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An ongoing measles outbreak in Israel, involving ≈3,200 cases and 16 deaths, threatens the country's measles elimination status and reflects declining vaccination rates observed globally and within Israel. Epidemiologic investigations supported by sequencing suggest that a single importation triggered the outbreak, underscoring the critical role of rapid genomic surveillance in outbreak control.
Declining childhood vaccination rates have fueled a resurgence of measles in the United States. Surveillance systems may not accurately measure the true extent of outbreaks. As of May 2026, the largest ongoing measles outbreak in the United States originated along the Utah-Arizona border in a community with high vaccine exemption rates and limited engagement with healthcare systems, leading to incomplete testing and reporting. To quantify the true outbreak size, we used two independent approaches with complementary data sources: a phylodynamic analysis and an agent-based model. Both methods found significant underreporting, estimating the true outbreak size to be 3.1- to 4.8-fold larger than reported, with confirmed cases representing only 20.96%-32.5% total infections. These findings suggest that substantial underreporting of measles occurs, especially in tight knit communities. The use of complementary analytical approaches to evaluate completeness of reporting can reveal the extent of measles transmission and aid control efforts.
Door-to-door immunizations and a community canvass for susceptibles were marshalled to quell a rubeola outbreak in Norfolk, one of 25 outbreaks reported in Virginia from January through August 1977.
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Investigation of measles outbreaks during the fall of 1976 led to the discovery that Alkaska's school immunization law was not being enforced. In an effort to control a large outbreak of measles in Fairbanks, children were required to show proof of measles vaccination or be excluded from school. Of the Fairbanks schoolchildren, 25% were vaccinated against measles; 1,251 (11%) of 11,727 unvaccinated schoolchildren were excluded in January, and no further cases of measles occurred. Subsequently, the school law was enforced statewide, and on March 1, 1977, all children not immunized against diphtheria, tetanus, pertussis, polio, measles, and rubella were excluded from school (7,418 [8.3%] of 89,108). One month later, fewer than 51 children still did not meet immunization requirements. More than 35,000 children were vaccinated in the immunization campaign; no adverse side effects to any vaccine were reported.
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During the investigation of a measles outbreak in a rural community, a spectrum of illness was observed which ranged in severity from a brief febrile illness to one characteristic of typical measles. Unimmunized children were more apt to develop measles (p less than 0.001) than were immunized children. However, a proportion of both the immunized and unimmunized children developed a milder, "measles-associated," illness. Employing a logistic model, it was demonstrated that the probability of developing either measles or "measles-associated" illness decreased with increasing age at immunization but was not affected by the interval since immunization.
A deterministic model of recurrent epidemics is constructed using a non linear relationship between infection rate and number of contacts. Epidemic waves which are not damped are predicted and a relationship between community size and the period of recurrence is established. A possible explanation of measles outbreaks is suggested.
During November, 1975, to May, 1976, measles occurred at a rate of 20.3 cases per 1000 in a purported immunized population, of whom historical and serologic survey revealed that 9 per cent had no history of either measles illness or vaccination and 18 per cent did not have detectable measles antibody. Antibody was detectable in 92 per cent of those vaccinated at greater than or equal to 13 months, 80 per cent at 12 months and 67 per cent of those vaccinated when less than one year old (P less than 0.001), but no significant differences existed with increasing years since vaccination (P greater than 0.1). A second vaccination increased detectable antibody prevalence only in those originally vaccinated when less than nine months old (42 to 80 per cent, P less than 0.02). During a measles outbreak, more cases occurred in those receiving vaccine when less than 12 months old than in those vaccinated at greater than or equal to 12 months (37 per cent vs. 9 per cent, P less than 0.001). A second vaccination protected those originally vaccinated at less than 12 months (35 per cent ill without a second vaccination vs. 2 per cent with, P less than 0.001). Thus, a single measles vaccination of children less than 12 months old does not protect; a second vaccination will protect this group.
Anamnestic data in respect to measles failed to correspond to the results of serological examination of contacts at the foci of the given infection. The collective immunity level in children's institutions is inadequate for the prevention of measles outbreaks. The incidence of the disease depended both on the level of immunity among the children and on the duration of presence of the source of infection in the focus. Live measles vaccine protected 90 percent of the vaccinated children from contracting the disease in the foci. At the very beginning of the postvaccinal period immunization defects were revealed in 26.5 percent of the vaccinated children who fell ill with measles. Morbidity index among the vaccinated individuals constituted 3.8 percent. One of the causes of measles contraction by the vaccinated individuals was the loss of postvaccinal immunity. Systematic control over the antimeasles immunity level with the aid of serological investigations is necessary for the purpose of detection of persons sensitive to measles in children's collective bodies.
