Off the Kuff

What a depressing headline.

Amid a widespread decline in childhood measles vaccination rates since before the COVID-19 pandemic across the United States, a study published Monday found that coverage can vary substantially within a state.

Looking at county-level data in 33 states, researchers at Johns Hopkins University found that the MMR (measles, mumps and rubella) vaccination rate decreased from 93.92% in the 2017-2018 school year to 91.26% in the 2023-2024 school year. Other states were not included because they had missing vaccination data, the authors of the study said.

Of the 2,066 counties the study looked at, 78% saw a decline in vaccination rates. Only four of the 33 states — California, Connecticut, Maine and New York — saw an increase in the average county-level vaccination rate, the study found.

The data shows significant diversity in the levels of vaccination within and across states, which the authors of the study say could “help inform targeted vaccination strategies.”

[…]

The CDC has also reported state-level declines in vaccination coverage for kindergartners by school year, saying the rate among U.S. kindergartners has decreased from 95.2% during the 2019-2020 school year to 92.7% in the 2023-2024 school year.

It sure would be nice to have a federal government that had a strategy for improving vaccination rates, wouldn’t it? The one grimly optimistic thing I can think of to say here is that we have seen an uptick in measles vaxxes in Texas since this outbreak began. Nothing quite focuses the mind like the specter of actual risk. It may be a blip, but against that we’re almost certain to see more outbreaks like this, so maybe there will be more of the resulting boosts. Depressing, but it is what it is.

Pull up a chair, make yourself comfortable, and practice some deep breathing as you read this.

Sick children began showing up at Texas hospitals in January.

Dr. Leila Myrick was on call when the first child landed in Seminole’s emergency room, where she consulted a medical textbook to confirm measles, a disease she had never actually seen.

Myrick had moved her family from Atlanta to Seminole in 2020, drawn by the promise of small-town medicine in a city cut out of the desert, a conservative but diverse community where many of her patients were Mennonite and Latino. She had taken care of their families in the five years since — through Covid and baby deliveries and everything in between. A framed poster of Myrick cradling newborns hangs in the hallway outside her office.

Measles now threatened these children, and Myrick did what she could to persuade parents to vaccinate them. She gave interviews, answered calls on a local German-language radio show, stayed late at her clinic and worked weekends at the hospital.

But her message faced competition.

Children’s Health Defense, the country’s largest anti-vaccine nonprofit, has downplayed the danger of measles for decades, falsely calling it benign and beneficial to the immune system. Seminole’s outbreak didn’t deter the group, which wrongly suggested it had been caused by a local vaccination campaign and then floated other contradictory theories: that the vaccines were failing, shedding the measles virus, or perhaps working too well, leading somehow to a super virulent strain.

Myrick watched her neighbors repeat these distortions in a local Facebook group, “Seminole TX Residents NEED to KNOW,” sometimes naming her directly.

“Every doctor that pushes the jabs gets commission from the big Pharma,” one woman wrote.

In late February, the Gaines County library posted a flyer “kindly” asking that unvaccinated and measles-sick patrons not come in. By the evening, after an outcry in the comments, the library removed the post.

“I see a vulnerable population getting fed the wrong information and making decisions for their children’s health based on wrong information,” Myrick said. “And I feel helpless.”

Responsibility for managing the outbreak fell on Zach Holbrooks, executive director of the South Plains Public Health District.

Holbrooks grew up in Seminole and after stints in Lubbock and Austin moved back in 2008 to lead public health across four counties. Run on about $2 million in grants a year, the health department’s responsibilities are broad — vaccines and family planning, but also disaster response, fire protection, food safety, landfills, inspections, permits and more.

Holbrooks didn’t see measles coming, though he is quick to say he probably should have — vaccine exemptions in Gaines County had more than doubled in the last 10 years, and about 1 in 5 kindergarteners were now skipping the shots.

When the first cases were confirmed at the end of January, “my heart sank,” Holbrooks said.

The district kept only a couple of doses of the measles, mumps and rubella vaccines on hand — enough for new families moving into the area, not to meet the sudden need of an outbreak. The two epidemiologists Holbrooks had on staff were immediately overwhelmed by case investigations. Holbrooks also didn’t have outreach materials in Low German or a relationship with the Mennonite community, which he now urgently needed a way into.

He turned to the state, which brought in nurses, testing supplies and vaccines. He set up a vaccine and testing clinic outside Seminole Hospital District; a spray-painted arrow on unfinished plywood signaled where to go.

Billie Dean, a nurse and site leader at the clinic, remembered one Mennonite woman who drove by every day in a compact gold car.

