US Loses Measles Elimination Status After 26 Years as Cases Surge Past 5,400

The United States has lost its measles elimination status, ending a 26-year run during which the highly contagious virus was no longer considered continuously circulating within the country, after an independent expert committee reporting to the Pan American Health Organization (PAHO) determined that sustained transmission had persisted for more than a year.

The decision, first reported by The Wall Street Journal and confirmed by a source close to the process to CNN, marks a significant setback for a nation that had held elimination status since 2000 and had long been viewed as a leader in global disease eradication . PAHO’s rules require a country to demonstrate the absence of uninterrupted transmission of the same measles strain for at least 12 months; the committee concluded the US had failed to meet that standard .

How the Decision Was Reached

The independent committee examined genetic evidence from virus samples collected across multiple states. Scientists trace tiny genetic changes that occur each time a virus copies itself, allowing them to determine whether infections are part of the same chains of transmission. A preprint study published in August by Utah’s public health laboratory showed that a single measles strain had circulated in the state for more than a year, accounting for over 95% of cases there, traveling from southwestern Utah to central Utah and causing more than 600 cases between June 2025 and June 2026 . Sustained outbreaks were also documented in South Carolina, Pennsylvania, Wisconsin, and New York.

“The Utah data alone would have been enough to make the case,” said Dr. Angela Rasmussen, a virologist at the University of Saskatchewan and editor-in-chief of the journal Vaccine.

A Record Year for a Preventable Disease

The CDC has confirmed 5,394 measles cases across 47 jurisdictions in 2026—more than double the 2,289 cases reported in all of 2025 and the highest annual total since 1991 . Nearly all cases have occurred in people who were unvaccinated or whose vaccination status is unknown. Roughly one in nine reported cases has resulted in hospitalization, and state health departments have reported at least 10 measles-associated deaths this year, including several children and an infant in Wisconsin .

The CDC’s own website lists a lower death count, reflecting a dispute between the agency and state health departments over how measles-associated deaths are classified. Pennsylvania, the hardest-hit state with seven deaths, defines a measles-associated death as one occurring within 30 days of symptom onset in a confirmed case unless caused by an unrelated event—a standard consistent with WHO and long-standing CDC practice, according to epidemiologists who spoke to Al Jazeera .

Vaccination Rates Fell Below the Immunity Threshold

The resurgence follows years of declining vaccination coverage. National MMR coverage among kindergarteners fell to 92.4% in the 2025-2026 school year, down from 95.2% in 2019-2020 and below the 95% threshold needed to prevent community transmission . Approximately 280,000 kindergarteners lacked documentation of completing the MMR series. Exemptions from school vaccination requirements rose to 4.2%, the highest rate ever recorded, driven almost entirely by non-medical exemptions .

The two-dose MMR vaccine is 97% effective at preventing measles .

Political and Public Health Fallout

The loss of elimination status represents a stark reversal for a country that played a leading role in eradicating smallpox and worked for decades to drive measles offshore. Dr. Demetre Daskalakis, former director of the CDC’s National Center for Immunization and Respiratory Diseases, called the development “a vital sign for our public health system” that “shows cracks in our foundation.”

The decision comes amid sustained scrutiny of Health and Human Services Secretary Robert F. Kennedy Jr., who has for years questioned the safety and efficacy of the MMR vaccine without scientific evidence. In August, President Trump signed an executive order calling for splitting the MMR vaccine into three separate shots—a move with no precedent in any country and no supporting scientific evidence, according to Johns Hopkins public health experts . CDC Director Dr. Erica Schwartz, confirmed in August, told Reuters before the decision that the agency would not fundamentally change its response if elimination status were lost .

“This is just so devastating and so sad that we are where we are today,” said Dr. Nuwan Gunawardhana, an infectious disease epidemiologist at Columbia University Irvine Medical Center. “This just kind of points towards the direction of really reversing a generation of public health progress.”

What Comes Next

Regaining elimination status will require the US to end sustained transmission and remain outbreak-free for at least 12 months—a daunting prospect given diminished public trust in vaccines, rising non-medical exemptions, and the current trajectory of cases. Canada and Mexico have also faced elimination status reviews amid regional outbreaks .

“Whether or not we’ve officially lost our elimination status to me is much less important than, basically, measles is here,” said Dr. Peter Hotez, co-director of the Center for Vaccine Development at Texas Children’s Hospital. “It’s pervasive, and vaccination rates are down across the country, and I don’t see us getting back to normal anytime soon.”