This Year's 5,182 Measles Cases Exceed 2018 Through 2025 Combined. The Elimination Review Is Due This Month.
CDC counts 5,182 U.S. measles cases in 2026, 711 more than the prior eight years combined, as PAHO weighs whether the U.S. keeps elimination status.
The United States has recorded 5,182 confirmed measles cases this year, more than in 2018 through 2025 combined, according to Centers for Disease Control and Prevention data current as of Nov. 5 and posted Nov. 6.
The total arrives as the Pan American Health Organization's expert commission prepares to rule on whether the country still meets the definition of measles elimination, a status it has held since 2000. A Reuters report published Nov. 6, carried by the Honolulu Star-Advertiser, said the commission was expected to decide the following week. It is the first time annual cases have topped 5,000 since 1991, the report said.
How does 2026 compare with recent years?
It is the largest year in a generation by a wide margin. The CDC table puts 2025 at 2,289 cases, which this year has already more than doubled.
Our year-by-year table from the CDC page: 2018, 381 cases. 2019, 1,274. 2020, 13. 2021, 49. 2022, 121. 2023, 59. 2024, 285. 2025, 2,289. 2026 through Nov. 5, 5,182.
By our arithmetic, 2018 through 2025 add up to 4,471 cases, so 2026 exceeds those eight years combined by 711. The five years from 2020 through 2024 total 527 cases, roughly a tenth of this year's count. The weekly increase was 330 cases, from 4,852 in the prior update, Reuters reported.
The outbreaks are fewer but bigger. The CDC page lists 16 outbreaks in 2024, with 69 percent of cases outbreak-associated, and 48 in 2025, with 90 percent. This year it counts 43 new outbreaks so far, and 96 percent of cases are tied to one. By our division, that is about 116 outbreak-associated cases per new outbreak this year, against about 43 in 2025, though some of this year's cases belong to chains that began in 2025, so the ratio overstates the change.
The CDC says 47 jurisdictions have reported 5,164 cases, with 18 more among international visitors. Of all cases, 4,993 were outbreak-associated. Reuters reported 562 hospitalizations, or 11 percent of cases, and said 96 percent of patients were unvaccinated or of unknown vaccination status. By age, the report counted 2,132 cases in people 20 and older, 2,104 in ages 5 to 19 and 908 in children under 5.
Adults now make up the largest share of cases. A febrile rash in a 30-year-old belongs on the measles differential this year, in adult clinics and urgent care as much as in pediatrics.
Where are the cases?
Pennsylvania remains the largest outbreak. Its health department reported 1,487 cases and 287 hospitalizations, according to Reuters, up from the 1,222 cases we reported on Oct. 18. South Carolina, with 670 cases, and Utah, with 536, had the next-highest totals in CDC data.
Death counts depend on the source. The CDC lists four measles-associated deaths this year after switching to National Center for Health Statistics mortality data, Reuters reported, while state health departments have reported more. Pennsylvania alone has reported six, and New York and Wisconsin each reported a death in the week of the update.
What is PAHO deciding, and on what clock?
PAHO defines endemic transmission as “uninterrupted circulation of the same virus genotype and lineage for 12 months or more” in a given area. In a March 2 update, it said the review of the United States and Mexico would take place in November 2026, and that the analysis period runs one year from the onset of the reported outbreaks: “20 January 2025 in the United States and 1 February 2025 in Mexico.” The commission sends its recommendation to PAHO's director, who communicates the classification to national authorities.
By our count, Nov. 10 is day 659 since that Jan. 20, 2025, onset date. The question before the commission is whether transmission linked to that period has continued unbroken for at least 12 months. If it finds that it has, the country would lose elimination status. The clinical facts would not change overnight, but the label carries weight in public health planning and in how the country's vaccine program is judged.
What should practices do this week?
The checklist has not changed, but the volume has. Check MMR status at visits for adults as well as children, and offer catch-up doses where records are missing. Keep a plan for suspected cases that keeps the patient out of the waiting room and calls the local health department before testing. Federal vaccine guidance has been unsettled this year, as our report on the cancelled October meeting of CDC's vaccine advisers described, so check your state health department's measles page for current exposure and testing guidance. The next CDC update and PAHO's decision are both due within days.
Reported, fact-checked and edited by The Script Pad's editorial staff. See How we use AI.
This article is for professional education and does not replace clinical judgment. Treatment decisions should be based on the individual patient and current guidelines.
