Measles cases in 2026?
Short Answer
Both the model and the market overwhelmingly agree that Above 500 measles cases in 2026 is most likely, with only minor residual uncertainty.
1. Executive Verdict
- Measles outbreaks increasingly spread to previously unaffected US communities.
- State vaccine policy diverges from traditional national guidance framework.
- Kindergarten MMR vaccination rates decline, increasing national vulnerability.
- Persistent low US MMR vaccination rates prevent herd immunity.
- Increased international travel and global events drive cross-border transmission.
- Up to a quarter of US outbreaks linked to specific European strains.
Who Wins and Why
| Outcome | Market | Model | Why |
|---|---|---|---|
| Above 10000 | 23.0% | 31.5% | Global measles resurgence, fueled by vaccination gaps, suggests continued high case numbers. |
| Above 4000 | 75.0% | 76.0% | Vaccination disruptions during COVID-19 are driving the ongoing global increase in measles cases. |
| Above 6000 | 55.0% | 53.0% | The WHO reported a 79% increase in cases in 2023, indicating a strong upward trend. |
| Above 2000 | 96.0% | 94.0% | Improved diagnostic tools and surveillance methods could lead to higher reported case counts. |
| Above 8000 | 31.0% | 39.5% | Conflict zones and humanitarian crises continue to complicate effective measles vaccination efforts. |
Current Context
US measles cases surge significantly, with major outbreaks and vaccination concerns. As of February 19, 2026, the United States has reported 982 confirmed measles cases across 26 states, representing a 7.9% week-over-week increase from 910 cases [^]. Reports indicate over 1,000 US cases already this year, exceeding last year's May total [^]. South Carolina leads with 632 CDC-confirmed cases and 973 total cases in its ongoing 2025-26 outbreak [^]. Other states experiencing rising case numbers include Utah (117), Florida (64), Arizona (49), Washington (26), and Virginia (10) [^]. While seven new outbreaks have emerged in the US in 2026, 92% of current cases stem from outbreaks that began in 2025 [^]. A notable development is the Virginia Department of Health's decision to reject the CDC's immunization schedule, instead aligning with the American Academy of Pediatrics for broader protection [^].
England faces measles surge, impacting vaccination rates and global elimination status. England has recorded 130 laboratory-confirmed measles cases between January 1 and February 16, 2026, with an increase of 34 cases since February 12 [^]. This surge is largely concentrated in North London, with Enfield reporting 50 cases and Haringey 10 [^]. The UK, alongside Spain, Austria, Armenia, Azerbaijan, and Uzbekistan, recently lost its measles-free status from the World Health Organization [^]. Queensland, Australia, has also issued a measles alert due to a confirmed case [^]. Demographically, 84% of US cases involve children and young adults up to age 19, with 25% in children under five; in England, 76% of cases affect children aged 10 and under [^]. Critically, 94% of US patients were unvaccinated or had unknown vaccine status, including 906 of South Carolina's 973 cases [^]. Only 10 US states and Washington, D.C., currently maintain the 95% herd immunity level among kindergartners [^]. So far in 2026, 4% of US cases required hospitalization, with no measles-related deaths reported in either the US or England, though the US recorded three deaths last year [^]. Six US cases are linked to international travel, illustrating how the disease re-enters countries where it was previously eliminated [^].
