” Brown said. “If people have concern or fear about vaccinations, so they can make the best educated decision for themselves and their families.”
Before the U.S. began immunizing against measles in 1963, an estimated 3 million to 4 million people became infected each year, about 48,000 were hospitalized and 400-500 died, according to the CDC.
Two doses of measles vaccine is 97 percent effective at preventing the disease, and one dose is 93 percent effective, according to the Centers for Disease Control and Prevention. While some vaccinated people can occasionally become infected, health officials said their symptoms are generally milder and they are less likely to spread the disease to other people.
It can take about two or three weeks after the measles vaccine is given for it to be fully protective, according to the CDC.
The CDC recommends children receive two-doses of a measles vaccine, with the first dose given when they are about a year old, and a second dose administered when they are 4-6 years old, before they start school. Older children, teens and adults who haven’t been vaccinated, are unsure of their vaccination status and can’t find their vaccination records, or have evidence of immunity against measles, should also receive the vaccine, the CDC says.
Some people who were vaccinated during the 1960s with a type of inactivated or killed measles vaccine or with a vaccine of unknown type should be revaccinated. The CDC says this is because they may be among fewer than 1 million people who received a killed measles vaccine that was available during 1963-1967 that was not effective.
People born before 1957, who were likely infected with measles before vaccines became available, are presumed to be protected against the disease.
Primary care doctors can help arrange measles vaccinations. Local health departments also can help connect people with free or reduced cost vaccinations against measles and other diseases. Contact Harris County Public Health at 823-927-7350 or www.hcphtx.org/Vaccines; or the City City of Houston health centers by calling 832-395-9100.
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