On August 17th, Texas health officials from the DSHS announced that the state’s measles outbreak — one of the largest and deadliest in decades — had officially ended after 42 days without new cases. The outbreak, which began in late January, resulted in at least 762 infected people in Texas and the death of two young children in the state.
More than 1,350 measles cases were reported by the CDC in 2025 — the highest number in over three decades. Potential outbreaks in other states continue to be monitored as students nationwide return to school.
The SUNN Post spoke to two infectious disease experts currently researching the outbreak and treating infected patients about the challenges facing communities as the new school year begins.
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Dr. Amy Edwards is the Director of the Pediatric COVID Recovery Clinic and the Associate Medical Director of Pediatric Infection Control at UH Rainbow Babies and Children’s Hospital.
Dr. Issa Hussam is the director of the largest infectious disease department in Houston, Collaborative Life Sciences Health.
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Q: Which populations are most at risk of contracting the measles?
Dr. Edwards: “Those who aren’t vaccinated or who can’t be vaccinated – children under 1 year of age, people with compromised immune systems, etc.”
Dr. Hasam: “The unvaccinated.”
Q: Who is at risk of severe disease from measles?
Dr. Edwards: “Children under 5 years of age, the elderly, and those with compromised immune systems.”
Q: What precautions should schools implement for fall reopening?
Dr. Edwards: “They should ensure that all their students comply with state mandates to be fully vaccinated.”
Dr. Hasam: “Schools should ensure that all students and staff are up to date with their measles, mumps, and rubella (MMR) vaccinations, as this provides the best protection against measles. Additionally, they should implement measures for early identification and isolation of suspected cases, improve indoor airflow, and promote good hygiene practices to prevent outbreaks.”
Q: How effective are quarantine measures in school settings?
Dr. Edwards: “People with measles are contagious from around the time they start to have respiratory symptoms until 5 days after the rash starts. But prior to the rash starting, there isn’t much to differentiate measles from other respiratory infections (cough, runny nose, pink eye, etc), so a child may not be tested for measles until the rash starts, which is usually several days into illness. Many schools no longer exclude children who are ill unless they are very ill (high fevers), and there is even a school in Tennessee that is no longer accepting doctor’s notes as an excused absence for missed school. There is a lot of pressure on parents not to take sick leave from school, so more and more kids are attending school ill. If someone with measles attends school thinking they have just a cold or mild flu, they could infect a lot of people. Once someone has been diagnosed with measles, then all non-immune children and teachers are placed in isolation for 21 days as a way of preventing further spread. This is effective only with full compliance. The surgeon general of Florida encouraged parents to decide if their measles-exposed child should be excluded or not (rather than having the health department decide). Thankfully, this wasn’t passed as a law or mandate, so the Department of Health ignored him, but the public health implications are staggering!”
Dr. Hasam: “School quarantines are very effective if caught early and complied with staying away from school, public places, extracurricular activities for at least 4 days from their rash onset.”
Q: What vaccination coverage rates provide community protection?
Dr. Edwards: “Measles has a very high attack rate and is VERY contagious. Because of this, the vaccination rate has to be very high (greater than 95%) to ensure no community spread. We call this herd immunity.”
Dr. Hasam: “It is necessary to achieve ≥95% vaccination coverage with two doses of measles vaccines.”
Q: When should parents/young adults seek medical evaluation for potential exposure? What are the early signs and symptoms parents should watch for?
Dr. Edwards: “If someone is unvaccinated or undervaccinated, they can get the vaccine as post-exposure prophylaxis. The incubation period for the virus is often longer than the incubation period for the vaccine, so if someone was exposed less than 3 days ago, we can vaccinate them, and that can protect them from severe disease. For those who can’t be vaccinated, we can give them pooled human immunoglobulin, which contains high rates of measles IgG, which can also protect from severe disease, but it has to be given within 6 days of exposure. So anyone who finds out they are exposed and isn’t protected by two doses of the measles vaccine should discuss it with their PCP right away. As should anyone who is immunocompromised, as the vaccine is often less effective in them.”
Dr. Hasam: “Parents and young adults should seek medical evaluation for potential measles exposure if they have been in contact with someone diagnosed with measles or if they exhibit symptoms such as high fever, cough, runny nose, red watery eyes, or a rash. It’s important to consult a healthcare provider, especially if they are unvaccinated or unsure of their vaccination status.”
Q: How are health departments coordinating outbreak response?
Dr. Edwards: “I am not aware of any significant coordination campaigns. Most health departments are struggling with understaffing and underfunding. There may be local coordination going on on the ground in Texas, but the CDC is not spearheading any specific campaigns that I know of.”
Dr. Hasam: “Health departments are coordinating measles outbreak responses by collaborating with local and state health authorities to identify gaps in preparedness, optimize community outreach, and utilize data analytics for effective decision-making. They also provide technical assistance, laboratory support, and vaccination efforts to manage and contain the outbreak effectively.”
Q: What lessons from COVID-19 apply to measles prevention?
Dr. Edwards: “Measles is much more contagious than COVID was, if we learned anything from COVID it is that public health is a much more controversial topic than it used to be, people don’t seem as willing to comply with public health measures as they used to be (imagine shutting down movie theaters and public swimming pools during the summer to stop polio transmission – I feel like there would be protests now if we tried something like that). But we also learned that short-term measures such as shutting things down must be combined with longer-term measures in order to be effective. Though in truth, we already knew that, but the COVID pandemic brought that home for us as we watched many states shut down, do nothing, and then open back up only to be buried under COVID cases.”
Dr. Hasam: “To keep our hard-fought-for measles eradication and prevent possible near outbreaks, we must pay more attention to the point that measles eradication is a global health priority. Measles eradication is achievable, as there is an effective tool against it: an effective, safe, and inexpensive vaccine. As the measles outbreak is still prevailing in some regions, countries should develop strategies to maintain the high vaccination coverage during such health crises like COVID-19, and preventive measures should not result in neglecting other disease surveillance. Now, after about three years of the COVID-19 pandemic, the situation has been stabilized to some extent, and we should focus on experience and learnings to become well prepared for the upcoming pandemics.”
Q: How can communities improve vaccination coverage?
Dr. Edwards: “Vaccination campaigns are most effective when community leaders (religious and non-religious) work with public health leaders and physicians to encourage people to be vaccinated and when parents and young adults have access to accurate information about the safety and efficacy of vaccines and the dangers of being unvaccinated.”