Declining vaccination rates universally blamed for measles resurgence, raising health concerns. Experts widely attribute the current measles resurgence to declining vaccination rates and growing vaccine hesitancy [^]. Sruti Nadimpalli, a pediatric infectious disease physician, states that decreased vaccine uptake is the primary cause, while Vanessa Saliba, a consultant epidemiologist, notes the North London outbreak predominantly affects unvaccinated children [^]. The highly contagious nature of measles, described as more infectious than COVID-19 or Ebola, means 90% of unvaccinated individuals exposed are likely to get sick, with the virus remaining infectious in a room for up to two hours after an infected person leaves [^]. Experts emphasize that measles is far from a benign childhood illness, posing risks of severe complications such as pneumonia, brain inflammation, long-term disability, and death, particularly for young children and immunocompromised individuals, along with the rare but devastating long-term risk of Subacute Sclerosing Panencephalitis (SSPE) [^]. The ongoing outbreaks also raise significant concern about the United States potentially losing its measles elimination status, a designation for no sustained domestic spread for at least a year [^]. This scenario is viewed as a serious setback, signaling widespread vaccination gaps and a potential return to year-round preventable disease [^]. Consequently, the consensus among public health experts is that vaccination remains the most critical strategy to halt the spread and protect vulnerable populations, with federal health officials urging vaccination [^]. Public concerns revolve around recognizing symptoms, understanding personal protection needs, managing exposure, preventing transmission, and comprehending the long-term effects of measles [^]. There is also considerable debate regarding the reasons for declining vaccination rates and strategies to counter misinformation, especially in the wake of the COVID-19 pandemic [^]. Health agencies continue to provide regular updates, but no explicit upcoming events or deadlines beyond ongoing monitoring have been identified [^].
2. Market Behavior & Price Dynamics
Historical Price (Probability)
Outcome probability
Date
This prediction market, which appears to resolve on whether total US measles cases in 2026 will exceed a threshold of 4,000, has exhibited a distinct downward trend since its inception. The market opened with traders assigning a 40% probability to the outcome, briefly rose to a high of 42%, but has since declined steadily to its current price of $0.31, or a 31% implied probability. The significant total trading volume of over 57,000 contracts suggests strong market participation and conviction behind these price movements. Key price levels include the initial resistance in the low $0.40s, which the market failed to hold, and the current price around $0.31, which may be establishing a new area of support. The historical low of $0.10 serves as a more distant floor for the market.
The primary driver of the price decline appears to be the market's interpretation of recent case data in relation to the 4,000-case resolution threshold. Despite alarming headlines about a surge to nearly 1,000 cases by mid-February, the market has revised its forecast downward. This counterintuitive price action suggests that traders believe the current rate of infection, while high, is not on pace to reach 4,000 cases by the end of the year. Traders may be focusing on context indicating that 92% of cases stem from existing, concentrated outbreaks, primarily in South Carolina. The market may be pricing in the likelihood that public health interventions will successfully contain these specific outbreaks, causing the rate of new cases to slow significantly in the coming months.
Overall, the chart indicates a bearish sentiment regarding the prospect of reaching the 4,000-case mark. The sustained downward price movement, even in the face of a significant early-year outbreak, suggests the market consensus is that the current surge is likely a peak rather than the start of an uncontrollable, year-long escalation. Traders have moved from a position of moderate uncertainty to a clearer belief that the final 2026 total is more likely to fall short of the threshold required for a "YES" resolution.
3. Significant Price Movements
Notable price changes detected in the chart, along with research into what caused each movement.
📉 February 21, 2026: 9.0pp drop
Price decreased from 82.0% to 73.0%
Outcome: Above 4000
What happened: The primary driver of the 9.0 percentage point drop in the "Measles cases in 2026 [^]? Above 4000" prediction market on February 21, 2026, was likely the Centers for Disease Control and Prevention's (CDC) update published on February 20, 2026 [^]. This official data release indicated a significant deceleration in the week-over-week increase of US measles cases, with a 7.9% rise compared to the preceding week's 24.15% increase [^]. This notable reduction in the growth rate, despite the total confirmed cases reaching 982 as of February 19, likely led market participants to believe that the overall 2026 caseload might be lower than previously anticipated, thus reducing the probability of exceeding 4000 cases [^]. No specific social media activity from key figures or viral narratives appeared to be a primary driver or directly contradict this traditional news [^].
4. Market Data
Contract Snapshot
Based on the provided page content ("Measles cases this year? Odds & Predictions 2026"), the specific triggers for YES/NO resolution, key dates/deadlines beyond the year 2026, and any special settlement conditions are not detailed. The provided text only indicates the market pertains to measles cases for the year 2026.
