“Anti-vax thinking is a luxury – it’s easy when you think all your neighbors are getting vaccinated.” Sara Brown, epidemiologist

As I sit down to write this, the news is full of endless talk about tariffs, imports and exports. But, it was only by reading epidemiologist Sara Brown’s report that you’ll see later in this issue that I learned this export news: 

“Mexico is currently facing its largest measles outbreak in decades, with 1,753 confirmed cases and 4 deaths. Lab results and case tracking suggest that this outbreak may be partly linked to the one that began in Texas.”

Before we get Sara’s full update on measles, let’s take the time to join Dr. Scott Hamstra, a pediatrician and retired Captain in the U.S. Public Health Service with a specialty in infectious diseases, as he puts the current outbreak in perspective while offering hope for anyone working in vaccination programs.

Reflections from the Measles Front Lines

By Dr. Scott Hamstra, M.D., STChealth Chief Medical Consultant

The recent rise in measles brings back vivid memories for those of us who have been on the front lines of measles prevention for over three decades.

The 1990’s national response to the measles crises was nothing short of remarkable. Parents, pediatricians, public health professionals, and leaders at every level — county, state, and federal — came together to protect our children. Out of that collaboration emerged bold initiatives. Congress authorized the Vaccines for Children (VFC) program, and state immunization information systems were launched — critical tools that helped drive vaccine access and public health coordination.

This united response echoes the American response to polio in the 1950s, when Jonas Salk and Albert Sabin became national heroes. Americans rallied behind the March of Dimes campaign, and children eagerly took their polio vaccines on sugar cubes — a moment so iconic it inspired the Sound of Music lyric, “A spoonful of sugar helps the medicine go down.”

It’s worth noting this effort began years earlier: the March of Dimes was founded in 1938 by President Franklin D. Roosevelt as the National Foundation for Infantile Paralysis. FDR had contracted polio in 1921, and his own experience with the disease — and lifelong paralysis — inspired him to launch a national effort to combat polio and fund research for a vaccine. Although he did not live to see polio eradicated from the USA and now nearly everywhere in the world, his vision laid the groundwork for this public health triumph.

In both cases — polio and measles — American science changed the trajectory of our lives, not just in the U.S., but across the globe.

Still, history is easy to forget. In the 1950s, the U.S. averaged more than 500,000 measles cases and nearly 500 deaths each year. Today, with a population twice the size, we could easily be facing over a million cases and 1,000 deaths annually — if not for the measles vaccine.

Our success in preventing measles has made it almost invisible — and with that invisibility came growing complacency. Still prior to this 2025 outbreak, the vast majority of parents still chose to vaccinate their children, and yet as the number of those opting out slowly increased this created dangerous pockets of vulnerability.

Now, with more than 1,000 cases and a handful of deaths already reported in 2025, a shift is happening. Parents and leaders are recognizing the very real risk and are once again taking action — reaffirming our collective commitment to protect children and preserve public health.

Public health isn’t just about data — it’s about memory, trust, and action. Let’s remember what we’ve overcome — and why we can’t afford to let our guard down.

As a pediatrician, I’ve seen both sides of this story. Early in my career, I cared for children with diseases we now rarely see. Over time, I watched those illnesses fade away — not by chance, but because vaccines worked. It’s been one of the most powerful parts of my career, and it’s why I feel so strongly about speaking up now.

I remain hopeful. We’ve faced challenges like this before, and we’ve met them with science, compassion, and collective resolve. I believe we’ll do it again — and come out stronger.

If you’re a parent, a health professional, or a policymaker, your voice and actions matter now more than ever. Let’s recommit to the hard work of protecting our communities — together.

I’m grateful to everyone — past and present — who’s helped make these public health victories possible. Let’s keep the momentum going and ensure future generations don’t have to relearn these hard lessons.

Where We Are Now: Measles Update

By Sara Brown, MPH, CHES

Epidemiologist II at STChealth

As of May 29, 2025, the U.S. has reported 1,046 confirmed cases of measles, with Texas alone accounting for 729 of them. Roughly 96% of those infected are either unvaccinated or have an unknown vaccination status. Of those infected, only 1% had received one dose of the MMR vaccine, and only 2% had both recommended doses.

Young children are being hit especially hard: 30% of all cases are in kids under 5. And while the overall hospitalization rate sits at 12%, that number jumps to 22% for children in this age group—a rate consistent with previous outbreaks.

So far in 2025, 3 people have died from measles. 2 of them were unvaccinated, school-aged children with no known health issues in Texas and 1 adult in New Mexico. These are the first measles-related deaths in the US since 2015 and the first involving children in over 2 decades.

The outbreak in Texas appears to be slowing down in most areas. As of May 25, 2025, the Texas Department of Health estimates that fewer than 10 confirmed cases remain infectious; however, this figure may underestimate true active cases as cases are likely underreported.

