Measles Cases Surpass 2000 in 2026, Threatening US Elimination Status

The United States is on pace to surpass its 2025 measles case total before summer's end. As of June 25, 2026, the CDC confirmed 2134 measles cases in 41 jurisdictions, including 30 new outbreaks and 1982 cases—93%—that are linked to ongoing outbreak activity.¹

Among the 2026 cases, 93% occurred in patients who were unvaccinated or had unknown vaccination status, 4% in patients who had received 1 dose of MMR, and 4% in patients with 2 doses. By age group, 21% of cases were reported in children under 5 years, 51% in patients aged 5 to 19 years, and 28% in patients aged 20 years or older. A total of 136 patients were hospitalized, representing 6% of all confirmed cases. No deaths have been reported to date in 2026.¹

The full-year 2025 total was 2288 confirmed cases, itself a 30-year high, and the nation's 2000 measles elimination status is now under direct threat as vaccine coverage continues to erode and the Pan American Health Organization (PAHO) prepares to review that status in November 2026.²

A National Crisis Defined by Declining Immunity

The root cause of the current resurgence is well-documented. National measles, mumps, rubella (MMR) vaccination coverage among kindergartners declined from 95.2% during the 2019–2020 school year to 92.5% in the 2024–2025 school year, according to the CDC.¹ That figure falls short of the greater-than-95% threshold required to maintain community immunity—commonly called herd immunity—and leaves approximately 286,000 kindergartners across the country at risk. At local levels, coverage can fall far lower, such as in some Texas communities, where vaccination rates dropped to as low as 50%, fueling the largest single-state outbreak in recent years, which reached over 720 cases by mid-2025.³

Utah offers the most acute current example. The state recorded 673 measles cases as of May 2026—its largest outbreak in 40 years—with 12% of kindergartners either exempt from the MMR vaccine or lacking proper documentation during the 2025–2026 school year. The outbreak prompted health officials to deploy advanced surveillance tools, including a wastewater dashboard to detect viral shedding in communities, and to issue recommendations for early extra MMR doses for infants as young as 6 months.²

Research on vaccination coverage trends after outbreaks suggests the damage is difficult to reverse. A cross-sectional study published in JAMA Network Open examined MMR coverage in a central Ohio pediatric care network of approximately 150,000 children in the 20 months following a 2022 postelimination outbreak. Timely receipt of the first MMR dose remained unchanged throughout the observation period, and the highest level of overall coverage observed—77.9%—was still significantly below the 93% herd immunity threshold defined by the World Health Organization (WHO) Region of the Americas. The authors concluded that targeted, data-informed public health strategies and ongoing surveillance are urgently needed to close immunity gaps.⁴

Misinformation, Hesitancy, and the Pharmacist's Role

Beyond clinical protocols, the measles resurgence presents pharmacists with a communication challenge of equal urgency. Surveys show that one-third of US adults have encountered the false claim that the MMR vaccine is more dangerous than measles infection itself, and some patients believe vitamin A can prevent the disease. Although vitamin A can help manage complications of active measles infection, it does not prevent the virus; the link between vaccines and autism—repeatedly debunked—continues to fuel hesitancy in some communities.³

Traditional advice-giving often backfires in these encounters, causing patients to become defensive. A session at the American Pharmacists Association 2026 Annual Meeting and Exposition addressed this dynamic directly. Ashley Chinchilla, PharmD, BCACP, associate IPPE director of ambulatory care at the University of Georgia School of Pharmacy, presented on the use of motivational interviewing (MI) as a framework for rebuilding patient trust.⁵

"When you have compassion for someone, you're not only feeling what they're feeling, but you are making an intentional choice to prioritize that person's well-being," Chinchilla said during the session.⁵ "Encouraging and supporting the person's autonomy is a big component of MI."

MI, a collaborative, person-centered guiding style first developed in the 1980s for the treatment of alcohol use disorders, has since been adapted across health care disciplines, including pharmacy. According to the American College of Clinical Pharmacy, MI is designed to elicit and strengthen a patient's own internal motivation for change—a priority in vaccine hesitancy conversations where lecturing patients tends to deepen resistance rather than reduce it. Pharmacists can apply the "OARS" technique: asking open-ended questions, offering affirmations, using reflections to confirm the patient feels heard, and summarizing the dialogue to establish a path forward.⁵

Practical tools such as the "readiness ruler"—in which a patient rates their vaccination intent on a scale of 1 to 10—can efficiently surface a patient's own reasons for considering a vaccine, a concept MI practitioners call "change talk." When a patient gives a midrange score, asking why they chose that number over a lower one prompts them to articulate their own openness to vaccination, which is far more persuasive than an external argument.⁵

Lauren Angelo, PharmD, associate dean for academic affairs at Rosalind Franklin University in North Chicago, Illinois, emphasized the importance of pharmacist visibility and accessibility in building long-term trust with hesitant communities.

"Trust is something that, in most cases, needs to be earned, and if that trust is lost, it is a very difficult hill to overcome to regain that trust," Angelo said.³ "I think to build that trust and rapport, we need to be present and we need to be seen as a resource within our community. If we're able to step outside of the pharmacy and offer clinics or educational sessions that are offsite and during extended hours so patients can attend, that will go a long way in building that trust and rapport and working at that individual level with specific patients."

As PAHO prepares to evaluate the United States' measles elimination status this fall, the measles resurgence represents both a clinical and communication emergency—one in which pharmacists' dual role as immunization providers and trusted community health educators has never been more consequential.^2,3,5

"Misinformation about vaccines is on the rise," Chinchilla concluded.⁵ "Addressing vaccine misinformation effectively requires both accurate information and effective communication. MI can be useful in navigating [these] conversations."

REFERENCES

1. CDC. Measles cases and outbreaks. Centers for Disease Control and Prevention. June 5, 2026. Accessed June 29, 2026. https://www.cdc.gov/measles/data-research/index.html

2. Gallagher A. Postexposure prophylaxis proves effective against measles in infants. Drug Topics. May 27, 2026. Accessed June 29, 2026. https://www.drugtopics.com/view/postexposure-prophylaxis-proves-effective-against-measles-in-infants

3. Gallagher A. Measles outbreak reaches over 800 confirmed cases in the US. Drug Topics. June 7, 2025. Accessed June 29, 2026. https://www.drugtopics.com/view/measles-outbreak-reaches-over-800-confirmed-cases-in-the-us

4. Nowosielski B. Measles vaccine coverage persists well below herd immunity threshold. Drug Topics. September 29, 2025. Accessed June 29, 2026. https://www.drugtopics.com/view/measles-vaccine-coverage-persists-well-below-herd-immunity-threshold

5. Nowosielski B. Motivational interviewing is paramount in addressing vaccine hesitancy. Drug Topics. March 29, 2026. Accessed June 29, 2026. https://www.drugtopics.com/view/motivational-interviewing-is-paramount-in-addressing-vaccine-hesitancy-apha-2026