Unfortunately, measles and bird flu have gotten worse. Johns Hopkins epidemiologist Caitlin Rivers reports in her “Force of Infection” Substack blog that, while the numbers of outpatient visits for children with flu declines, “most of the country is still recording high or even very high levels of activity. The Northeast is currently most affected, with several eastern states reporting very high levels of activity. The Northeast also has the highest percentage of visits to the emergency department (ED) that are for influenza. The Southern region and eastern portion of the Midwest are also still in the thick of it. The Western region is more mixed, with some states already declining into the moderate category, while others are still reporting high or very high levels of activity.”
Onto Katelyn Jetelina, “Your Local Epidemiologist,” and her update on measles:
The measles outbreak in West Texas is growing. This is the most contagious virus, making any public health response resource-heavy. But two obstacles are making this outbreak particularly challenging: 1. The true number of cases is unclear. The official count is 228 cases across 10 counties. Note: New Mexico’s measles outbreak — 30 cases, 1 death — is now genetically linked to Texas, meaning these two outbreaks are one …
Dr. Jetelina continues:
Measles marches on, facing two major challenges. It’s very hard to say whether we are at the beginning or middle of the outbreak, mostly because I don’t trust the numbers. Several signs suggest substantial underreporting:
• Death ratio. We’ve seen two deaths so far, yet only 228 cases have been reported. Measles typically kills 1 in 1,000 unvaccinated individuals. They were either extremely unlucky, or there are more cases than reported.
• Very sick hospitalized patients. By the time these hospitalized children get to the hospital, they are very sick, meaning parents may be delaying care. The second measles fatality (which was an unvaccinated adult) never even went to the hospital.
• Epidemiologists are encountering resistance to case investigations…. The community at the center of this outbreak is likely far larger than official U.S. Census figures suggest.
• I wager the ‘true’ count is much higher than reported. A CDC response team is now on the ground, working directly with local and state epidemiologists to help get this under control.
She created the following map to illustrate some of the health threats we are facing across the country:
It only took a day before the measles portion of this map was outdated. As The Washington Post reported on March 12, 2025, measles had spread to both coasts:
The Post reported:
Los Angeles County in California, Suffolk County in New York and Howard County in Maryland detected their first confirmed cases of measles this year, while Oklahoma reported two possible cases, local health authorities said this week. The spread of the highly infectious disease comes as an outbreak of more than 200 cases has continued to grow in Texas, and as the Centers for Disease Control and Prevention warned health-care workers and potential travelers to ‘be vigilant’ ahead of spring and summer travel.
Health officials in Los Angeles County — the most populous county in the United States — reported a case Tuesday in a resident who may have been exposed on board a China Airlines flight that landed at Los Angeles International Airport on March 5. The New York State Department of Health announced on Tuesday its first known case of measles outside New York City this year. The patient, who is younger than 5 years old, lives in Suffolk County on Long Island.
Sadly, we have been recently reminded of the ever-present danger measles presents and have learned firsthand the consequences of the lackluster federal response. Earlier, on March 9, 2025, the Virginia Department of Health issued this bulletin:
The Virginia Department of Health offered this guidance:
Listed below is the date, time, and location of the potential exposure site: Dulles International Airport (IAD): in Terminal A, on transportation to the main terminal and in the baggage claim area between 4 p.m. and 9 p.m. on Wednesday, March 5.
Measles is a highly contagious illness that can spread easily through the air when an infected person breathes, coughs, or sneezes. Measles symptoms usually appear in two stages. In the first stage, most people have a fever of greater than 101 degrees, runny nose, watery red eyes, and a cough. These symptoms usually start seven to 14 days after being exposed. The second stage starts three to five days after symptoms start, when a rash begins to appear on the face and spread to the rest of the body. People with measles are contagious from four days before the rash appears through four days after the rash appeared.
What should you do if you were at the above location on the day and time specified? If you have never received a measles containing vaccine (either the measles, mumps and rubella [MMR] vaccine or a measles-only vaccine which is available in other countries), you may be at risk of developing measles. Anyone who was exposed and considered to be at risk of developing measles should contact their healthcare provider immediately.
[Emphasis added.]
Yes, despite rampant anti-vaccination propaganda, without the measles, mumps, and rubella (MMR) vaccine or a measles-only vaccine, you risk developing measles. Here, for the moment at least, is what the CDC has to say about measles and how it spreads:
Measles is one of the most contagious of all infectious diseases. Up to 9 out of 10 susceptible people with close contact to a measles patient will develop measles. The virus is transmitted by:
• Direct contact with infectious droplets.