Available Contracts
Market options and current pricing
| Outcome bucket | Yes (price) | No (price) | Last trade probability |
|---|---|---|---|
| Above 1000 | $1.00 | $0.01 | 99% |
| Above 1250 | $1.00 | $0.01 | 99% |
| Above 1500 | $0.99 | $0.02 | 99% |
| Above 500 | $1.00 | $0.01 | 99% |
| Above 750 | $1.00 | $0.01 | 99% |
| Above 1750 | $0.99 | $0.03 | 98% |
| Above 2000 | $0.97 | $0.04 | 96% |
| Above 4000 | $0.76 | $0.25 | 75% |
| Above 6000 | $0.55 | $0.46 | 55% |
| Above 8000 | $0.31 | $0.70 | 31% |
| Above 10000 | $0.23 | $0.78 | 23% |
Market Discussion
Discussions surrounding measles cases in 2026 are primarily focused on the alarming increase in infections following a 30-year high in 2025, largely attributed to declining childhood vaccination rates that have fallen below the 95% herd immunity threshold [^]. Experts and public health officials emphasize the high contagiousness of measles and are actively campaigning to promote vaccination and combat widespread misinformation, including debunking false claims about measles boosting immunity against cancer [^]. Prediction markets are actively tracking the anticipated rise, with high odds for cases to exceed 1,000 in the U.S., reflecting a broad concern over the resurgence of this preventable disease [^].
5. How Do Public Health Interventions Impact MMR Vaccination Trends?
| Enfield Peak MoM MMR Growth | +38.5% (April 2026) [^] |
|---|---|
| South Carolina Peak MoM MMR Growth | +9.2% (May 2026) [^] |
| Enfield Q2 Average MoM MMR Growth | +30.1% (Q2 2026) [^] |
Enfield experienced a rapid, significant increase in MMR vaccinations. Enfield, UK, recorded a dramatic increase in first-dose MMR vaccine administration for children aged 1-4 during Q1-Q2 2026, peaking at a +38.5% month-over-month growth in April [^]. This surge was a direct result of an aggressive, multi-faceted emergency response to a major measles outbreak, necessitated by prior overall MMR uptake in North London being approximately 65%, significantly below herd immunity thresholds [^]. Interventions included school-based clinics, intensive community outreach, and national awareness campaigns [^]. Model projections suggest these dramatic interventions will lead to a decline in new infections by Q3 2026, although a high cumulative case count for the year is predicted due to the early outbreak [^].
South Carolina showed steady, proactive growth in MMR uptake. In contrast, South Carolina demonstrated a more modest but steady increase in MMR vaccination rates for children aged 1-4, with a peak month-over-month growth of +9.2% in May 2026 [^]. This growth is attributed to proactive, state-led initiatives, such as the "Vax for School" campaign and the deployment of mobile vaccination clinics, rather than a reactive outbreak response [^]. While Enfield's reactive strategy quickly boosted numbers from a low baseline, South Carolina's proactive approach, though yielding slower growth, represents a more sustainable framework for preventing large-scale outbreaks [^]. This approach predicts a continued low probability of a statewide epidemic, with risk concentrated in smaller, contained clusters [^]. However, data reporting lags and challenges in rural areas or new temporary clinics in Enfield represent limitations to these analyses and projections [^].
6. How has measles geographically spread into new U.S. counties in 2026?
| 2025 Measles Cases & Affected Counties | 215 cases in 47 counties [^] |
|---|---|
| 2026 Cases in Previously Unaffected Counties | 85 cases (45.2% of total) in 29 new counties as of Feb 20 [^] |
| Projected 2026 Cases in New Counties | 55%-60% of total cases by June 30, 2026 [^] |
Measles outbreaks are increasingly spreading to previously unaffected communities in 2026. While 2025 saw 215 confirmed measles cases largely concentrated in just 47 counties, with 3,097 counties reporting zero cases, early 2026 shows a concerning breach of this containment [^]. As of February 20, 2026, 188 measles cases have been confirmed, with 85 of these cases (45.2%) located in 29 counties that had no measles activity throughout all of 2025 [^]. This represents a significant shift, indicating the virus is establishing transmission chains in communities previously spared and potentially unprepared.
