Key Takeaways
- The United States experienced its largest measles outbreak in over 35 years, with nearly 1,000 cases reported between October 2025 and early 2026, primarily in South Carolina and West Texas.
- Although the outbreaks have been declared over (no new cases for >42 days), the U.S. is still on track to record more measles cases in 2026 than any year since the disease was declared eliminated in 2000.
- Canada lost its measles‑elimination status on November 10, 2025; as of early 2026 it has reported 907 cases, with Manitoba accounting for the majority (556 cases).
- In 2025 Canada recorded 5,436 measles cases, including two deaths, highlighting a resurgence that began before the 2026 surge.
- The Pan American Health Organization (PAHO) issued an epidemiological alert urging stronger surveillance, timely vaccination, and community‑based case‑finding across the Americas.
- Manitoba responded by expanding pharmacists’ scope of practice to administer measles vaccine to youths aged 2‑19, aiming to improve accessibility and boost immunity.
Overview of the Recent Measles Resurgence in North America
Measles, a highly contagious vaccine‑preventable disease, has re‑emerged in both the United States and Canada after years of sustained elimination. In the U.S., state health officials announced the conclusion of the largest outbreak in more than three‑and‑a‑half decades, centered in South Carolina and mirrored by a separate surge in West Texas. Simultaneously, Canada’s loss of measles‑elimination status in late 2025 precipitated a notable rise in cases across several provinces, prompting public‑health alerts and vaccine‑access initiatives. The parallel timelines underscore how gaps in immunization coverage can quickly translate into widespread transmission, even in countries that previously achieved elimination status.
Details of the South Carolina Outbreak
The South Carolina Department of Public Health reported that the first measles cases linked to the outbreak appeared in October 2025. Over the ensuing six months, nearly 1,000 laboratory‑confirmed cases were identified, with more than 600 occurring in 2026 alone. The outbreak resulted in at least 21 hospitalizations, though fortunately no deaths were attributed to this cluster. Health officials emphasized that the outbreak’s containment relied on aggressive case identification, isolation of infectious individuals, and targeted vaccination campaigns in affected communities. The absence of fatalities was credited to timely medical care and the relatively high baseline vaccination coverage in the state, despite pockets of susceptibility that fueled the spread.
West Texas Measles Surge and Its Consequences
Concurrent with the South Carolina episode, West Texas experienced a significant measles wave from January 2025 through August 2025, accumulating over 760 reported cases. This outbreak disproportionately affected children, with more than two‑thirds of cases occurring in pediatric populations, and led to 99 hospitalizations. Tragically, two children died as a result of measles complications, underscoring the severe outcomes that can arise when the virus reaches unvaccinated or under‑vaccinated groups. The Texas Department of State Health Services highlighted that the majority of transmissions occurred within close‑contact settings such as schools, daycare centers, and households, reinforcing the importance of maintaining high two‑dose MMR (measles, mumps, rubella) coverage to interrupt chains of infection.
Implications for the United States Moving Forward
Although state officials declared both outbreaks over after more than 42 days with no new associated cases, epidemiological models suggest the United States remains vulnerable to a larger measles burden in 2026. Experts warn that if current trends persist, the nation could record its highest annual measles count since the disease was declared eliminated in 2000. This projection is driven by lingering immunity gaps, vaccine hesitancy in certain communities, and the potential for importation of cases from international travelers. Public‑health agencies continue to advocate for routine immunization checks, catch‑up campaigns for adolescents and adults, and robust surveillance to detect and respond swiftly to any sporadic cases before they ignite wider transmission.
Canada’s Loss of Measles‑Elimination Status
Canada’s measles‑elimination status was officially revoked on November 10, 2025, after sustained transmission disrupted the goal of zero endemic cases. Since the start of 2026, Health Canada’s measles and rubella weekly monitoring report has logged 907 reported cases nationwide, of which 834 are laboratory‑confirmed and 73 remain probable. The provincial breakdown reveals Manitoba as the epicenter with 556 cases, followed by Alberta (281), British Columbia and Ontario (23 each), Nova Scotia (10), Quebec (9), and Saskatchewan (5). These figures illustrate a concentrated outbreak primarily affecting the Prairie provinces, while other regions experience only sporadic import‑related cases.
Historical Context: Canada’s 2025 Measles Burden
Prior to the 2026 surge, Canada already faced a substantial measles resurgence in 2025, recording 5,436 cases (4,777 confirmed, 361 probable) and suffering two fatalities. This high case count indicated that immunity gaps had persisted well before the loss of elimination status, setting the stage for continued transmission into the following year. The dual‐year data highlight the importance of maintaining high vaccination coverage not only to achieve elimination but also to sustain it, as even modest declines in immunity can precipitate large outbreaks when the virus is reintroduced.
PAHO’s Response and Recommendations
On February 3, 2026, the Pan American Health Organization (PAHO) issued an epidemiological alert urging member states—including Canada and the United States—to prioritize strengthening routine surveillance, ensuring rapid investigative responses to suspected measles cases, and closing immunity gaps through targeted vaccination efforts. PAHO’s analysis found that 98 % of Canadian measles cases were acquired domestically, with less than 1 % having an unknown or under‑investigated source of exposure, underscoring that local transmission rather than importation drove the surge. The organization recommended active community, institutional, and laboratory searches for early case detection, alongside complementary vaccination activities such as school‑based clinics and outreach to underserved populations.
Manitoba’s Initiative to Expand Vaccine Access
In response to its leading case count, the Manitoba government announced on March 31 that pharmacists in the province are now authorized to administer the measles vaccine to individuals aged two through nineteen, effective immediately. Health Minister Uzoma Asagwara described the move as a “commonsense step” that leverages the trusted, accessible role of pharmacists to increase vaccine uptake among children and adolescents—groups most affected by the outbreak. By broadening the pool of vaccine‑administrators, Manitoba aims to reduce logistical barriers, improve convenience for families, and bolster herd immunity in a jurisdiction where measles transmission has been most intense.
Conclusion: The Path Forward for measles Control in North America
The recent measles experiences in the United States and Canada illustrate both the fragility of elimination status and the potency of coordinated public‑health interventions. While the specific outbreaks in South Carolina, West Texas, and Manitoba have been contained, the underlying challenges—vaccine hesitancy, inequitable access, and surveillance lapses—persist. Sustained investment in routine immunization, rapid case detection, and community‑engaged education will be essential to prevent future resurgences and to reclaim and maintain measles elimination across the continent. Continued vigilance, guided by alerts from bodies like PAHO and proactive measures such as Manitoba’s pharmacist‑led vaccination program, offers a roadmap toward safer, measles‑free communities.