An outbreak of measles at the University of California at Los Angeles provided the opportunity to study clinical, epidemiologic, and serologic characteristics of the disease in young adults in the present vaccine era. Of the 34 cases studied, 18 occurred in persons who thought they were immune. Fifteen of 19 seronegative students vaccinated during the epidemic responded with a secondary (IgG) antibody response. Antibody prevalence studies indicated that 91% of the student population had measles antibody at the onset of the outbreak, and history relating to measles correlated poorly with antibody prevalence. Of 212 adults vaccinated, 58% complained of one or more symptoms. Seventeen percent were confined to bed, and in three women vaccine-associated illness was notably severe. That measles will continue to be a problem in adults with our present national approach to immunization is predicted.
PURPOSE OF REVIEW: Measles has reemerged as a significant global public health threat, with increasing morbidity and mortality associated with declining vaccination rates. This review summarizes current global outbreaks, history of measles, vaccination and elimination status, vaccine hesitancy, and outbreak response and lessons learned highlighting different novel digital epidemiological tools. RECENT FINDINGS: Measles continues to surge worldwide with an estimated 11 million infections in 2024, which is more than prepandemic levels. Developing and developed countries are both facing measles outbreaks, with the United States at risk of losing measles elimination status. Recent studies have showed that worldwide percentages of two-dose measles vaccination were lower than 95% that is required to interrupt measles transmission in all WHO regions. Novel epidemiological tools such as interactive simulators, real-time use of dynamic models, serosurveillance, and others are transforming measles outbreak response and enable earlier outbreak detection, tracking, and targeted public health interventions. SUMMARY: Vaccine hesitancy is one of the top global health threats and developing a tailored evidence-based approach is necessary to establish and maintain measles elimination.
During a community outbreak of measles, 10 patients aged 11 through 19 were hospitalized with prominent pulmonary infiltrates and clinical manifestations of high fever and rash. Diagnoses of atypical measles were confirmed by hemagglutination-inhibition and complement-fixation antibody studies. Patients were followed with pulmonary function studies for 12 weeks. The most common admitting diagnoses were varicella, scarlet fever, meningococcemia, and Rocky Mountain spotted fever, due largely to the protean cutaneous manifestations. Roentgenographic studies showed diffuse, segmental, and nodular chest lesions. Hypoxemia (mean arterial Po2, 58 mm Hg) and markedly reduced lung volumes were noted. Gradual resolution of physiologic abnormalities was noted during 12 weeks, but two children had persistent nodular densities seen on chest roentgenograms. Atypical measles in the older child and young adult has a wide spectrum of pulmonary manifestations ranging from acute respiratory failure to isolated nodular lesions. Proper recognition of this syndrome will prevent unnecessary invasive diagnostic procedures.
The measles vaccine, introduced over 60 y ago, has been proven to be both safe and effective. Despite the genetic diversity of the measles virus, eradication is considered possible with near-complete coverage of the two-dose vaccination schedule. However, real-world data show that this level of control has not yet been achieved. In addition to outbreaks among unvaccinated individuals, increasing numbers of measles cases are occurring among fully vaccinated, seropositive individuals. Both primary and secondary vaccine failures have been documented. Reduced vaccine effectiveness may occur in people with innate immune deficiencies, immunocompromised individuals (including those with HIV), and patients with chronic conditions such as diabetes. Furthermore, in regions without circulating wild-type virus, vaccine-induced antibody levels tend to decline over time and the impact of this may be more significant among infants. Emerging evidence highlights the importance of T lymphocyte - mediated immunity on effective B cell mediated immune response. Compounding the challenge, measles vaccination and infection are politicized, undermining public trust. Given the high transmissibility of measles, its potential for presymptomatic transmission, and the absence of specific early symptoms, complete eradication may not be feasible in the near term. Nevertheless, combining vaccine advocacy, transparent communication, and ongoing research will be critical to improving global vaccination strategies and public confidence.
As a result of a large outbreak of measles, measles hemagglutination inhibition (HI) titers were measured in 465 immunized children. Titers of less than 1:4 were found in 14.6% of children immunized at 12 months of age as compared to 5.2% of those immunized at 13 months of age or later. Measles antibody titers were higher in the mothers of seronegative children who had been immunized at 11 or 12 months of age than in the mothers of seroposotive children. Measles HI titers of 1:4 or more were present in 94% of children immunized at 13 months of age or later between 1962 and 1964. The findings suggest that vaccine failure and not waning antibody accounts for the majority of titers of less than 1:4 in immunized children. Reimmunization programs should be considered for those who were immunized before 13 months of age.
Stimulated by an outbreak of measles that was spread throughout a school by the ventilating system, we looked into the possibility of preventing this hazard in air conditioned buildings. The amount of air recirculated by air conditioning systems increases as the temperature difference between indoor and outdoor air increases and often exceeds 70 per cent. Germicidal u.v. radiation in central supply ducts seems almost ideally suited for disinfecting recirculated air, being effective, safe, and cheap. The effectiveness of disinfecting recirculated air in blocking person to person transmission of airborne infection can be predicted to be great at the beginning of a potential outbreak and negligible during an established epidemic. Infection introduced by the air conditioning process, recently implicated in causing Legionnaires' Disease, might also be prevented. Air disinfection would supplement immunization in the control of respiratory infection and might be cost effective.