CDC

Rising measles cases in Texas and New Mexico prompt CDC alert

March 7, 2025

CDC has issued a Health Alert Network (HAN) advisory regarding the rapidly expanding measles outbreak in Texas and New Mexico. As of March 7, 2025, there have been 208 confirmed cases (198 in Texas and 10 in New Mexico), with two reported deaths. With the upcoming travel season, CDC emphasizes the critical role of healthcare professionals in preventing the spread of measles through vigilant monitoring and vaccination.

Recommendations for Healthcare Professionals

• Ensure all patients without other evidence of immunity, especially those planning international travel, are up to date on MMR vaccine per routine ACIP recommendations:
  Children are recommended to receive 2 doses of MMR. The first dose is given at 12–15 months of age and the second is given at 4–6 years of age before school entry.Infants 6 months of age or older can receive MMR prior to international travel or in outbreak settings (see below). MMR is not licensed for children <6 months of age.Adults not at high risk of exposure are recommended to have at least 1 documented dose of MMR in their lifetime, or other evidence of immunity (e.g., positive measles IgG). Adults at high exposure risk, including students at post-secondary institutions, healthcare workers, and international travelers, should have two documented doses.
• Ensure patients who reside in areas with an ongoing measles outbreak follow state and local guidance. Texas Department of State Health Services (DSHS) has issued the following recommendations for the affected counties in Texas:
  Infants 6 through 11 months receive an early dose of MMR vaccine (i.e., infant dose), and a second dose at 12-15 months, at least 28 days after the first.Children older than 12 months who have not been vaccinated should receive one dose immediately and follow with a second dose at least 28 days after the first. Children older than 12 months with one prior dose should receive an early second dose of MMR vaccine separated by at least 28 days.Teenagers and adults previously vaccinated with one dose of MMR vaccine should receive a second dose. Those with no evidence of immunity should receive one dose of MMR vaccine immediately and follow with a second dose at least 28 days later.
• Ensure all U.S. residents older than age 6 months without evidence of immunity who are traveling internationally receive MMR vaccine prior to departure:
  Infants 6 through 11 months of age should receive one dose of MMR vaccine before departure. Infants who receive a dose of MMR vaccine before their first birthday should receive 2 more doses of MMR vaccine; the first of which should be administered when the child is 12 through 15 months of age and the second at least 28 days later (generally at age 4-6 years of age but can be administered sooner if indicated).Children 12 months of age or older should receive two doses of MMR vaccine, separated by at least 28 days.Teenagers and adults without evidence of measles immunity should receive two doses of MMR vaccine separated by at least 28 days.
• Be aware that some patients may develop a mild rash reaction in the 3 weeks following MMR vaccination. This does not typically require testing or public health intervention since a person with a rash due to a vaccine reaction is not infectious. If a symptomatic person who has been recently vaccinated also has a known or suspected measles exposure, consultation and additional testing may be required from the local or state health department to evaluate for acute measles.
• Consider measles as a diagnosis in anyone with fever and a generalized maculopapular rash with cough, coryza, or conjunctivitis who has recently traveled internationally, or domestically to a region with a known measles outbreak, or has other known or suspected exposure to measles.
• If you suspect measles:
  Isolate:
  Isolate patients with suspected measles immediately, ideally in a single-patient airborne infection isolation room (AIIR), or in a private room with a closed door until an AIIR is available. Patients with suspected measles should not remain in the waiting room or other common areas of a healthcare facilityProtect healthcare providers against measles by adhering to standard and airborne precautions when evaluating confirmed or suspect cases, regardless of their vaccination status. Healthcare providers without presumptive evidence of measles immunity who are exposed to measles should be excluded from work from day 5 after the first exposure until day 21 following their last exposure and offered post-exposure prophylaxis, as appropriate.Healthcare systems should ensure all healthcare providers have presumptive evidence of immunity to measles, ensure they can rapidly retrieve healthcare provider immunization status in case of exposures and offer postexposure prophylaxis when indicated.Offer measles testing outside of facilities to avoid possible transmission in healthcare settings. Call ahead to ensure immediate isolation for patients referred to hospitals for a higher level of care.
  Notify: Immediately notify state, tribal, local, or territorial health departments (24-hour Epi On Call contact list) about any suspected case of measles to ensure rapid testing and investigation. States report measles cases to CDC.Test: Laboratory confirmation should be pursued for all patients with suspected measles. CDC recommends collecting either a nasopharyngeal (NP) swab or throat (OP) swab for reverse transcription polymerase chain reaction (RT-PCR) testing as well as a blood specimen for serology testing from all patients with clinical features compatible with measles. Collecting a urine specimen along with an NP/OP swab may improve sensitivity of testing.Manage:
  Post-exposure prophylaxis (PEP): In coordination with local or state health departments, provide appropriate measles PEP to close contacts without evidence of immunity, as soon as possible after exposure, either with MMR vaccine (within 72 hours) or immunoglobulin (within 6 days). The choice of PEP is based on elapsed time from exposure or medical contraindications to vaccination.Supportive care: There is no specific antiviral therapy for measles. Medical care is supportive to help relieve symptoms and address complications such as pneumonia and secondary bacterial infections. Consistent with guidance from the American Academy of Pediatrics, vitamin A may be administered to infants and children in the U.S. with measles as part of supportive management. Children with severe measles, such as those who are hospitalized, should be managed with vitamin A. Vitamin A should be administered under the supervision of a healthcare provider and is not a substitute for vaccination. Overuse of Vitamin A can lead to toxicity and cause damage to the liver, bones, central nervous system, and skin. Pregnant women should avoid taking high levels of vitamin A as it has been linked to severe birth defects.

Source:

(2025, March 7). CDC. Expanding Measles Outbreak in Texas and New Mexico and Guidance for the Upcoming Travel Season. https://www.cdc.gov/han/2025/han00522.html