• Airborne spread when an infected person breathes, coughs, or sneezes.
Measles virus can remain infectious in the air for up to 2 hours after an infected person leaves an area.
In its March 11, 2025 analysis, “Where U.S. Measles Outbreaks Are Spreading,” The New York Times noted:
Measles continues to spread in West Texas and New Mexico, with more than 250 people infected — many unvaccinated school-age children. Two cases in Oklahoma, for which state officials have not provided a location, have also been linked to these outbreaks. Eleven other states have reported isolated measles cases, typically linked to international travel …
In both states, most measles cases have spread among people who are unvaccinated or with unknown vaccine status. For years, Gaines County has had low childhood vaccination rates, largely because of the area’s large Mennonite community. While there is no religious doctrine that explicitly forbids vaccines, the insular Christian group has historically avoided interacting with the health care system and has a long tradition of using home remedies and supplements. Roughly 82 percent of the kindergarten students in the county had received the measles-mumps-rubella vaccination, or M.M.R., last year, which is far below the 95 percent coverage needed to prevent outbreaks in a community …
Vaccination rates can vary widely by school district. The Loop Independent School District in Gaines County is a small district with one school and the lowest rate of measles vaccination in the affected Texas counties. Only 46 percent of kindergarten students had received their M.M.R. vaccine in the 2023 school year, down from 82 percent in 2019 …
In Lea County, N.M., the M.M.R. vaccination rate for children and teens is relatively high, at about 94 percent. But the rate among adults is much lower: 63 percent have received one shot of M.M.R., and only 55 percent have received both shots, according to local health officials, though they noted that there may be vaccinated adults whose records have not been added to the system. Adults make up more than half of reported cases in New Mexico.
Measles is one of the most contagious known infections. In a hypothetical community where nobody had immunity from the virus and each infected person infected 18 others, a small outbreak would quickly grow out of control.
[Emphasis added.]
You would imagine, as I have previously reported, that with the obvious signs of the clear and present danger we are facing from measles and influenza, with all these very real threats to our public health, Health and Human Services (HHS) Secretary Kennedy would have his hands full protecting the American people. Yet, he remains determined to wage the wrong war. Not on disease, but on public health. Not on measles and the flu, but on vaccination.
Two recent articles clearly illuminate his determination to deny the combined knowledge and experience of almost every accomplished expert in epidemiology and medicine as he pursues his discredited political agenda. The New York Times reported on a recent FOX interview in which Kennedy not only endorsed a discredited treatment protocol for measles but suggested, contrary to current CDC analysis, that the measles vaccine might have been responsible for the outbreak:
The Times wrote:
In a sweeping interview, Robert F. Kennedy Jr., the health and human services secretary, outlined a strategy for containing the measles outbreak in West Texas that strayed far from mainstream science, relying heavily on fringe theories about prevention and treatments. He issued a muffled call for vaccinations in the affected community, but said the choice was a personal one. He suggested that measles vaccine injuries were more common than known, contrary to extensive research.
He asserted that natural immunity to measles, gained through infection, somehow also protected against cancer and heart disease, a claim not supported by research … Mr. Kennedy described vaccination as a personal choice that must be respected, then went on to raise frightening concerns about the safety of the vaccines. He said he’d been told that a dozen Mennonite children had been injured by vaccines in Gaines County. People in the community wanted federal health workers arriving in Texas ‘to also look at our vaccine-injured kids and look them in the eye,’ Mr. Kennedy said.
Yet the M.M.R. vaccine itself has been thoroughly studied and is safe. There is no link to autism, as the secretary has claimed in the past. While all vaccines have occasional adverse effects, health official worldwide have concluded that the benefits far outweigh the very small risks of vaccination. Mr. Kennedy asserted otherwise: ‘We don’t know what the risk profile is for these products. We need to restore government trust. And we’re going to do that by telling the truth, and by doing rigorous science to understand both safety and efficacy issues.’ …
Early in the interview, Mr. Kennedy acknowledged the seriousness of measles infection, noting that it can lead to death, brain swelling and pneumonia. But he also described the illness as rarely fatal, even before 1963, when the vaccine became available. He said measles has a ‘very, very low infection fatality rate.’ According to the Centers for Disease Control and Prevention, for every thousand people infected with measles in the United States, the virus kills one to three. One study estimated that without vaccination today there would be 400,000 hospitalizations and 1,800 deaths annually.
