Following the death of the child in Texas in February of 2025, the CDC advised all Americans to make sure they were up to date on their vaccines. Some populations may want to consider getting a booster shot, if they are unsure of their immunization status.

People who got both MMR shots are protected for life. Those born before 1957 have “presumptive evidence” of immunity, since there is a high likelihood that they survived measles and have antibodies from the infection. But all healthcare workers should seriously consider getting a shot, even if they were born before 1957. People who got the inactivated vaccine between 1963 and 1967 should get at least one dose of the modern vaccine. Having an undocumented memory of the disease is not sufficient evidence of immunity, unless the person was born before 1957.

People born after 1957 should get at least one shot if they aren’t sure about their immunization status. People who should definitely get two shots four weeks apart are those who are at especially high risk for exposure, such as college students, the aforementioned healthcare workers, international travelers, and women before they become pregnant (Katella, 2025).

6.1 Immunization Recommendations

Two MMR vaccines have been approved by the FDA. M-M-R II was licensed in 1978. In June of 2022, the FDA approved a second MMR vaccine for people over one year old. The two vaccines are fully interchangeable. The first dose should be administered between 12–15 months and the second at age 4–6 years. Infants older than six months but younger than one year may receive a single dose before international travel or during a measles outbreak. International travelers older than one year and children who have not been previously vaccinated can receive two doses at least four weeks apart (Lucal-Krow, et al., 2022). Children who are vaccinated before they turn a year old should still get two more doses after their first birthday.

One lingering effect of the Wakefield paper, which fabricated a connection between autism and the MMR vaccine, is that many of the children who were not vaccinated are now young women of childbearing age. This means that a large cohort of women who may wish to become pregnant are susceptible to measles and rubella.

Pregnant women with measles are at greater risk of developing pneumonia, miscarriage, intrauterine growth retardation, premature birth, and neonatal death, or the loss of the baby within 28 days of birth. The very rare but fatal condition of subacute sclerosing panencephalitis, which typically manifests years after the infections, progresses much faster when it afflicts pregnant women. It is worth noting that the MMR vaccine also protects against rubella, which is usually less dangerous than measles. However, pregnant women who get rubella risk delivering a baby who will suffer with congenital rubella syndrome, an incurable lifelong affliction that may include deafness, heart defects, and intellectual disabilities.

Obstetricians and midwives are encouraged to actively inquire into the vaccination status of their patients. If an unvaccinated pregnant woman is exposed to measles, she should be offered Human Normal Immunoglobulin within six days of exposure and the MMR vaccine after delivery. However, the inadvertent administration of the MMR vaccine to pregnant women is not associated with adverse outcomes either to the woman or the fetus (Khalil A, 2024).

Breastfeeding is not a contraindication to MMR or MMRV vaccine. There is no evidence that the measles or mumps vaccine virus leaks into the milk after vaccination. One study of breastfeeding women vaccinated with a live, attenuated rubella virus found no transmission of the live virus to their babies. However, limited studies have shown that some infants briefly tested positive for rubella shortly after their mothers received the MMR vaccine but did not develop symptoms of the disease (Drugs and Lactation Database, 2024).

Evidence of immunity against measles is acceptable if one of the following is met:

• Written documentation of age-appropriate vaccination with a live measles virus–containing vaccine.
• Laboratory evidence of immunity or serologic confirmation of the disease.
• Born before 1957.
• Disease history.

The CDC accepts evidence of immunity with written documentation of one or more doses of the live measles vaccine (MMR) administered after the first birthday. It also accepts two doses of MMR for school-age children and adults who may be at high risk as evidence of immunity.

6.2 Prevention and Screening Strategies

Although measles was declared eliminated in the U.S. in 2000, the country continues to experience outbreaks, especially in communities with low rates of vaccination. At the end of March 2025, the CDC’s weekly measles update page listed confirmed measles cases in 18 jurisdictions: Alaska, California, Florida, Georgia, Kansas, Kentucky, Maryland, Michigan, New Jersey, New Mexico, New York City, New York State, Ohio, Pennsylvania, Rhode Island, Texas, Vermont, and Washington.

General strategies that help prevent measles transmission include:

• Community vaccination: the main prevention for all settings, including schools, hospitals and the general public. Prevention through 95% vaccination in all communities remains the best approach.
• Screening: there is no screen for measles until a patient presents with symptoms. Screening for compliance with vaccine recommendations is done however by public schools, many of which require documentation before registration for school.

6.3 Educating Parents and Communities

Education remains one of the most important tools in the fight against vaccine disinformation. Trusted healthcare providers are more important than ever, especially as the Department of Health and Human Services shifts its priorities.

In March of 2025, HHS launched a new study on the long-debunked connection between autism and vaccines. The study was to be led by David Geier, who was disciplined by the Maryland State Board of Physicians in 2011 for practicing medicine without a license. Geier and his father, Dr. Mark Geier, had improperly diagnosed autistic children and injected them with unapproved treatments. Relying on dubious research, the men claimed that the injections would counter the effects of mercury in thimerosal, a preservative in the influenza vaccine that has not been found to cause autism. David Geier’s father, Dr. Mark Geier, lost his medical license in the wake of the scandal.

Childhood vaccination rates are plummeting, and the U.S. is cutting its funding to Gavi, an organization that promotes international vaccinations. In March of 2025, the investigative news outlet ProPublica reported that shortly before the measles outbreak in Texas, CDC decided not to release an assessment of the high risk of measles spreading in under vaccinated areas. A spokesperson for the agency stated that getting vaccinated was a personal choice.

In the vacuum that is currently being created by the U.S. government, experts on public health and vaccines at universities, hospitals, and associations are stepping up their campaigns to address disinformation. The American Association of Pediatrics recommends that healthcare professionals discuss vaccine disinformation with their patients, including where it comes from and who benefits from it. They urge providers to be frank about what is still unknown about vaccines, and emphasize the number of lives saved from immunizations, rather than those that will be lost by not immunizing.

CDC and the Canadian Paediatric Association recommend informing parents which immunizations are due, rather than inviting them to share their views on the subject. Many locales in Canada and the U.S. relied on community organizations to act as “health ambassadors” to promote culturally appropriate messaging around the COVID-19 vaccines, a strategy that could be helpful in promoting the measles vaccines as well. Small local health departments can act in a similar capacity, since they are not always viewed with the same mistrust as larger government entities.

Pediatricians and other family healthcare providers are still widely trusted. For those who work with vulnerable populations, advocacy for vaccine campaigns can be extremely helpful.