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The Centers for Disease Control and Prevention reported Friday that the United States has logged 2,318 measles cases in the first seven months of this year, surpassing last year’s total of 2,289.

It’s the largest number of measles cases the U.S. has seen in 35 years, and comes amid a decadeslong slide in childhood vaccination rates. The majority of infected people — 93%, according to the CDC — are unvaccinated.

“We have joined the rank of countries where vaccination is not reaching the levels needed to protect all of our children against some of the most contagious diseases,” said Dr. Richard Besser, a pediatrician and president of the Robert Wood Johnson Foundation. When vaccine levels dip, measles is usually the first vaccine-preventable disease to rise because it’s by far the most contagious.

“Measles is the canary in the coal mine. What it’s saying is that our communities are vulnerable, not just from measles, but from whooping cough, meningitis, chicken pox and other diseases that are readily controllable with vaccines,” Besser said. “We’re on a crash course.”

The wave has been building since January 2025.

That month, Dr. Richard Eby, a family medicine doctor, was working a weekend shift at Permian Regional Medical Center in Andrews, Texas, about two hours south of Lubbock, when he saw his first measles case. The child needed to be admitted for dehydration and shortness of breath.

Eby knew there’d be more. The child’s mother told him that classes at their small, private school had been canceled two days prior because so many kids were sick with measles. “I knew at that point that the official case count was only capturing a fraction of what was already spreading in the community,” he said. “Most people did not get tested unless they were very sick.”

It was already too late to stop the outbreak, which grew to 762 cases and the first measles deaths, including two young girls, in the U.S. in more than a decade. The West Texas outbreak would become the first major wave of escalating measles outbreaks across the country that have since stretched into a second year, and now threaten the nation’s status of having eliminated the virus in 2000.

New outbreaks

New measles outbreaks are popping up in Arizona, Delaware and Wyoming. The Pennsylvania Health Department is reporting 132 cases, with 27 diagnosed in the past week alone.

Virginia’s outbreak that took off in May appears to be slowing. The state has logged 177 cases, but hasn’t reported any new ones since July 4.

Piedmont Health District, located in central Virginia, has accounted for the majority of that state’s cases. The district health director, Dr. Maria Almond, said her staff has painstakingly gone door to door, encouraging vaccinations to stop the outbreak.

“We go into homes, we listen to their needs, we educate, and we continue to monitor those families and revisit them because they are reluctant to engage in medical care until they are ready and feel safe,” Almond said. “Very often, we are able to link families with care resources.”

The CDC has sent staffers to help with outbreaks in several states, including Virginia. The federal health response to ongoing measles outbreaks, however, has been minimal. The CDC has been without a permanent director for the majority of President Donald Trump’s second term, and Health and Human Services Secretary Robert F. Kennedy Jr., a longtime vaccine skeptic, has distanced himself from news of ongoing outbreaks.

“Last year and this year would not be as bad if we had strong, well-funded local public health departments and a CDC that was well-staffed and ready to respond to outbreaks,” said Dr. Adam Ratner, a pediatrician and member of the American Academy of Pediatrics Committee on Infectious Diseases.

The majority of children, 92.5%, get measles vaccines, according to 2025 CDC data. About 95% of a population needs to be vaccinated against measles to achieve herd immunity.

“We’re starting to pay the price for the decreased vaccination rates that we’re seeing in some communities,” Ratner said.

‘The flu on steroids’

Utah’s measles outbreak, which began in June 2025 in a small, tight-knit community bordering Arizona, is still ongoing after stretching to every part of the state, including the more populous Salt Lake City area. More than 700 people in Utah have been infected to date, according to the state Health Department, with 514 cases diagnosed this year.

But this year’s surge in measles cases has been driven largely by an outbreak that hit the northwest corner of South Carolina, in an area known as the Upstate. Cases began last fall before accelerating wildly just after the Christmas season.

“From the get-go, you’re just thrown into the fire,” said Dr. Stuart Simko, a pediatrician at Prisma Health in Greer, South Carolina. “Measles spreads a lot more rapidly and more efficiently than Covid ever could, and that was the scariest part.”

Simko had never seen a case of measles before the state’s outbreak that ultimately infected 997 people. He said he and his colleagues had to learn to spot a child with measles quickly. “It looks like the flu on steroids,” he said. “They’re covered in a rash, their fever is at 104, 105. They just don’t have any energy.”

While the majority of measles cases have occurred in children and teenagers, Piedmont Health’s Almond said that adults can also get very sick.

“This community’s really felt it in their adults with severe nausea, vomiting, diarrhea and dehydration,” she said. “It is terrible and severe.”

Adults have been hit hard in Pennsylvania, too. Just 39% of cases have occurred in people under age 18, according to the state Health Department.

It’s unclear whether the ongoing outbreaks will cause the U.S. to lose its status of having eliminated the virus from circulation in 2000. The Pan American Health Organization is expected to make a decision in November.