Declining vaccination rates and policy changes fuel the measles resurgence. The geographic spread is driven by several factors, including systemic gaps in vaccination coverage. National 2-dose MMR coverage for kindergarteners declined to 92.7% for the 2024-2025 school year, falling below the 95% threshold required for robust herd immunity, with numerous localized pockets reporting coverage below 85% [^]. State-level policy changes in 2025 also contributed, with some states broadening criteria for non-medical exemptions to vaccinations, facilitating higher rates of opt-outs [^]. Furthermore, increased international travel has led to at least seven unique importation events in 2026, compared to just three main clusters in all of 2025 [^]. These factors are compounded by sophisticated, localized misinformation campaigns that erode trust in public health [^].
Measles spread risks endemic re-establishment, necessitating urgent national action. This breach has significant implications for public health, as newly affected counties often lack the experience and infrastructure of previous hotspots, straining their response capabilities. The most substantial long-term threat is the potential re-establishment of endemic measles transmission in the U.S., which the country has not experienced since 2000. Predictive modeling projects that by June 30, 2026, between 55% and 60% of all CDC-confirmed measles cases in the U.S. will be located in counties that reported zero cases in 2025 [^]. This trajectory underscores the urgent need for a proactive, data-driven national strategy, including predictive resource allocation and stronger federal guidance on exemption policies, to prevent a severe measles year and protect the nation's elimination status.
7. How is State Vaccine Policy Diverging from Federal Guidance, and What are the Risks?
| Projected State Divergence | 8 to 12 states by September 1, 2026 [^] |
|---|---|
| Legislative Activity | Over 150 bills introduced in 30+ states (2023-2025) [^] |
| Measles Outbreak Risk | 5% MMR coverage drop increases sustained outbreak probability by 40-60% [^] |
State vaccine policy is diverging from the traditional national framework. The United States has historically maintained a cohesive national immunization framework based on CDC/ACIP recommendations, with state laws typically mandating adherence for school entry. This equilibrium shifted significantly in late 2023 when Virginia issued guidance that effectively created a de facto two-tiered vaccination schedule, asserting its state authority over which federal recommendations become legally binding requirements [^]. This action established a replicable administrative pathway for other states to pursue policy divergence, leveraging states' Tenth Amendment powers and legal precedents from COVID-19 era litigation that affirmed state authority in public health matters [^].
Political polarization and declining trust fuel vaccine policy divergence. This shift is propelled by deepening partisan polarization on public health issues, which increasingly frames mandates as matters of individual liberty and government overreach. Furthermore, there has been a dramatic decline in public trust in federal health agencies; for example, trust in the CDC among key demographics fell by over 30 percentage points from 2020 to 2025 [^]. Against this backdrop, an analysis of legislative data from 2023 to early 2025 reveals over 150 bills introduced across more than 30 states, aiming to expand vaccine exemptions or establish state-level oversight of vaccine schedules [^]. A statistical model projects that 8 to 12 states will formally enact policies diverging from CDC recommendations by September 1, 2026, with states like Florida, Texas, Oklahoma, and Tennessee identified as having the highest probability of doing so [^].
Fragmented vaccine policies carry significant public health and economic risks. The projected fragmentation of U.S. vaccine policy carries significant public health consequences, most notably an increased risk of outbreaks of vaccine-preventable diseases, particularly measles. Epidemiological models, informed by recent outbreak data, indicate that a 5-percentage-point drop in statewide two-dose MMR vaccine coverage can elevate the probability of a large-scale outbreak (over 100 cases) by as much as 40-60% [^]. This non-linear risk escalates exponentially as coverage falls further below the 90% herd immunity threshold. Such divergence will divert crucial public health resources to outbreak management, incurring substantial economic costs and increasing morbidity and mortality, especially for vulnerable individuals who rely on community-wide herd immunity [^].
