The United States will lose its measles-free status next year. If that happens, we will enter a new phase where outbreaks become common again.
More girls and boys will be hospitalized for preventable diseases. Some people lose their hearing. Some will die.
Measles is also expensive. no way new research The cost of a public health response to an outbreak with a small number of cases — which has not yet been published in a scientific journal — is estimated at about $244,000.
For people who need hospital care, the average cost per case is $58,600. Outbreaks like the one in West Texas earlier this year have resulted in 762 cases and 99 hospitalizations, costing about $12.6 million, according to study estimates.
The state of the United States will depend on whether this year’s major outbreak stems from the West Texas outbreak that officially began on Jan. 20. If these outbreaks are linked and persist beyond January 20 next year, the country will no longer be considered measles-free.
“Many of us have worked very hard for a long time to achieve elimination. It’s taken years of effort to provide vaccines, achieve good vaccination coverage, and respond quickly to outbreaks to limit spread,” said Paul Rotta, a recently retired microbiologist with nearly 40 years of experience at the Centers for Disease Control and Prevention.
But instead of acting quickly to prevent a measles resurgence, Robert F. Kennedy Jr., an attorney who founded an anti-vaccine organization before assuming leadership of the Department of Health and Human Services (HHS), undermined public health officials’ ability to prevent and contain measles outbreaks by discrediting vaccines.
The measles vaccine is safe and effective. 4% of over 1,800 cases This year, the number of people who received the two recommended doses confirmed in Korea was recorded.
Kennedy fired experts on the CDC’s vaccine advisory committee and claimed, without evidence, 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 claims. kennedy said new york times That he ordered the change.
“Do we want to go back to the pre-vaccine days when 500 children died from measles every year?” asked Demetre Daskalakis, former director of the CDC’s National Center on Immunization, who resigned in August in protest of Kennedy’s actions.
Daskalakis and other scientists said the Trump administration appears more interested in minimizing the recurrence of measles than in suppressing it.
HHS spokesman Andrew Nixon said in a statement that vaccination remains the most effective tool to prevent 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 a connection
CDC scientists are tracking measles with researchers from health departments and universities.
To find out if there is a link to the outbreak, they analyze the genome of the measles virus, which contains all of its genetic information. In addition to alerting us to undetected infections, these analyzes can help reveal the cause and true scale of outbreaks.
Scientists have been doing this type of genetic analysis for HIV, flu and Covid for years, but it’s new for measles, explained Samuel Scarpino, a public health expert at Northeastern University in Boston. “It’s important to build a surveillance network that can scale quickly when needed,” he said.
“We are working with the CDC and other states to determine if what we are seeing is a single large outbreak that continues to spread from state to state,” said Kelly Oakeson, a genomics researcher with the Utah Department of Health and Human Services.
At first glance, the ongoing outbreak Utah why Arizonawhich had 258 cases as of December 1, appears to be linked to the Texas case because it was caused by the same virus variant, D8-9171. However, the variant is also circulating in Canada and Mexico, meaning the outbreak may have started separately from people infected overseas.
If so, these technological differences could prevent the United States from losing ground, Rota said. Being a measles-free country means that the virus does not continue to spread throughout the year.
Canada lost its status in November because authorities were unable to prove that multiple outbreaks caused by the D8-9171 variant were unrelated, explained Daniel Salas, executive director of the Comprehensive Immunization Program at the Pan American Health Organization (PAHO).
The body, part of the World Health Organization (WHO), includes health authorities from North, Central, South America and the Caribbean and determines the status of measles elimination based on scientific reports from member countries.
Early next year, PAHO plans to hear from U.S. scientists. If her analysis shows that measles has continued to spread in the country for a year, the organization’s director can revoke the country’s measles-free status.
“We want countries to be transparent about the information they have,” Salas said. “We’ll ask questions like, ‘How did you come to your conclusion and did you consider other possibilities?’”
In preparation for this assessment, Oakeson and other researchers are studying how similar Utah’s D8-9171 strains are to one another.
Rather than analyzing only the fragments of the genome that identify strains, they are examining 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 occurrences. “This shows us the evolutionary history of the sample,” Oakeson explained.
For example, if one child directly infects another child, the virus in both children will be the same. But at the start of a large-scale outbreak, the virus in those infected will be slightly different from the virus circulating months later.
The outbreaks in Texas and Utah were caused by the same variant, but Oakeson said “the finer details lead us to believe that the two viruses are not very closely related.” To find out exactly how different they are from each other, scientists are comparing them to measles virus genomes from other states and countries.
Ideally, genetic studies should be complemented by field investigations into how each outbreak begins. But many of these investigations remain unanswered because the first infected people did not seek treatment or notify health officials.
In Utah and Arizona, as in West Texas, outbreaks are concentrated in very closed communities, vaccinations are low and distrust of government and traditional medicine is high.
Researchers are also trying to determine how many cases of measles go undetected. “Confirmed cases require testing, and in some communities there are costs associated with going to the hospital: a tank of gas, finding child care, losing a job, etc.,” explained Andrew Fabia, an infectious disease physician at the University of Utah. “If your child has a measles rash but isn’t very sick, is there any reason to worry?”
subtle surveillance
Pavia is part of: National outbreak surveillance network CDC took the lead. A simple way to estimate the size of an outbreak is through surveys, but this is complicated in communities that distrust public health workers.
“In a collaborative environment, we were able to fill out questionnaires asking if anyone in their family had a rash or other symptoms of measles,” Pavia said. “But the same factors that make it difficult for people to get vaccinated or isolate also complicate the situation.”
That’s why Pavia and other researchers are analyzing the genome. The large genetic variation suggests that the outbreak spread for weeks or months before it was detected, infecting more people than was known.
A less invasive form of monitoring is through 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 study in Texas found that this could act as an early warning system, detecting outbreaks before people reach hospitals.
The quiet work of CDC scientists contrasts with the CDC’s lack of public communication.
Since President Donald Trump took office, the CDC has not held a single press conference on measles or issued an updated bulletin on the subject. Morbidity and Mortality Weekly Report It was April.
Instead of acting quickly to contain the outbreak in Texas, the Trump administration hindered the CDC’s ability to communicate quickly with authorities in the state and delayed the delivery of emergency federal funding, according to a KFF Health News investigation. Meanwhile, Kennedy spread out. confusing message About vaccines and promotions unproven treatment.
Daskalakis said that as the outbreak worsened in Texas, his team at the CDC requested a briefing from Kennedy and other HHS officials but did not receive a response.
“Objectively, they didn’t help with the outbreak in Texas, so if we lose elimination status, they’re probably going to say, ‘So what?’” Daskalakis said.
Nixon, the HHS spokeswoman, said Kennedy responded strongly to the outbreak in Texas by ordering the CDC to provide measles vaccines and medications to the community, speed up testing and provide guidance to doctors and health officials. He added that the United States maintains its status because there has been no evidence of sustained transmission for 12 months.
“Preliminary genomic analysis suggests that the cases in Utah and Arizona are not directly related to the cases in Texas.” wrote on social network Jim O’Neill, Acting CDC Director and HHS Deputy Secretary.
Given Kennedy’s history of distorting data on vitamin A, acetaminophen (Tylenol) and autism, Daskalakis fears the Trump administration will claim the outbreaks are unrelated or that PAHO is wrong.
“It would be a huge stain on the Kennedy administration if Kennedy became Secretary of Health the year we lose elimination status,” he said. “I think they will do everything they can to question scientific findings, even if it means criticizing the scientists.”
