Measles cases in 2026?

A severe measles epidemic prompts a strategic shift in CDC funding. The United States is currently experiencing a severe measles epidemic, with 588 confirmed cases reported by late January 2026, potentially reaching approximately 7,400 cases for the year if current trends persist . This surge follows a decline in childhood measles vaccination coverage to 92.7% during the 2023-2024 school year, falling below the 95% threshold required for herd immunity . In response to this crisis, the Centers for Disease Control and Prevention's (CDC) Fiscal Year 2026 budget proposes a strategic shift towards long-term public health infrastructure investments. These investments prioritize advanced data systems, enhanced laboratory capacity, and improved frontline readiness . This proactive funding model contrasts sharply with the reactive emergency supplemental funds allocated in 2025, which primarily addressed immediate crisis costs .

Global funding contraction complicates long-term domestic health investments. This shift towards long-term infrastructure investment occurs amid a significant contraction in global health funding. Between 2025 and 2026, aid from major donors is projected to decline by 11.3%, coupled with a 40% loss in overall USAID funding . This global decline heightens the risk of international measles outbreaks and subsequent importations, which could exacerbate the domestic epidemic . While the strategic focus on new data systems and laboratory upgrades in the FY2026 budget is important, their full benefits may not be realized for one to three years . Consequently, continued escalation of measles cases is probable in the first half of 2026 due to existing immunization gaps and increased importation risks. The effectiveness and rapid disbursement of "frontline readiness" funding will be critical for containing outbreaks in the latter half of 2026 and beyond; sufficient, agile funding could reduce case counts below initial projections, whereas inadequate funding risks exponential growth .

MMR vaccine non-medical exemptions are projected to increase for the 2025-2026 school year. Non-medical exemption (NME) rates for the Measles, Mumps, and Rubella (MMR) vaccine are anticipated to continue rising in Florida, Texas, Arizona, and Ohio for the 2025-2026 school year. This trend is significantly influenced by legislative developments, such as Florida's proposed 'Medical Freedom Act' (Senate Bill 1756) and Ohio's Parental C.H.O.I.C.E. Act (House Bill 561), both designed to broaden or protect exemption rights. In Texas, administrative streamlining, including making exemption forms downloadable, has already contributed to a 36% increase in NME requests in July 2025 compared to July 2023.

Rising exemption rates are demonstrably weakening herd immunity, leading to increased measles cases. The upward trend in exemption rates directly contributes to weakened herd immunity, a concern underscored by recent measles outbreaks. Arizona, for instance, experienced a significant surge from five measles cases in 2024 to 214 in 2025. Nationally, the United States recorded 2,242 measles cases in 2025, marking a 33-year high, with 93% of these cases occurring in unvaccinated individuals.

Measles cases in 2026 are highly probable to surpass 2025's record. The combination of expanding exemptions, a growing susceptible population, and the early 2026 case count, which reached 588 by early February, strongly suggests that measles cases in 2026 will likely exceed the record set in 2025. This risk is particularly elevated in identified hotspots such as Florida, Texas, Arizona, and Ohio.

Measles projections for the second half of 2026 reveal contrasting trends among Mexico, the United Kingdom, and Brazil. Mexico faces a severe and accelerating measles outbreak. The country reported an incidence rate of approximately 5.6 cases per million in early Q1 2026, with vaccination coverage remaining below the 95% threshold. This trajectory indicates a continued acceleration of the outbreak, posing an imminent threat to Mexico's measles elimination status for the second half of 2026.

The United Kingdom risks continued outbreaks and potential acceleration. Despite a low incidence rate near zero per million in early Q1 2026, the UK officially lost its measles elimination status on January 26, 2026, following sustained transmission over the previous year. With two-dose MMR coverage for five-year-olds at only 83.7%, public health experts warn of continued outbreaks and potential acceleration into the second half of 2026 if vaccination uptake does not significantly improve.

Brazil exemplifies successful measles containment and vigilance. The nation reported only approximately 0.2 cases per million in 2025 and was re-verified as measles-free in November 2024. Bolstered by robust public health infrastructure and MCV1 coverage at 87% in 2023, projections for the second half of 2026 focus on maintaining vigilance against importation and sustaining containment efforts.