“We would see her pull in, and we were like, ‘Oh, she’s back,’” Dean said. Each day, they told her how many people had gotten vaccinated the day before, how none had come back with side effects. After two weeks, she rolled down her window and said she was ready. A few days later, she came back with her daughter and grandson.

Holbrooks printed flyers in English, Spanish and, with the assistance of a local author, Low German, to distribute at grocery stores, libraries, post offices and churches, and he gave updates on the local TV and radio stations.

Still, cases in the area ticked up, nearly doubling in a week to 80, a sure undercount, since officials knew many people weren’t being tested. In a letter published in February in The Mennonite Post, a German-language newspaper, a married Seminole couple reported “a lot of sick people here. Many have fever or diarrhea, vomiting or measles.”

Epidemiology deals in numbers. With measles, they go like this: With 1,000 cases, about 200 children will require hospitalization, 50 will develop pneumonia, and one to three will die.

The numbers caught up to Seminole on Feb. 26.

To invoke the old Mister Rogers maxim, there are a lot of helpers to see in this story. A lot of people in Gaines County and Lubbock and elsewhere did their level best to keep people healthy, answer their questions, get them and their kids vaccinated, and just generally beat back the avalanche of disinformation and bullshit from the professional deniers and bullshit peddlers. The article starts with a focus on one of them, so be prepared going in. And look, it’s easy for us to fall into non-empathetic ditches, in part because there are so many people involved in this story who will be on the express train to hell if such a place exists, but we can’t lose our own humanity. Look again at how many helpers there are in this saga. For all the darkness, there’s also plenty of light.

This is a good sign for the short-term future.

Measles is on a downward trend in the state, and the four people in Tarrant County who were infected appear to have not infected anyone else, Dr. Brian Byrd, director for Tarrant County Public Health, said during a recent meeting.

“The message is we’re trending in the right direction, however, we need to stay vigilant,” Byrd said at the June 2 Tarrant County Mayors’ Council meeting. “There are still pockets of unvaccinated people around Tarrant County.”

Measles symptoms appear one to three weeks after a person is exposed. Byrd said the 21-day window has passed since anyone was last exposed by the four people in Tarrant County who were infected. The four were family members.

“We don’t expect any cases stemming from those four cases,” Byrd said.

I’ve been keeping an eye on the known exposures in population centers as a possible vector for the case rate to go back up. So far it seems like the response from the local health officials has been enough to prevent that from happening. Kudos to them, let’s hope they can keep it up.

And let’s remember to do our part.

The Centers for Disease Control wants everyone with international travel plans to make sure they’re fully vaccinated against measles, a change that comes as outbreaks simmer all over North America.

A recent measles outbreak in Colorado was tied to a Turkish Airlines flight that landed in Denver. Canada and Mexico are wrestling with outbreaks, too, and now the CDC has stepped up its advice to international travelers: make sure you’re fully vaccinated or don’t go.

At least 1,088 measles infections have been reported in the U.S. so far this year — most connected to local outbreaks, including one in Texas that accounts for 742 of those cases. But CDC has also gotten 62 reports of air travelers contagious with measles while flying this year.

Each unvaccinated person on a plane with an infected traveler is at high risk for contracting the airborne virus and passing it to others, so the CDC wants travelers to confirm they’ve had both doses of the measles vaccine at least two weeks before they travel.

Travelling while unvaccinated is irresponsible. Travelling while actively sick is downright malevolent. Don’t be that guy.

We will end with some good news.

The Texas health department reported no new cases of measles on Friday, the first time the state has not recorded an increase since the outbreak began in February.

The state, which is the epicenter of the current measles outbreak, has a total of 742 confirmed cases as of Friday.

The number of new cases continues to decrease, from an average of about 12 per day around the peak to fewer than one case per day recently, Chris Van Deusen, director of media relations at the Texas health department, told Reuters in an email.

“The fact that (we) haven’t had any new hospitalizations reported in more than two weeks gives us confidence there are not major numbers of unreported cases still occurring out there,” said Van Deusen.

The United States is battling one of the worst outbreaks of the highly contagious airborne infection it has seen, with over 1,000 reported cases and three confirmed deaths.

Despite the slowing spread of the infection in Texas, the country continues to record weekly increases in measles cases elsewhere.

The U.S. Centers for Disease Control and Prevention said a total of 1,168 confirmed measles cases were reported by 34 jurisdictions as of Thursday, an increase of 80 cases since its previous update last week.

Since 2000, the only time infections surpassed the 1,000 mark was in 2019, when the country reported 1,274 cases.

There have been 17 outbreaks, defined as three or more related cases, reported in 2025, the CDC said.

There were four cases in the Tuesday report, so four for the week, and a step down from the around-ten-per-week plateau we’d been at. If this is the new normal, then so much the better.