MAP: Which States Are Likely to Have the Most Measles Cases in 2026?

Introduction: The Re-Emergence of a Preventable Threat

Measles, a highly contagious viral disease once declared eliminated in the United States in 2000, has resurged as a significant public health concern in the 2020s. Recent years have witnessed a troubling increase in measles outbreaks across numerous U.S. states, primarily driven by declining vaccination coverage in specific communities and increased international travel. According to the Centers for Disease Control and Prevention (CDC), the first half of 2024 alone saw over 120 confirmed measles cases spread across more than 15 states, marking one of the most active periods in decades. This trend raises a critical question: if current patterns persist, which states will face the greatest burden of measles circumstances—more accurately termed “cases”—by 2026? This article provides a data-driven, pedagogical analysis of the factors influencing measles transmission, projects high-risk states for 2026 based on verifiable CDC statistics and epidemiological models, and offers practical guidance for protection. Our goal is to present an accurate, non-speculative forecast that underscores the vital role of the MMR vaccine in preventing a worsening public health crisis.

Key Points: Your Quick Guide to the 2026 Measles Outlook

Projected Hotspots: Based on 2024 outbreak data and vaccination coverage maps, states with historically lower MMR vaccination rates and recent cluster outbreaks—such as Texas, Florida, New York, Idaho, and Washington—are at the highest risk for significant case numbers in 2026 if trends continue.
Primary Driver: The single most critical factor is community vaccination coverage. Areas where fewer than 90% of children receive the two-dose MMR series create vulnerability for sustained transmission.
CDC Monitoring: The CDC actively tracks measles importations from countries with ongoing outbreaks (e.g., parts of Europe, Asia, and Africa) and works with state health departments to contain local spread.
No Federal Mandate: Vaccination requirements are set by states, leading to a patchwork of laws regarding school entry and exemption policies (medical, religious, philosophical), which directly impacts local herd immunity.
Prevention is Certain: The MMR vaccine is 97% effective after two doses. High vaccination rates remain the only proven method to prevent outbreaks and protect vulnerable populations like infants and immunocompromised individuals.

Background: Measles Biology, Vaccination, and U.S. History

What Is Measles and Why Is It So Contagious?

Measles is caused by the rubeola virus, a member of the Paramyxoviridae family. It spreads through respiratory droplets and airborne particles, meaning an infected person can transmit the virus even after leaving a room. The virus remains infectious in the air or on surfaces for up to two hours. Symptoms begin with high fever, cough, runny nose, and conjunctivitis (pink eye), followed by a characteristic red rash that typically starts on the face and spreads downward. Complications are severe and include pneumonia, encephalitis (brain swelling), and death. Before vaccines, measles caused millions of cases and hundreds of deaths annually in the U.S. Globally, it remains a leading cause of vaccine-preventable child mortality.

The MMR Vaccine: A Triumph of Public Health

The measles-mumps-rubella (MMR) vaccine is a live attenuated vaccine recommended by the CDC and the World Health Organization (WHO). The schedule calls for a first dose at 12-15 months and a second dose at 4-6 years. Two doses are approximately 97% effective at preventing measles; one dose is about 93% effective. “Herd immunity” or “community immunity” for measles requires approximately 95% vaccination coverage to interrupt transmission and protect those who cannot be vaccinated (e.g., infants under 12 months, individuals with certain immune disorders). The vaccine has an excellent safety record, with serious adverse events being extremely rare.

U.S. Elimination and the Path to Resurgence

In 2000, the CDC declared measles eliminated from the U.S., meaning there was no continuous disease transmission for 12 months. This success was attributed to high vaccination rates and effective public health infrastructure. However, elimination is fragile. Since 2000, nearly all U.S. cases have stemmed from importations—travelers bringing the virus from regions where measles is endemic. When these importations encounter communities with low MMR vaccination rates, outbreaks occur. The 2014 Disneyland outbreak (111 cases across multiple states) and the 2019 outbreak (1,282 cases in 31 states, the highest since 1992) were landmark events in this resurgence. A concerning trend since 2020 has been the decline in childhood vaccination rates for various reasons, including vaccine hesitancy, access issues during the COVID-19 pandemic, and the loosening of school exemption laws in some states.

Analysis: Forecasting High-Risk States for 2026

Predicting specific 2026 measles case numbers by state requires analyzing current epidemiological data and trend trajectories. We rely on verifiable CDC data from 2022-2024, including annual measles case reports, state-level MMR vaccination coverage from the National Immunization Survey (NIS), and documented outbreak clusters. This section identifies the factors that elevate risk and names the states most likely to report the highest number of cases in 2026 if mitigation efforts are not intensified.

Methodology: How We Identify Risk

This projection uses a multi-factor model based on CDC methodologies for risk assessment:

Recent Outbreak Activity: States with ≥3 confirmed cases in a 12-month period (CDC outbreak definition) are flagged for continued vulnerability.
Kindergarten Vaccination Coverage: The most granular, reliable data is for children entering kindergarten (age 5-6). States with <90% coverage for the two-dose MMR series are at higher risk. Data is from CDC NIS-Teen and school-entry assessments.
Exemption Rates: States with higher percentages of non-medical exemptions (philosophical or religious) correlate with lower community immunity.
International Travel Hubs: States with major international airports (e.g., JFK in NY, LAX in CA, MIA in FL, DFW in TX) see more importations.
Historical Cluster Patterns: Past outbreaks often recur in the same geographic and sociocultural pockets due to persistent under-vaccination.

It is crucial to note that this is a forecast based on current trends, not a certainty. Aggressive public health interventions, such as targeted vaccination clinics and community outreach, could alter these projections.

States with Critically Low MMR Vaccination Coverage

CDC data for the 2022-2023 school year reveals several states where two-dose MMR coverage among kindergarteners falls below the 95% herd immunity threshold. These are the bedrock of risk.

Texas: Coverage is approximately 89% statewide, but with dramatic local disparities. The 2023 outbreak in Gaines County (West Texas),

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