CDC says measles cases are most likely underreported as outbreak swells in Texas

Measles cases are most likely being underreported in the United States as public health officials scramble to find resources to address a ballooning outbreak in the Southwest, according to a senior scientist at the Centers for Disease Control and Prevention.

So far this year, 747 cases have been recorded in the United States, according to NBC News’ tally. Two unvaccinated children in Texas and an unvaccinated adult in New Mexico have died. The adult tested positive for measles, but the official cause of death is still under investigation. 

Dr. David Sugerman, a senior scientist leading the CDC’s measles response, said Tuesday at a meeting of the CDC’s vaccine advisory committee that more than 90% of the cases are “related to the Southwest outbreak, driven by transmission in close-knit, undervaccinated communities.” The other cases have largely been imported from other countries, he said.

“We do believe that there’s quite a large amount of cases that are not reported and underreported,” Sugerman said Tuesday as he updated the committee on measles. “In working very closely with our colleagues in Texas; in talking with families, they may mention prior cases that have recovered and never received testing, other families that may have cases and never sought treatment.”

Sugerman said the CDC has deployed 15 people to Texas to help manage the outbreak and is sending seven more this week. It continues to make measles vaccines available to health departments at their request, he said, and it is helping standardize and expand wastewater surveillance.

However, the CDC slashed $11.4 billion in Covid funding last month, some of which helped state health departments respond to disease outbreaks. Sugerman said the loss of Covid grant money has created “funding limitations” in Texas, where state officials are redirecting staffers to work on the measles response or moving them from other regions to help support efforts in the outbreak area.

“We are scraping to find the resources and personnel needed to provide support to Texas and other jurisdictions,” Sugerman said. 

As of Tuesday, 561 cases had been confirmed in the West Texas outbreak, according to the state’s Department of State Health Services. Each measles case may cost $30,000 to $50,000 to address, which “adds up quite quickly,” Sugerman said. 

Before this year, the United States had not had a measles death in a decade, and a child had not died of measles since 2003. Many public health experts have criticized Health and Human Services Secretary Robert F. Kennedy Jr.’s approach to the outbreak. While Kennedy has called for people to get the measles vaccine, he has framed vaccination as a personal choice and emphasized unproven treatments like steroids or antibiotics. He has also repeatedly claimed that immunity from measles vaccines wanes quickly, despite robust evidence that two doses of the vaccine offer lifelong protection.

At a media event Tuesday in Indiana, Kennedy said the CDC has “done a very good job at controlling the measles outbreak,” pointing to higher case numbers in Europe. However, the figure he cited — 127,000 cases — was the total last year across 53 countries. Disease experts say that is an apples-to-oranges comparison with the current outbreak in the United States.

Kennedy also suggested Tuesday that “healthy children should not die of measles” if doctors know how to treat it. In reality, no specific treatment is approved for measles, and unvaccinated children are vulnerable to severe complications, such as pneumonia and swelling of the brain. Roughly 1 to 3 out of every 1,000 children with measles die from respiratory and neurological complications, according to the CDC.

The CDC’s vaccine advisory committee met Tuesday for the first time since Kennedy took office on Feb. 13. The meeting was originally scheduled for late February, but the Department of Health and Human Services postponed it. A senior HHS spokesperson said at the time that the delay was intended to allow time for public comment. 

Kennedy has previously accused the committee members of having conflicts of interest, citing ties to the pharmaceutical industry. Most scientists say it is appropriate for members to accept industry funding for vaccine research, as long as it is disclosed.

Helen Keipp Talbot, who chaired the committee Tuesday, lamented that the group had to discuss rising measles case numbers.

“I find it absolutely devastating that we’re having this update today,” she said. “There’s no reason why we have healthy children dying of measles in the U.S. when this vaccine is amazing. It’s highly effective and has a very long-lasting immunity.”