In New Mexico, after an early spike in cases, there were several weeks of steady, moderate measles transmission. Thanks to public health efforts—and possibly because fewer people were left who could catch the virus—case numbers began to decline. However, small surges in late March and again in mid-May show just how important it is to keep up prevention efforts until the outbreak is truly under control. Measles has now been reported in six counties across the state, and this week, cases are climbing again in Sandoval County.

Mexico is currently facing its largest measles outbreak in decades, with 1,753 confirmed cases and 4 deaths. Lab results and case tracking suggest that this outbreak may be partly linked to the one that began in Texas.

If current vaccination trends continue, the risk of measles becoming endemic with recurrent outbreaks is foreseeable.

International Vaccine Codes Initiative:

A Report on Efforts to Make Immunization Records More Accurate Around the World

By Shannon Coleman, STChealth Director of Immunization Programs

If you’re reading this, then I’m sure you’ll agree that vaccines are one of the most effective tools in public health. But, for them to work well, the records that track them need to be accurate, easy to share, and understandable across different countries and healthcare systems. The International Vaccine Codes Initiative (IVCI) is working to fix a major issue that became clear during the COVID-19 pandemic: there is no single, expert-led system for the way vaccines are labeled and tracked globally. However, I recently returned from an international conference, held in Bordeaux, France, and I’m pleased to pass along this encouraging report:

IVCI is creating a worldwide network of vaccine coding specialists who are working together to improve how vaccines are recorded. Their focus is supporting the Unified Nomenclature of Vaccines (NUVA), a coding system designed to bring consistency to vaccine records around the world. This initiative is not about changing how vaccines are currently coded in each country; instead, it’s about making existing systems work better together. IVCI is building tools to “translate” between different code sets, helping them connect smoothly. They are also setting standards to measure and improve vaccine coding and building a community where coding experts can learn from each other and raise the bar for quality and accuracy. A big step forward came recently when NUVA was added to the SNOMED CT International edition, making it an official global standard. 

Because we at STChealth help manage immunization records for more than a third of the U.S. population and also in places like Qatar, we’ve designed tools to work well with systems like NUVA, helping ensure vaccine records are accurate and compatible around the world. At the International Summit on Vaccine Coding & Standards in Bordeaux in May of this year, I was able to share insights on how vaccine codes are used in the U.S. and joined global discussions about real-world challenges, legal standards, and how to make different systems work together. 

By contributing to IVCI and supporting NUVA, our goal is to help make sure that the systems behind vaccines are just as strong and dependable as the vaccines themselves. My thanks to the hosts of this conference and I hope to be sending updates on our group’s progress soon.

Future Growing Pains of Cities and Towns?

By Bill Davenhall, Geomedicine Analyst

The United States continues to be a nation of small towns; in fact, about 75% of all Incorporated Places (Cities and Towns) had populations under 5,000 people in 2024. Population change at the national level does not necessarily reflect what is happening in states, regions, or Incorporated Places and growth and decline is not evenly distributed.  Many of the factors that contribute to population growth or decline are not well known and seldom easy to generalize. The most accurate data comes from the US Census Bureau. Here is what they found about population changes in all of the 14,479 Incorporated Places (i.e. Cities, Towns. Townships, and Metro governments) essentially formally organized and functioning governmental units which will generally have elected local leadership at their helm, including some of the most interesting changes in the most recently released data by the Census Bureau. 

• Southern States generally have shown, on average and  across all sizes of Incorporated Places  have witnessed the  greatest population percentage gains than any other region of the US.
• Princeton, Texas (a Dallas suburb) had the highest growth rate among all Cities over 20,000, at 31%.
• Washington, DC added 15,000 residents nearly doubling its gain experienced  in 2023.
• Los Angeles, CA added 31,000 residents in 2024 after several years of declines.
• Jacksonville FL and Fort Worth TX crossed the 1 million population mark in 2024.
• Cites that had the largest number (20,000 or more) of new people added to their communities included  New York, Houston, Los Angeles, San Antonio, Fort Worth, Charlotte, Chicago.

A significant  takeaway from these newest estimates (2024) are the practical implications to the operational and functional dynamics of communities in managing  this population growth. The Places on the list below will certainly experience  greater demands across a wide variety of community services including water and sewage, housing, transportation, recreational spaces,  and of course health and human services. Some will experience more “growing pain” than others. 

Check out the list below of the Top 22 Cities/Towns that Grew the most in 2024 – you might be surprised. Curious about where you live? Find complete data (in Excel format) for all 19,000+ Cities and Towns here along with the Census Bureau methodologies used in making these estimates.

As always, I appreciate 2^nd opinions!