It’s official.  After 26 years the US has lost its measles elimination status. 

The decision is from the Pan American Health Organization (PAHO).  Their independent expert commission on measles and rubella met with Washington, D.C. this week to review the evidence and the PAHO director makes the final decision on each country.

If you’ve been following this, it’s not really a surprise.  Pediatricians and public health workers have seen this coming for months, but it’s still a bit of a blow to read it in writing.

We need to go through this calmly as a headline like this tends to land in one of two camps.  It either sounds like a doomsday alarm or it sounds like a very posh label that has nothing to do with your child’s day to day reality.  Neither of these is quite right so let’s sort it out.

Elimination never meant zero cases.  Even in the years that we were deemed eliminated we still saw cases of measles in the US from time to time.  Someone would contract it while traveling, bring it back and the public health teams would then come in and help to stop the spread before it could really take hold.

The official position is all to do with time.  A country is deemed to have lost its elimination status if the same strain on measles continues to circulate within its borders for 12 months or more without interruption. To determine that, the commission looks at the size of the outbreak and the quantity of the country’s case surveillance, with a very strong reliance on genetic testing of the virus to establish whether outbreaks in different locations are link.

Think of it as a campfire. A spark on wet grass just dies out.  That’s been the case here with the measles for decades.  A spark that lands on dry bush and keeps burning for a year is a fire that has found sufficient fuel to keep itself going.  In this instance the fuel is the number of people who are unvaccinated.

The US got the elimination status in 2000 with only 85 cases reported that year.  In 2026, we have already seen over 5,412. 

The decision itself is largely symbolic.  PAHO can’t fine a country or impose any sanctions.  One epidemiologist told CIDRAP that it was a loss of standing and a loss of achievement.  To me it’s just the scoreboard finally catching up with what’s been going on in the field for some time.

Let’s start with the reassuring part–yes there is, I promise! 

If your child is fully vaccinated, they’re well protected.  Two doses of MMR are about 97% effective at preventing measles.  This year 96% of the US cases have been found in the unvaccinated or those with unknown vaccination status.  You don’t need to bubble wrap your kids or go to the store without them.  The status change doesn’t in any way make the MMR vaccine any less effective than it was last week.

So why am I still concerned?

Measles is the most contagious virus we know of.  If one infected person walks into a room with 100 unvaccinated people, you could expect around 90 of them to catch it.  It’s a virus that doesn’t need much of an opening at all.

Measles can be a whole lot more serious than the rather mild childhood illnesses that some of us remember.  So far this year, 11% of US patients with measles have been hospitalized and there have been at least 8 deaths from measles in 2026.  There’s also concern about congenital measles - measles passing from an infected pregnant person to her baby - which is now a genuine public health threat for the first time in generations.

This is far more than just one outbreak in one part of the country.  One epidemiologist has likened it to popcorn with one outbreak after another popping up, growing, collapsing and then moving to a new location.  As of early November, only five states had reported zero cases this year.

The group I think about most are the people who can’t look after themselves.  Babies don’t get their first MMR until 12/15 months.  There are also some kids who due to certain medical conditions can’t have the vaccine at all.  Those kids are entirely reliant on the rest of us.

Your child’s vaccine protects your child.  Everyone’s vaccines protect the baby who’s not old enough yet.

Canada is a very useful preview as they went through this a year before us.

Canada got rid of measles in 1998 and lost its status in November 2025.  A recent BMJ analysis has traced a significant portion of that back to a wedding in New Brunswick in October 2024.  A guest from Thailand infected a number of guests from Ontario who then brought it back to their homes.  From there it went on to cause an outbreak with 2,064 confirmed cases and 313 probable cases.

93% of the case were in the unvaccinated (or status unknown).  The vast majority of cases were in closely-knit communities that have had historically low vaccination rates.  The researchers note that the low uptake, combined with decades or no measles around, has left a huge cohort of people with no protection at all.  The same strain subsequently appeared in the US, Mexico and the Netherlands.

Canada lost its status and as a result the whole of the Americas lost their regional elimination status.  At that same November 2025 meeting, the US was sustained with “major concerns” (i.e. a yellow card).

What was the most useful in the Canada story was what worked.  The messages sent by public health teams were respectful of individual choice and used community health workers who spoke the language and understood the culture.

There’s real hope in that part of the story as well.  Brazil lost their elimination status in 2019 and regained it in 2024.  Venezuela regained theirs in 2023.

Measles isn't the only thing that's been spreading rapidly.