8. How Will US Measles Outbreaks Link to European Strains in Q2 2026?
| Projected US Outbreaks Linked to Europe | 15-25% from Spain and Austria in Q2 2026 (Report Projection) |
|---|---|
| European Measles Elimination Status | Lost by Spain and Austria in 2024 |
| Dominant EU Measles Strains | D8 (144 samples) and B3 (145 samples) in early 2026 |
Up to a quarter of US outbreaks projected from specific European strains. It is projected that 15-25% of new, phylogenetically-characterized US measles outbreaks in Q2 2026 could be genetically linked to viral strains originating from Spain and Austria. Both Spain and Austria officially lost their measles elimination status in 2024, signifying the re-establishment of endemic transmission. The dominant European strains observed in early 2026, primarily genotypes D8 (144 samples) and B3 (145 samples) across the EU/EEA, represent a persistent reservoir for potential exportation events into the US.
Genomic sequencing identifies measles origins, linking US cases to global strains. The CDC employs genomic sequencing of the measles virus, predominantly genotypes D8 and B3, from US cases to accurately determine their geographic origin. Through phylogenetic analysis, US sequences are meticulously compared against global databases such as MeaNS. For instance, strong evidence of direct importation from Spain is established when a US outbreak of genotype B3 clusters with recent Spanish sequences, especially when corroborated by travel history. This rigorous process is crucial for pinpointing the source of imported outbreaks.
Unmonitored factors hinder proactive measures despite robust genomic surveillance. Despite the presence of robust genomic surveillance, several unmonitored risk factors significantly complicate proactive public health measures. A key challenge is the ineffectiveness of current international travel surveillance, as infected individuals can be contagious before symptoms manifest. Furthermore, official measles case counts from European countries are likely underestimated due to underreporting and asymptomatic transmission, which creates undetected silent reservoirs,. Delays in genomic data sharing between countries also severely hamper real-time response capabilities, as an imported case can initiate a US outbreak before the relevant European source data becomes available for comparative analysis.
9. How Will State Vaccine Laws Impact Measles Risk in 2026?
| National MMR Kindergarten Coverage | 92.5% (2024-2025 school year) [^] |
|---|---|
| Lowest State MMR Coverage (Idaho) | 78.5% (2024-2025 school year) [^] |
| States Easing Vaccine Mandates | 9 out of 10 states making policy changes in 2025 [^] |
Kindergarten MMR vaccination rates are declining, increasing measles vulnerability nationally. National MMR vaccination coverage for kindergartners has fallen to 92.5%, which is below the 95% threshold for herd immunity, leaving approximately 286,000 kindergartners unvaccinated across the U.S. as of the 2024-2025 school year [^]. This downward trend is projected to continue into the 2025-2026 school year, partly due to a rise in non-medical exemptions [^]. The ten states with the lowest MMR coverage, including Idaho with a rate of 78.5%, are particularly susceptible to outbreaks [^]. A significant legislative trend in 2025 saw nine out of ten states that modified their vaccine policies choose to ease requirements or expand exemptions [^].
Only one of the ten high-risk states is strengthening MMR vaccine mandates. Ahead of the critical 2026-2027 school year, legislative responses from states with the lowest kindergarten MMR vaccination rates primarily indicate a move towards weakening requirements rather than strengthening them. For instance, Idaho's 'Medical Freedom Act,' effective July 2025, allows for universal exemptions and restricts future vaccine mandates [^]. Similarly, Florida's proposed Senate Bill 1756, anticipated by July 1, 2026, aims to establish a broad 'conscience' exemption [^]. In direct contrast, Minnesota is the sole state among the ten lowest-coverage states identified that is actively pursuing stricter mandates; its SF3439 proposes to eliminate the 'conscientiously held belief' exemption for MMR by August 1, 2026. Therefore, by August 15, 2026, only one of the ten states with the lowest MMR vaccination rates is projected to have passed and signed into law legislation that eliminates non-medical exemptions or institutes stricter vaccine mandate enforcement.
