As the number of Texas measles cases tied to a West Texas outbreak slows to a trickle, South Plains public health director Zach Holbrooks remembers the call from a colleague in an adjacent county six months ago that would change both his — and the state’s — entire 2025.
“Katherine was the first person to let me know there was a case,” said Holbrooks, referring to Lubbock’s public health director, Katherine Wells. A Mennonite child from Seminole’s Gaines County — one of four counties under Holbrooks’ charge — had been hospitalized in Lubbock with measles. “So that’s what got the communication rolling between me and Katherine and the state.”
From that first case reported on Jan. 29, the outbreak in West Texas would make up the largest single cluster of measles cases since the virus was declared eliminated in the United States in 2000, killing two and spreading to multiple states. As of this week, 762 people have been infected, shattering the previous U.S. record from 2019, when an outbreak among the Orthodox Jewish community in New York City resulted in 649 cases. Nationwide, the United States is suffering its worst measles outbreak in nearly three decades with the West Texas outbreak making up more than half of the 1,309 cases nationwide.
While it’s been more than a month since a new case has been reported in Gaines County, cases traced back to West Texas continue to be reported across the state in East Texas’ Lamar and Fannin counties, where this week saw the addition of nine new cases.
Technically, Gaines and Lubbock counties are no longer considered active outbreak counties. The spread here seems to have run its course. “They either got the vaccine, the booster or the real thing,” said Dr. Wendell Parkey, chief of staff of Seminole Memorial Hospital.
But as the region catches its breath and wait for the entire outbreak to end, health professionals like Holbrooks, Wells and Parkey, as well as the Texas Department of State Health Services (DSHS), have all been considering what worked and what could be improved after working the first real infectious disease test, post COVID-19.
Their answers included better reporting of cases at the patient level, more help with streamlining the testing process at the start and surprisingly, a more balanced treatment approach that was not solely fixated on vaccination.
As of Friday, DSHS has spent more than $10.6 million in outreach, testing and resource support to the region.
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To better track the spread and stop it, the state has worked with local providers and health departments to carefully document exactly how many measles infections occur. To do that, public health officials rely on local providers and hospitals to inform them when there is a case.
However, that number is likely an undercount because it is based on patients treated, not those who ride out the virus from their homes.
Statistically, up to three measles cases per every 1,000 results in death. Gaines had two deaths, which would indicate the number of infections were far greater than the 441 reported.
“Not everybody who gets sick goes to the hospital,” Holbrooks said.
Among the more popular places for infected Mennonites to seek out health care was with Lubbock physician Ben Edwards, who treated hundreds of patients in a temporary clinic in Seminole. The Mennonite’s skepticism of mainstream medicine elevated Edwards — who denounced vaccines and promoted vitamin A and budesonide, something more commonly used to treat asthma, as alternative prevention and treatment options — to a medical hero for the religious community.
While the local hospital in Seminole regularly reported to Holbrooks’ office every measles patient it treated, information from local providers, such as Edwards, was tougher to come by.
“It was frustrating,” Holbrooks said.
Reporting cases quickly to local health authorities helps them respond more quickly to keep disease from spreading, as well as to keep cases from becoming more serious where hospitalization is necessary.
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Public health officials’ measles messaging focused on getting the word out on vaccination.
Once he reached out to community leaders, Holbrooks worked to get public health messaging aired in both English and the Mennonites’ dialect of informal or Low German.
Holbrooks had wanted to put more vaccination and field clinics closer to the Mennonites but quickly saw that doing so would attract too much attention. News of the outbreak brought a sudden influx of national reporters to tiny Seminole, forcing many locals to shy away from pop-up vaccination clinics where TV cameras and photographers were stationed.
Eventually, Seminole health workers moved to a drive-through vaccination clinic through their local show barn, a local livestock exhibition facility used by youth groups, allowing more privacy for those interested in obtaining a measles-mumps-rubella or MMR vaccine.
Even 75 miles north in Lubbock, Wells, the city’s public health director, found that public vaccination spots, while often a hallmark of back-to-school events in August, were not as big a draw in the larger city.
Both she and Holbrooks recognized later that focusing on vaccination from the start could have sent a message that vaccines were the only option for treatment, possibly dissuading more susceptible residents or those with milder measles cases from asking questions or getting more help.
“We should have one more of a treatment clinic [model] and had more boots on the ground, working with churches … to engage better with the Mennonite community,” Wells said.
These vaccine clinics could have been made less clinical and paired with other options, such as checking oxygen levels and passing out Pedialyte to help infected patients stay hydrated.
Such an approach could have invited more visitors and conversation, resulting in better triaging of residents and letting them know to seek more help from the local hospitals, Wells said.
“We should have found a way to set up something that was free, kind of caring for people with measles, not saying you’re like this infectious person,” Wells said.
There’s a lot more, so read the rest. I have a ton of respect for everyone who worked to minimize the effects of this outbreak and who had a lot working against them. I would not have the patience to deal with people who wanted to know more about cod liver oil and Vitamin A, but they did and I thank them for it. It’s a good thing we learned from this because we will have opportunities to apply those lessons, probably sooner than we think.