A 2025 KFF poll found that 63% of adults had heard the false claim that the MMR vaccine causes autism. Around 1 in 4 adults said vitamin A probably or definitely prevents measles (it doesn't). The proportion of adults who had heard that the vaccine is more dangerous than the disease rose by nearly half over the course of a year.

I flew recently to NYC and I sat next to a lovely woman who when she found out I was a Pediatrician, proceeded to tell me her sister’s son has autism and which vaccines I would recommend avoiding. (Hint: NONE. I told he should get them all) 

Those beliefs manifest in real decisions. Of parents who thought at least one of those false claims was true, 24% said they had delayed or skipped some of the vaccines for their children, compared to 11% of parents who didn't believe any of them. In Texas hospitals have had cases of children presenting with both measles and vitamin A toxicity following the promotion of high dose vitamin A online.

We can see the ripple effect in the school data. For the 2025-2026 school year kindergarten vaccine exemptions hit a record 4.2% (up from 3.6% the year before and nearly double what it was five years ago). Only 92.4% of the kindergarten cohort had both MMR doses and some 280,000 started school without any proof of full MMR protection. For measles we need around 95% coverage to prevent an outbreak.

The mixed messages from the top haven't helped. In August the President directed the health people to split the MMR into three separate shots, even though there are no separate measles, mumps and rubella vaccines for sale in the U.S. and the CDC themselves state there is no published evidence of any benefit. When the CDC released the record number of exemptions their statement didn't actually go on to encourage parents to vaccinate at all. We also looked at the January 2026 changes to the childhood schedule and the amount of confusion that caused. When the voices of the trusted don't speak up or are unclear, the rumors are very happy to fill the gap.

And I know this so well from the work I’ve done for over a decade online and in person: Misinformation works because it taps into love and fear and every parent has both in abundance. The vast majority of parents who believe a false claim are doing so out of a genuine desire to protect their children. That's something we need to bear in mind before we go about our response.

The most encouraging figure from that KFF poll was this one: at least half of adults were in the "uncertain" camp, stating the false claims were "probably true" or "probably false". KFF refer to this group as the “malleable middle”. To me that suggests that a significant number of parents are still listening and still making up their minds about who they can trust. That's a door we can walk through.

We still have a huge amount of influence over what happens next. Measles prevention has always been a team effort and every family is on the team. A few places to start:

Check your family's records. Children need two MMR doses (first at 12-15 months, second at 4-6 years). If your child is 6-11 months old and you're going overseas or live in an area where there's an outbreak, you can ask your provider about an early dose. That early dose doesn't count as one of the two routine doses so your child would still receive both of them after their first birthday. Adults too, check your own records. If you're not sure at all, your doctor can help you.

Know the signs and call ahead. Measles typically begins with a high fever, cough, runny nose and red watery eyes and the rash appears a few days later. If you think your child has measles then call the office before you come in. That way the office can keep you out of a full waiting room of little ones. 

Stay up to date with the sources you trust. The numbers are changing every week and the local outbreak is going to be far more relevant to your family than the national story. The local health department, the CDC measles page, HealthyChildren.org from the AAP and the PedsDocTalk vaccine guide are all good places to check. Your provider is still your one stop shop.

Call out the misinformation, please. That one in particular takes real courage. When you come across a false claim, try to approach it with curiosity rather than a correction. "Where did you see that? Can you provide a recent source" is a far better opening than "That's wrong". Share one good source rather than a whole load. Tell people why your family chose to vaccinate as your personal story will often have a far greater impact than any statistic. And just before you post anything, take five seconds to check where it actually came from. That little pause is a tiny habit that can have a massive effect.

You won't change every mind and that's perfectly fine. You don't need to win the comment section. The aim is simply to be the reliable, trustworthy voice that someone comes back to when they're finally ready to ask the real question.

I know that news can be pretty heavy, particularly if you've been watching the vaccine conversation get louder and more complicated over the last couple of years.

But step back for a moment. We can collectively bring our status back by:

Brazil has shown us that it can be won back. Canada has shown us what it takes when trust is the lead.

We've got a safe and effective vaccine, we've got plenty of supply and millions of parents who want to do the right thing for their kids. That's a very strong position to be in to start from.

Have you had a conversation about vaccines with a friend or family member that actually went well? What helped? I'd love to hear what worked for you, because your answers might help another parent who is dreading that same talk.

Dr. Mona will answer these questions in a future Sunday Morning Q&A email. Chances are if you have a parenting concern or question, another parent can relate. So let's figure this out together!