Mr. Kennedy said the Department of Health and Human Services would conduct clinical trials on several unproven treatments for measles, including a steroid, budesonide; an antibiotic called clarithromycin; and cod liver oil, which he said was ‘the safest application of vitamin A.’ Mr. Kennedy said he had heard from two local doctors that these treatments had led to ‘miraculous and instantaneous recovery … We need to really do a good job of talking to the frontline doctors and see what is working on the ground,’ he said. ‘Those therapeutics have really been ignored by the agency for a long, long time.’
Mr. Kennedy’s focus on unverified treatments has frustrated some doctors in Gaines County, who have been trying to explain to patients that there is no antiviral for measles and that they have little control over which patients suffer serious symptoms. ‘We already are dealing with people that think measles is not a big deal,’ said Dr. Leila Myrick, a family medicine doctor in Seminole, Texas, who has been caring for patients with measles for several weeks. ‘Now they’re going to think they can get this miracle treatment and that they definitely don’t need to get vaccinated. It’s a 100 percent going to make it harder.’
[Emphasis added.]
Kennedy Jr. often makes claims that are only partially accurate. Katelyn Jetelina and Dr. Kristen Panthagano offer some additional context:
Vitamin A is helpful for children deficient in vitamin A. When it comes to measles, vitamin A is recommended by the World Health Organization (WHO) for people who contract the disease. But there’s a key reason why. The WHO serves 197 countries, many of which are low- and middle-income nations where vitamin A deficiency is a major public health issue, particularly among children. In these areas, vitamin A deficiency does make measles far more dangerous because it plays a crucial role in immune dysfunction, particularly in T cell responses and antibody production.
Supplementing among deficient children significantly reduces measles mortality:
• A meta-analysis of more than 1 million children across 19 countries found that vitamin A supplementation reduces measles-related mortality by 12%.
• An analysis of eight randomized controlled trials found no overall mortality reduction from vitamin A. However, in three studies focused on African children under two years old, vitamin A supplementation reduced mortality by 79%.
However — and this is important — context matters. The U.S. context: Minimal benefit, real risks. Only 0.3% of the U.S. population has a vitamin A deficiency. While we don’t have large-scale U.S. data because measles is now quite rare thanks to vaccination, smaller studies from other high-income countries with similarly low levels of vitamin A deficiency suggest vitamin A doesn’t make much of a difference for measles …
There is some data to suggest vitamin A levels may drop during a measles infection, which is partly why physicians in the U.S. often give vitamin A to children with severe measles requiring hospitalization. When administered in controlled doses under the supervision of a doctor, it is a low-risk intervention, which is why many physicians in Texas are likely giving it to hospitalized measles patients right now and why WHO has a sweeping recommendation. But in the U.S., it’s unclear how much it’s really helping …
Why doesn’t everyone just take vitamin A? Because you can overdose on it. Home supplementation of vitamin A is risky, especially for children. Since vitamin A is a fat-soluble vitamin, excess amounts can’t be easily excreted and can build up to toxic levels. This can lead to liver damage and other serious health issues. This risk is compounded by the fact that supplements in the U.S. aren’t well regulated. Unlike prescription medications, vitamin A supplements sold at stores like CVS aren’t tested for consistency or purity by the FDA —meaning the actual dose in each pill can vary.
You might remember Admiral Brett P. Giroir, M.D., who served as the assistant secretary for health at HHS during the first Trump administration. He quickly posted on X (formerly Twitter) in response to the Kennedy interview:
Thank you @RealRFKJR2024 for emphasizing the critical importance of #Measles vaccination and the need for education & compassion to parents. But please do not rely on #VitaminA to save your child in the US – helps in Africa where there is deficiency-not here. I have both treated…
— Brett Giroir (@DrGiroir) March 3, 2025
As I did my own research, I found a recent study in The Pediatric Infectious Disease Journal titled “Vitamin A in Children Hospitalized for Measles in a High-income Country,” which examined the effectiveness of Vitamin A during a measles outbreak in Italy. The authors wrote:
Worldwide medical authorities recommend vitamin A supplementation for severe measles requiring hospitalization; however, evidence supporting its use in high-income countries is lacking. A nationwide vitamin A shortage reported in concomitance with a recent measles outbreak in Italy provided an opportunity to test the effectiveness of vitamin A in a high-income setting, approximating an unbiased allocation.
A total of 108 inpatient children (36% female, median age 16.3 months) were enrolled; 36 received 2 doses of oil-based vitamin A according to age, and 72 matched controls received standard care. There were no significant differences between the study groups in the duration of fever … length of hospitalization … maximum body temperature … rate of organ … and hematologic complications … or need for antibiotic treatment … Overall, vitamin A supplementation did not reduce the risk of any complications … Conclusion: Vitamin A does not change the clinical course of measles infection or the rate of complications in children hospitalized in a high-income country.