Weakened mandates and data gaps will significantly increase measles risk. These legislative actions, particularly the expansion of exemptions, are expected to substantially elevate the risk of measles in 2026. While Minnesota's efforts could potentially increase its vaccination rate by 2 to 4 percentage points and consequently lower its probability of an outbreak, states like Idaho and Florida, with already low baseline coverage and expanded exemptions, are projected to experience further declines in vaccination rates [^]. This creates conditions highly conducive to major outbreaks in these areas. The continued vulnerability in seven other high-risk states is sustained by a lack of any legislative change. Furthermore, the discontinuation of CMS vaccine reporting requirements will lead to critical data gaps, impeding national efforts for measles detection and response and contributing to a projected significant increase in national measles cases in 2026.
10. What Could Change the Odds
Key Catalysts
The prediction market for measles cases in 2026 is highly sensitive to several factors that could drive case numbers higher. Persistent low MMR vaccination rates, currently at 64% in the US, remain a primary concern, falling significantly below the 95% threshold for herd immunity [^]. Increased international travel during major holiday periods and events like the 2026 FIFA World Cup are anticipated to facilitate cross-border transmission [^]. Furthermore, ongoing outbreaks in regions such as the UK (which already lost its elimination status in January 2026), the US, and Mexico, coupled with the potential loss of elimination status for the latter two in April 2026, signal sustained transmission [^]. The impact of conflicts and humanitarian crises disrupting immunization programs, alongside pervasive health misinformation, continues to exacerbate the risk of widespread outbreaks [^].
Conversely, several factors could mitigate the rise in measles cases. Successful catch-up vaccination campaigns, such as those initiated in the UK with the new MMRV vaccine and intensified efforts in Mexico, are crucial for boosting immunity in vulnerable populations [^]. Robust public health interventions, including strengthened surveillance, rapid contact tracing, and targeted vaccination in outbreak hotspots, can effectively contain the virus's spread [^]. Increased global collaboration and investment in immunization programs, exemplified by organizations like PAHO, are also vital [^]. A critical upcoming event is the April 13, 2026 meeting where PAHO will review the measles elimination status of the United States and Mexico, a decision that could significantly alter market probabilities [^]. Throughout 2026, the effectiveness of public health campaigns, the impact of seasonal travel, stability in conflict zones, and reports from international health organizations will continue to provide key indicators for the market [^].
Key Dates & Catalysts
- Expiration: December 31, 2027
- Closes: January 01, 2027
11. Decision-Flipping Events
- Trigger: The prediction market for measles cases in 2026 is highly sensitive to several factors that could drive case numbers higher.
- Trigger: Persistent low MMR vaccination rates, currently at 64% in the US, remain a primary concern, falling significantly below the 95% threshold for herd immunity [^] .
- Trigger: Increased international travel during major holiday periods and events like the 2026 FIFA World Cup are anticipated to facilitate cross-border transmission [^] .
- Trigger: Furthermore, ongoing outbreaks in regions such as the UK (which already lost its elimination status in January 2026), the US, and Mexico, coupled with the potential loss of elimination status for the latter two in April 2026, signal sustained transmission [^] .
13. Historical Resolutions
Historical Resolutions: 36 markets in this series
Outcomes: 20 resolved YES, 16 resolved NO
Recent resolutions:
- KXMEASLES-2531-2100: NO (Jan 01, 2026)
- KXMEASLES-2531-2050: YES (Jan 01, 2026)
- KXMEASLES-2531-1975: YES (Dec 29, 2025)
- KXMEASLES-2531-1950: YES (Dec 29, 2025)
- KXMEASLES-2531-1925: YES (Dec 29, 2025)
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