Annals of Internal MedicineMeasles, Mumps, Rubella Immunization and the Resurgence of Measles in America

This commentary addresses the 2025 measles outbreak in the U.S. Great Plains, linking it to declining MMR vaccination rates. It evaluates evolving immunization strategies, particularly in outbreak zones, and highlights CDC and Texas DSHS policy adaptations. The article is grounded in epidemiological data and public health policy, not original clinical trial data.

⚕️ Key Clinical Considerations⚕️

• Outbreak Origin: The epidemic began in West Texas, where nonmedical vaccine exemptions have risen, leading to significant measles transmission across four states.
• Revised Pediatric Schedule: Texas DSHS now recommends an early MMR dose for infants aged 6–11 months in outbreak areas, aligning with WHO guidance.
• Accelerated Second Dose: Children over 12 months in affected counties should receive their second MMR dose 28 days after the first, not at 4–6 years.
• Adult Immunization Updates: Adults born after 1957 in outbreak zones may need a second MMR dose, especially if they only received one previously.
• Healthcare Worker Protocols: Regardless of birth year, healthcare personnel in outbreak areas should receive two MMR doses unless immune status is documented.

🎯 Clinical Practice Impact 🎯

• Patient Communication: Clinicians must clearly explain the rationale for early and accelerated MMR dosing, especially to hesitant parents.
• Practice Integration: Pediatric and internal medicine practices should update immunization protocols in line with local outbreak guidance.
• Risk Management: Proactive identification of under-immunized populations can mitigate outbreak spread and protect vulnerable groups.
• Action Items: Implement catch-up campaigns, verify staff immunity, and prepare for expanded adult vaccination if national elimination status is lost.
• Resource Implications: Increased vaccine demand and public health messaging efforts may strain local health systems.

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