JONATHAN M. METSCH, Dr.P.H. – Tracking Emerging Public Health Challenges – October 29, 2026– MEASLES
The patient was taken to Monroe Carell Jr. Children’s Hospital at Vanderbilt for treatment and has been released, hospital spokesperson Jessica Pasley said Oct. 29.
She didn’t release details including dates of treatment, where the child lives, where the child might have been exposed and whether the child was vaccinated.” (1)
“Pennsylvania’s measles outbreak is testing primary care practices on more than diagnosis. Physicians now need to know who is in the waiting room, which staff members are immune and how fast a suspected case gets reported.
The Pennsylvania Department of Health had confirmed 1,398 measles cases in 44 counties this year as of Oct. 28, including 265 hospitalizations and five measles-associated deaths, according to its measles dashboard. Of those cases, 85 were reported in the previous seven days, and fewer than 1% were in fully vaccinated people.”
“The state health department asks clinicians to report suspected cases immediately to 877-724-3258 or the local health department; state regulations set an outer limit of 24 hours. The department also posts an identification and testing guide and action steps after an exposure. CDC guidance also applies in physician offices:
Give patients with possible measles arrival instructions when they call.
Mask them and separate them from other patients as soon as they arrive.
Use an airborne infection isolation room if one exists; otherwise, a private room with the door closed while arranging transfer.
Leave the room empty for up to two hours afterward, and have staff wear N95 or equivalent respirators.” (2)
“For nearly two years, the U.S. has had to swallow an uncomfortable reality: A highly infectious disease it once eliminated is spreading again.”
“Measles is often described as one of the most contagious viruses, and it is uniquely unforgiving of weaknesses in public health defenses. A safe and highly effective vaccine has existed for decades.
But the virus’s spread exposes declining vaccination rates, eroding trust in health institutions and growing challenges in persuading people to protect themselves, their children and their communities, experts said.
Together, those vulnerabilities have made measles a revealing test of the country’s public health defenses. For some experts, the resurgence of a disease the U.S. eliminated more than two decades ago is a warning sign of its ability to contain future threats, from other vaccine-preventable diseases to emerging pathogens.
“Measles is the canary in the coal mine for so many different reasons,” said Jennifer Nuzzo, an epidemiology professor and director of the Pandemic Center at Brown University School of Public Health. “It’s the canary in the coal mine for other vaccine-preventable illnesses, where we could see a return of things that used to harm kids, but also for very acute, no-notice dangerous infectious disease emergencies.” “
The U.S. has the tools to prevent measles from spreading. But pockets of low vaccination
““At “current” state-level vaccination rates, measles could become endemic again in the U.S., resulting in an estimated 851,300 cases over 25 years, according to a large-scale epidemiological model published in JAMA in April 2025 by researchers at Stanford and other institutions. Under that scenario, the model predicts the measles cases could lead to 170,200 hospitalizations and 2,550 deaths over that period.”
While many people are currently immune through vaccination, outbreaks can increase in size and frequency if immunization rates decline over a longer period.
Michael Osterholm, an epidemiologist and the director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said he views the measles situation in Canada as a direct warning for the U.S.
Canada lost its official measles elimination status in November after a multi-province outbreak that generated more than 5,400 cases across 10 jurisdictions in 2025. Canada has a population of more than 40 million people.
“We have a population of 350 million. If you extrapolate, if we had the very same experience that Canada had over the next year or two, that would be up to 50,000 cases of measles in the U.S.,” Osterholm said. “I think that’s a potential future we have to be mindful of.””
“The measles resurgence is also raising questions about how effective the U.S. can be at detecting and responding to emerging public health threats before they spread.” (3)
“Since measles was declared eliminated in the US in 2000, the country’s occasional cases have come mainly from international travelers—visitors from far-flung places where the virus still spreads freely—or unvaccinated US residents who return from abroad with a highly infectious souvenir. But as vaccination rates have slipped nationwide in recent years and outbreaks grow bigger and more frequent, domestic travel now poses a greater risk than international incursions.
In a study published this week in NEJM Evidence, Washington state health officials highlight that risk, detailing how an explosive outbreak in South Carolina reached their distant state through five distinct importation events over two weeks in January. In all, the introductions led to 26 cases among residents before officials stamped out the spread.
South Carolina’s measles outbreak began on October 2, 2025, and was declared over on April 26, 2026. Officials confirmed 997 cases in the state during the outbreak. At the time, it was the largest measles outbreak recorded since the virus was declared eliminated, but Pennsylvania’s ongoing outbreak has since surpassed it.”……
“In the fifth importation event, a Washington state resident returned from out-of-state travel where they had contact with ill contacts and fell ill themselves on January 19. While contagious, they visited a school and a healthcare facility. Six close contacts fell ill. In all, this cluster of seven cases spanned January 19 to January 29. The genome sequences from five of the cases were nearly identical to those seen in South Carolina.” (4)
“As measles cases rise across Pennsylvania, pregnant women are turning to doctors with questions about a disease many thought had largely disappeared, raising concerns about miscarriage, premature birth and other complications.
Physicians told The Philadelphia Tribune the outbreak is also fueling confusion as patients navigate conflicting information about vaccines, exposure risks and how to protect themselves and their unborn children.” (5)
1.Nashville hospital treats child with confirmed measles case, by Beth Warren, https://www.tennessean.com/story/news/health/2026/10/29/measles-child-nashville-hospital/92499882007/?gnt-cfr=1&gca-cat=p&gca-uir=true&gca-epti=z117301e1132xxv117301d–81–b–81–&gca-ft=90&gca-ds=sophi
2.Before a measles patient walks in: lessons from Pennsylvania, Richard Payerchin, https://www.medicaleconomics.com/view/before-a-measles-patient-walks-in-lessons-from-pennsylvania
3.A ‘canary in the coal mine’: Measles resurgence exposes weaknesses in U.S. public health, experts say, by Annika Kim Constantino, https://www.cnbc.com/2026/10/27/us-measles-public-health.html
4.South Carolina’s measles outbreak jumped to Washington state 5 times in 2 weeks, by Beth Mole, https://arstechnica.com/health/2026/10/domestic-travel-poses-growing-risk-for-measles-and-a-new-challenge-for-states/
5.Pregnancy questions grow as measles cases increase across Pennsylvania, say doctors, by Marco Cerino, https://www.phillytrib.com/news/local_news/pregnancy-questions-grow-as-measles-cases-increase-across-pennsylvania-say-doctors/article_87680ece-58af-4d61-aa18-beb4bf28265f.html
curated by Jonathan M. Metsch, Dr.P.H. Clinical Professor of Environmental Medicine, Icahn School of Medicine at Mount Sinai