[Emphasis added.]
As Dr. Robert H. Shmerling noted in “Measles is making a comeback: Can we stop it?,” there are things people might not know but need to know about measles:
The measles virus readily spreads from person to person through the air we breathe. It can linger in the air for hours after a sneeze or cough. Estimates suggest nine out of 10 nonimmune people exposed to measles will become infected. Measles is far more contagious than the flu, COVID-19, or even Ebola.
Early diagnosis is challenging. It usually takes seven to 14 days for symptoms to show up once a person gets infected. Common early symptoms — fever, cough, runny nose — are similar to other viral infections such as colds or flu. A few days into the illness, painless, tiny white spots in the mouth (called Koplik spots) appear. But they’re easy to miss, and are absent in many cases. A day or two later, a distinctive skin rash develops. Unfortunately, a person with measles is highly contagious for days before the Koplik spots or skin rash appear. Very often, others have been exposed by the time measles is diagnosed and precautions are taken … During the latest outbreaks, more than one in six cases has required hospitalization.
Getting measles may suppress your immune system. When you get sick from a viral or bacterial infection, antibodies created by your immune system will later recognize and help mount a defense against these intruders. In 2019, a study at Harvard Medical School (HMS) found that the measles virus may wipe out up to three-quarters of antibodies protecting against viruses or bacteria that a child was previously immune to — anything from strains of the flu to herpesvirus to bacteria that cause pneumonia and skin infections.
‘If your child gets the measles and then gets pneumonia two years later, you wouldn’t necessarily tie the two together. The symptoms of measles itself may be only the tip of the iceberg,’ said the study’s first author, Dr. Michael Mina, who was a postdoctoral researcher in the laboratory of geneticist Stephen Elledge at HMS and Brigham and Women’s Hospital at the time of the study.
[Emphasis added.]
Quite clearly, HHS Secretary Kennedy Jr. isn’t reading what Rivers, Jetelina, and Panthagano have to say. But it also seems as if he isn’t acknowledging what his own CDC is reporting. As of March 7, their weekly surveillance of influenza notes:
All 10 HHS regions are above their region-specific baselines. Thirty-two jurisdictions reported high or very high levels of influenza-like illness. This is down from 42 jurisdictions last week. Based on data from FluSurv-NET, the cumulative hospitalization rate for this week is the highest observed since the 2010-2011 season. Sixteen pediatric deaths associated with seasonal influenza virus infection were reported this week, bringing the 2024-2025 season total to 114 pediatric deaths. CDC estimates that there have been at least 40 million illnesses, 520,000 hospitalizations, and 22,000 deaths from flu so far this season.
[Emphasis added.]
Katelyn Jetelina has taken CDC’s current statistics about seasonal influenza virus infections throughout the country and has made this map:
The answer to the spread of influenza, of course, is an answer Kennedy is doing his best not to acknowledge: increased immunization. As the CDC suggests:
The CDC cites a study titled “Decline in Vaccination Coverage by Age 24 Months and Vaccination Inequities Among Children Born in 2020 and 2021 — National Immunization Survey-Child, United States, 2021–2023,” which found:
Data from the National Immunization Survey-Child (NIS-Child) were analyzed to estimate coverage with childhood vaccines recommended by the Advisory Committee on Immunization Practices among U.S. children by age 24 months. Coverage with nearly all vaccines was lower among children born in 2020 and 2021 than it was among those born in 2018 and 2019, with declines ranging from 1.3 to 7.8 percentage points …
Implications for Public Health Practice: Recent decreases in coverage with most of the ACIP-recommended childhood vaccines could lead to a resurgence of vaccine-preventable diseases such as measles, varicella, and rotavirus and their associated morbidity and mortality …
Providers should review children’s histories and recommend needed vaccinations during every clinical encounter. Addressing financial barriers, access issues, vaccine hesitancy, and vaccine-related misinformation can also help to increase coverage, reduce disparities, and protect all children from vaccine-preventable diseases. Strategies that have been found effective include implementation of standing orders and reminder and recall systems, strong physician recommendations to vaccinate, and use of immunization information systems to identify areas of lower coverage that could benefit from targeted interventions to increase immunization rates.
[Emphasis added.]
So, we have an increasing challenge to public health, a proven solution, and yet our newly chosen secretary of Health and Human Services is committed to making things worse, not better. Shame on those Republicans who are also physicians serving in the United States Senate, and especially Bill Cassidy who specifically questioned him about vaccines, for ultimately validating Donald Trump’s uneducated and unfortunate choice of Robert F. Kennedy Jr.
