Houston Chronicle
As a West Texas measles outbreak continues to worsen, experts are concerned an increase in nonmedical vaccine exemptions among schoolchildren could make such outbreaks more common.
Twenty-four cases of the highly contagious respiratory illness have been confirmed in Gaines County, all of them in individuals who have not received the vaccine that protects against measles, mumps and rubella. Twenty-two cases are children under age 18, and six are children under age 5, Texas Department of State Health Services said Tuesday.
The recent outbreak represents the highest number of measles cases in Texas since 2019, when the state reported 23 cases across a dozen counties. But experts worry outbreaks could become more common in Texas due to a rise in “conscientious exemptions,” or parents and guardians who refuse to get their children vaccinated for religious, moral or philosophical reasons. Nonmedical vaccine exemptions have soared over the past decade, and Gaines County has one of the highest opt-out rates in Texas.
“Medical experts have been telling me for a year that it was going to happen,” said Terri Burke, the executive director of the Houston-based nonprofit The Immunization Partnership. “It was just a matter of time.”
The first two measles cases in West Texas came about two weeks after the virus was found in a pair of Houston residents. Officials said the West Texas outbreak does not appear to be connected to the Houston cases, and no other cases had been reported in Houston as of Wednesday.
Declining vaccination rates are concerning because measles can cause severe illness, said Dr. Catherine Troisi, an epidemiologist at the UTHealth Houston School of Public Health. One in five unvaccinated Americans will need to be hospitalized, and one in 1,000 will develop brain swelling that could cause deafness or an intellectual disability, according to the U.S. Centers for Disease Control and Prevention.
In Gaines County, nine children have needed to be hospitalized for treatment, the DSHS said.
“This can be very serious,” Troisi said. “It is not a benign disease.”
Gaines County outbreak
Officials in West Texas have been working to contain the outbreak, but it may take time for it to subside, said Katherine Wells, the director of Lubbock Public Health. That’s because measles is highly contagious; the CDC estimates that up to nine in 10 people around measles will become infected if they are not protected by vaccination.
Measles spreads through coughing, sneezing or just being near someone who is infected, and it can linger in the air for up to two hours. And the virus can be spread up to four days before a rash appears and up to four days after it’s gone, according to the CDC.
Public health officials have set up measles screening sites in the area, Wells said. Officials are also providing guidance to public schools, private schools and day cares.
“I hope this increases awareness around vaccines and shows why it’s so important,” she said.
The South Plains Public Health District, which serves Gaines County, set up a clinic to offer the measles, mumps and rubella vaccine amid the outbreak. More than 70 people have visited the clinic since last Thursday, SPPHD executive director Zach Holbrooks said in an email.
Declining vaccination rates
During the 2023-24 school year, about 2.3% of Texas students in kindergarten through grade 12 had exemptions to forgo routine childhood vaccinations for hepatitis, polio, the measles and other diseases, according to Texas Department of State Health Services Data. That percentage has been rising over the past decade but is still lower than the national average of about 3.3%.
Gaines County, with a population of about 22,000, was at higher risk for an outbreak because it has one of the highest nonmedical exemption rates in the state, experts said.
The percentage of Gaines County children with an exemption to at least one vaccine has tripled over the past decade, rising to about 13.6% of students in kindergarten through grade 12 during the 2023-24 school year, according to DSHS data. That’s more than five times the statewide average.
“I think a lot of people nationally in public health have been talking about [the risk for an outbreak] for a while,” Wells said. “And this is just an example of that happening.”
Harris County has an exemption rate of about 1.65 percent, also nearly triple its rate from 10 years earlier.
Experts are concerned those rates could get worse before they get better. Texas has relatively lax laws around vaccine exemptions, and lawmakers have sought to weaken those requirements even further through a series of bills filed in recent legislative sessions.
Experts also worry about the potential impact of Robert F. Kennedy Jr. if he is confirmed as Secretary of Health and Human Services. Kennedy has a long history of promoting misinformation about vaccines.
“It’s only going to bode worse for the future, when it comes to vaccination rates,” Troisi said. “And therefore, we’re going to be seeing these outbreaks.”
An opportunity for awareness
Burke said the Gaines County outbreak should be a cautionary tale for declining vaccination rates. The fact that nine Gaines County children have needed to be hospitalized shows how serious measles can be, she said.
“This whole incident points to how dangerous this is,” she said.
The best way to guard against a future outbreak is to improve vaccination rates across Texas, experts said. But they acknowledged that won’t be easy.
Studies have shown that Texas is consistently ranked among the worst states in the nation for health care access and affordability, and it has long had the highest number of uninsured children in the U.S. Increasing access and spreading awareness of programs like the federal Vaccines for Children program, which provides free childhood vaccinations, could improve vaccination rates, Troisi said.
Public health experts and health care providers nationwide are also struggling to combat false and misleading information about vaccines that has gained more traction since the COVID-19 pandemic. A recent KFF poll found that nearly 17% of parents delayed or skipped some recommended vaccines for their children, up from 10% two years earlier.
Once someone believes that a vaccine is dangerous – despite a host of studies that show they are safe – it’s hard to disavow them of that notion, Troisi said.
“It’s hard to change people’s minds,” she said.
Burke agreed that it will be difficult to sway someone’s opinion on vaccines. But she feels the Gaines County outbreak is “an opportunity to get people’s attention.”
“I recognize the tension … but vaccines give us all the freedom to live, to go to work, and to go to school without the fear or preventable disease,” she said. “We have to figure out a way to get that message out in a way that people will listen.”