States Zero In on Vaccine Uptake as Measles Outbreaks Spread

South Plains, Texas, had long declared its measles outbreak over when in January wastewater testing picked up what Zachary Holbrooks called “a blip, a spike.”

The testing found measles after months without traces of the virus, which by the 2025 West Texas outbreak’s end infected over 750 people, hospitalized nearly a hundred, and two children died.

With samples sent to Baylor University weekly, subsequent testing hasn’t picked up further traces, said Holbrooks, executive director for the South Plains Public Health District. The goal is to “test long-term” and see “if anything shows up.”

With the Centers for Disease Control and Prevention reporting over 1,200 confirmed measles cases and 12 new outbreaks in 2026, states across the US are taking similar steps to those taken in West Texas to manage infections, mounting outreach strategies, easing access to vaccines, and more.

Working against such efforts are low vaccination rates in pockets of states where misinformation and distrust of government spur outbreaks.

“Any state should be looking across its communities and identifying areas where the vaccination rates are lower than 95%. Those are the places that are very ripe for outbreaks,” said Jennifer Nuzzo, director of Brown University’s Pandemic Center.

Given 2025’s outbreak cycle, states should’ve been better prepared, Nuzzo said. Now, they’ll need to undertake “the very slow, laborious ground game of building trust” in communities to encourage vaccination.

In the past, states “tended to have more people and resources dedicated to building and maintaining” the community partnerships needed for managing health crises, Nuzzo said, much of which was “decimated” via funding cliffs after the Covid-19 pandemic.

“We’re trying to fight this battle with a couple of limbs tied behind our back,” Nuzzo said.

Far From Over

As of March 6, South Carolina’s health department reported 991 total cases, with 924 occurring among the unvaccinated.

In a March 4 media briefing, state epidemiologist Linda Bell said there was “strong increase in measles vaccination uptake” in February which is helping slow the outbreak. She added the CDC was going to assist in analyzing data collected over the outbreak to better understand transmission.

Bell noted, however, that there was a surge after Christmas, and she’s concerned infections could rise after spring break.

South Carolina’s outbreak is primarily concentrated in Spartanburg County, which straddles the border with North Carolina, where, as of March 5, 24 cases have been reported since December.

Erica Wilson, medical director of the Medical Consultation Unit in the Division of Public Health, North Carolina, said her state has been collaborating with South Carolina and learning from its response, including what communication strategies can reach high-risk populations.

North Carolina had anticipated measles after Texas’ outbreak, Wilson said.

The state provided counties with guidance on communicating with health-care facilities, ensured testing supplies, and identified schools with low vaccination rates, she said.

And while some communities are reluctant to vaccinate, Wilson said local partners have reported an increase in immunizations.

“When there’s not been a measles case in 20 years, it doesn’t seem like a big deal to not have immunity to measles. But when there is an outbreak right next door, that’s a different thing,” Wilson said.

Community Transmissions

Utah is facing a significant outbreak, counting 358 cases as of March 3, 162 of which occurred in 2026.

“We have so many people being exposed and going out into different communities that it just keeps on doing these little sparks all over that are causing additional cases,” said Leisha Nolen, Utah’s state epidemiologist.

The state is undertaking efforts to keep things under control, such as meeting with Western states to discuss approaches. Yet the most “complex” issue is communities that don’t want to come forward with infections.

One “very concerning” issue Nolen mentioned was people going to doctor’s offices and sitting in a waiting room for 20-plus minutes, only to find out they had measles and exposed everyone around them.

Most people in the room, she said, would’ve been vaccinated, though “the ones that really scare us” are babies, as traditionally, they weren’t able to get measles vaccines until 1 year old.

The state worked to increase awareness that early vaccination was an option for children, Nolen said.

Officials have given health-care systems posters to put up in waiting areas to encourage people to tell staff if they have measles symptoms, so precautions can be taken.

Coordination Among States

Neighboring Arizona is also fighting an outbreak, where, as of March 3, there have been over 270 casesin 2025 and 2026. The states have worked “very closely” since 2025, coordinating on messaging, responses and strategies, said Nicole Witt, assistant director of preparedness at the Arizona Department of Health Services.

“This outbreak, obviously, has lasted much longer than any of us I think had anticipated, and so that does create this constant loop for us of learning lessons and creating new strategies,” Witt said.

She said the Arizona Department of Health Services is working on a strategic plan that it hopes “will start to highlight priorities for us on how we can increase that vaccination rate.”

Some communities in the state have pockets in which around only 20% of the population is vaccinated, Witt said. And measles will continue spreading quickly until Arizona can get the vaccine rate “up where we need it to be.”

Texas’ Holbrooks said vaccine hesitancy had “always been a main issue” for addressing measles, but that his team had success meeting with local communities and their trusted members to overcome things such as language barriers or misconceptions about immunization.

He also said the SPPHD is going to invite private school staff who monitor health conditions to health department meetings with public school nurses to “bring them into the fold” and share information about things such as norovirus and other reportable illnesses.

Brown’s Nuzzo said of the spread of outbreaks: “This isn’t really something we’re going to stop unless we just boost vaccination rates across the country.”