It is one thing to ignore the easily found evidence of the effectiveness of vaccination, but it is incredibly worse and morally reprehensible to actively sabotage attempts to better protect the public from disease.
As The Washington Post reported:
The National Institutes of Health will cancel or cut back dozens of grants for research on why some people are reluctant to be vaccinated and how to increase acceptance of vaccines, according to an internal email obtained by The Washington Post on Monday. The email, titled ‘required terminations — 3/10/25,’ shows that on Monday morning, the agency ‘received a new list … of awards that need to be terminated, today. It has been determined they do not align with NIH funding priorities related to vaccine hesitancy and/or uptake.’
As The Post wrote:
Robert F. Kennedy Jr., the new secretary of NIH’s parent agency, the Department of Health and Human Services, has disparaged vaccines for years. He gained national notoriety over the past two decades by promoting misinformation about vaccines and a conjectured link to autism, drawing widespread condemnation from the scientific community …
Monday’s email was sent by Michelle Bulls, director of the Office of Policy for Extramural Research Administration. It instructed NIH officials who dispense money to researchers around the country to send termination letters by the close of business Monday. It did not specify where the order originated. For some studies that are partly about vaccine hesitancy and uptake, officials can offer the option of defunding only those activities, the email shows.
The termination notice should include the following language, according to the email: ‘It is the policy of NIH not to prioritize research activities that focuses gaining scientific knowledge on why individuals are hesitant to be vaccinated and/or explore ways to improve vaccine interest and commitment. … Therefore, the award is terminated.’ The email flagged more than 40 grants, according to two people familiar with the matter, who spoke on the condition of anonymity because they were not authorized to speak about the new order.
It is an especially fraught time to be canceling research into vaccine hesitancy, some experts argued, with more than 200 cases of measles in 12 states and two deaths from the disease. Measles vaccination rates have declined among kindergartners in the United States since 2019. All states and the District require measles vaccinations for schoolchildren, but more parents are requesting exemptions, citing medical, religious or philosophical reasons. ‘There is an urgent need to enhance vaccine acceptance behavior, especially due to the potential resurgence of measles and covid-19 still looming,’ said Manoj Sharma, a professor of social and behavioral health at the University of Nevada at Las Vegas, who had a CDC grant that ended last year to evaluate vaccine hesitancy …
Delesha Carpenter, a professor at the Eshelman School of Pharmacy at the University of North Carolina at Chapel Hill, has had an NIH grant to focus on coronavirus vaccine hesitancy for three years, along with partners at the University of Arkansas for Medical Sciences and the University of South Carolina. She has been bracing for the work to be upended, but she had not heard Monday afternoon whether her funding has been terminated. ‘If we take away research on vaccine hesitancy, we’re also going to be taking away the ability to provide people with the best information about whether the vaccine is in their best interest,’ Carpenter said. ‘They still have the decision to make.’
[Emphasis added.]
There is the clear strategic decision to abandon any attempts to investigate and presumably counteract the continuing trend of parents who decide not to immunize their children and themselves. And you can also add the cynical decision to prevent immunologists from gathering to discuss and decide how best to tailor next season’s flu vaccine:
As The New York Times discussed in “F.D.A. Cancels Meeting of Vaccine Experts Scheduled to Advise on Flu Shots”:
A panel of scientific experts that advises the Food and Drug Administration on vaccine policy — and that has been the target of criticism from Health Secretary Robert F. Kennedy Jr. — learned on Wednesday that its upcoming meeting to discuss next year’s flu vaccines had been canceled … The cancellation — and the postponement last week of a similar meeting of scientific advisers to the Centers for Disease Control and Prevention — plays into fears among scientists who worry that Mr. Kennedy will use his perch to sow doubts about vaccines and interfere with the regulatory process that leads to their approval.
[Emphasis added.]
Meanwhile, there is another growing public health threat. In “THE OTHER SIDE: Sick birds, sick kids, and RFK Jr.,” I addressed the problem with bird flu. That situation, too, has worsened. In the course of a little more than a week, the CDC reports an additional 212,000 birds have been affected in four more counties in the course of 12 additional outbreaks:
Everywhere we look—the unfortunate treatment of our veterans, the drastic cuts at USAID, the IRS, the Department of Education, the closing of the Environmental Protection Agency’s offices devoted to environmental justice—we see the clear signs of the Trump/Musk/MAGA efforts to destroy government as we know it.
But it is particularly painful to see the head of Health and Human Services turn his back on the efforts to combat the lethal outbreaks of influenza, bird flu, and measles. Instead of waging war on disease, he has gone to war on the public health.