The United States is experiencing a significant measles resurgence in 2026. A total of 737 confirmed cases have been reported across more than 17 states. The Centers for Disease Control and Prevention (CDC) recorded 588 cases as of January 29, 2026, noting that 94% of these cases are linked to ongoing outbreaks. High susceptibility among affected individuals is a critical factor, with 85% to 94% of those infected being unvaccinated or having an unknown vaccination status, primarily impacting children and adolescents.

Five states show the highest measles case counts in Q1 2026. South Carolina leads with 524 cases, followed by Utah (45 cases), Arizona (24 cases), North Carolina (14 cases), and Florida (9 cases). In these states, state legislation enacted between 2020 and 2025 has demonstrably limited the legal authority of county-level public health departments. These legislative changes specifically impact their ability to issue mandatory quarantine or school exclusion orders for unvaccinated individuals. Such modifications often introduce political or judicial oversight into public health decisions, creating delays and hindering a rapid response to fast-moving pathogens like measles.

The United States faces a critical threat to its measles elimination status. The nation is experiencing an unprecedented measles crisis, with confirmed infections reaching a 33-year high of 2,242 cases in 2025, and an additional 588 cases reported by January 30, 2026. This surge is largely driven by persistent, large outbreaks within under-vaccinated communities. The longest-running active transmission chain currently being tracked began in Upstate South Carolina on October 2, 2025. Based on the World Health Organization's definition of elimination, the U.S. is projected to lose its measles elimination status on October 2, 2026, if this particular chain of transmission continues uninterrupted, marking 12 consecutive months of endemic transmission.

Losing elimination status would profoundly impact public health strategies. This outcome would signify a substantial failure of the U.S. public health system, necessitating a strategic shift from 'outbreak containment' to 'endemic disease control.' Such a change would require constant, resource-intensive surveillance and control measures, thereby placing additional strain on already underfunded state and local health departments. It is also anticipated to lead to an inevitable rise in baseline annual cases, hospitalizations, and deaths, posing a severe threat to vulnerable populations, including infants and immunocompromised individuals [Learning]. Internationally, the U.S. would face increased scrutiny, particularly from the Pan American Health Organization (PAHO), which has scheduled a virtual meeting on April 13, 2026, to review the measles elimination status of both the U.S. and Mexico [Learning]. Domestically, a major contributing factor remains underlying vaccination gaps, with 93-94% of 2026 measles cases occurring in individuals with unvaccinated or unknown vaccination status.

Regaining measles elimination status presents a significant multi-year challenge. Should elimination status be lost, the process to re-establish it would be arduous, requiring the interruption of all endemic transmission. Following this, a sustained period of at least 12 months without any endemic transmission would be necessary, with a further 36 months required for formal re-verification of elimination [Learning].

The trajectory of measles cases in 2026 could be significantly impacted by several bullish catalysts, primarily a continued decline in global and national MMR vaccination rates. The U.S. kindergarten MMR vaccination rate dropped to 92.5% in 2024-2025, well below the 95% herd immunity threshold. Globally, first-dose coverage was 84% in 2024. Furthermore, the escalation of existing outbreaks, such as the 2,200 U.S. cases in 2025 and 588 by January 29, 2026, or Mexico's 740 cases in early 2026, signals ongoing spread. Increased international travel, particularly due to events like the FIFA World Cup in 2026, persistent vaccine hesitancy fueled by misinformation, and weakened public health infrastructure, as seen in the Democratic Republic of Congo, also contribute to a higher probability of more cases. Conversely, several bearish catalysts could lead to fewer measles cases. Aggressive and effective catch-up vaccination campaigns, like UNICEF's initiative to vaccinate 6 million children in Sudan in January 2026 and Mexico's urgent mobile clinics, could substantially boost immunity. Re-engagement with international health organizations such as WHO or PAHO, alongside improved public health messaging, could foster more coordinated and trusted efforts. Rapid and effective public health responses, including contact tracing and targeted vaccination, that successfully contain existing outbreaks would also reduce overall case numbers. Throughout 2026, key dates and ongoing monitoring will be crucial. This includes watching for additional vaccine deliveries, like the 4.1 million doses for Sudan in early February, and continuous reports on vaccination rates from CDC, WHO, and PAHO. Updates on measles outbreaks, especially from the Americas, will indicate the effectiveness of containment. The FIFA World Cup from June 11 to July 19, 2026, poses a risk for increased transmission. Monitoring whether countries like the U.S. and Mexico lose their measles elimination status, along with final 2026 case data expected in December, will directly influence the outcome.