In rural West Texas, a measles outbreak grows with no end in sight

SEMINOLE, Texas — When Aganetha Unger pulled up her large, white van to the emergency measles testing site, several of her eight children were coughing.

“We had some sickness in the house, not very bad, but some fever, some cough,” said Unger, who is Mennonite. One child, she said, had a fever of 103 degrees.

Her youngest getting tested was a 2-month-old, wrapped tightly in a pink blanket on her mom’s lap. When the EMS team swabbed her nose, she didn’t cry.

It was Thursday, eight days after the Texas Department of State Health Services first reported a measles outbreak on the rural, western edge of the state.

On Friday, the number of confirmed cases rose to 49, up from 24 earlier in the week, the state health department said. The majority of those cases are in Gaines County, which borders New Mexico.

Most cases are in school-age kids, and 13 have been hospitalized. All are unvaccinated against measles, which is one of the most contagious viruses in the world.

The latest measles case count likely represents a fraction of the true number of infections. Health officials — who are scrambling to get a handle on the vaccine-preventable outbreak — suspect 200 to 300 people in West Texas are infected but untested, and therefore not part of the state’s official tally so far.

The fast-moving outbreak comes as Robert F. Kennedy Jr. takes the helm of the Department of Health and Human Services. Kennedy, a vaccine skeptic, has long sown distrust about childhood vaccines, and in particular, the measles-mumps-rubella (MMR) vaccine, falsely linking it to autism.

During his confirmation hearings, Kennedy said he was not anti-vaccine. “I am pro-safety,” he said. “All of my kids are vaccinated, and I believe vaccines have a critical role in health care.”

HHS did not respond to a request for comment from Kennedy about the outbreak.

The Centers for Disease Control and Prevention can only send in its experts to assist if the state requests help. So far, Texas has not done so, the CDC said.

The CDC has sent approximately 2,000 doses of the MMR vaccine to Texas health officials at their request. However, most doses so far are being accepted by partially vaccinated kids to boost their immunity, rather than the unvaccinated.

Without widespread vaccination, experts say, the outbreak could go on for months.

Measles epicenter

The city of Seminole is the seat of Gaines County, Texas, and the epicenter of the current measles outbreak. It’s located in a vast, flat region filled with ranchers and peanut and cotton farmers.

There’s also a large Mennonite population, a religious sect that believes in “total separation from the outside world,” according to the Texas State Historical Association. These Mennonites chose to settle in Gaines County, in part, for its lack of regulation on private schools. This includes vaccine mandates.

As of the 2023-24 school year, Gaines County had one of the state’s highest vaccine exemption rates, at nearly 18%, according to health department data.

“We have a high, high number of unvaccinated,” said Tonya Guffey, the chief nursing officer at Seminole District Hospital. “It’s not that they’re not educated. It’s just what their belief is.”

Guffey noted that many of the unvaccinated people in the area were Mennonite. “We educate, we encourage, we do what we can for the community, but it’s their choice,” she said.

The pandemic also appears to have driven down vaccination rates.

“We have some outside of that group of people that are unvaccinated, and the Covid vaccine did play a part in that,” Guffey said.

Guffey, who was born and raised in Gaines County, has been in health care for over 30 years and said she’s never seen a measles outbreak before. Still, she wasn’t surprised by the size of the outbreak currently spreading across the county.

“With the large population of unvaccinated that we have,” Guffey said, “it’s not out of the numbers that you would expect.”

‘Hub’ city concerns

Measles cases were limited to rural areas surrounding Lubbock, Texas, the largest city in the region, until Friday afternoon, when Lubbock Public Health confirmed its first case.

The “hub” city, as it’s nicknamed, is where all of the big grocery and big box stores are.

People who live in Gaines County regularly head into Lubbock to shop and do other business. That includes a large number of unvaccinated people who may have been exposed to measles.

“Communities who don’t vaccinate are not necessarily isolated to their area. They commute to Lubbock,” said Dr. Ana Montanez, a pediatrician at Texas Tech Physicians in Lubbock. “By doing that, they’re taking the disease with them.”

Several of Montanez’s young patients were exposed recently, she said, one just by sitting in the same clinic waiting room with another child who was later confirmed to have measles. That child had traveled from another county for care.

Two doses of the MMR vaccine are needed for virtually full protection against the virus. The first is given at around age 1, but the second isn’t given until around age 5. That leaves kids slightly vulnerable for the several years that they are in between doses.

Doctors have the option of giving the second dose early, however, if a child has been exposed to the virus. That’s what Montanez has done for a few of her vulnerable patients. She also continues to counsel families who aren’t vaccinating their children about the benefits of the shots.

Young and vulnerable

The growing outbreak is worrisome to Carina Perez and her husband, Ben Ham, who are caring for a foster child they affectionately call “Muffin.”

The 18-month-old girl has only been eligible for the first dose of the MMR vaccine so far. She was also born with several health problems, including reactive airway disease, which makes it hard to breathe if she catches any kind of respiratory virus.

Muffin has been admitted to the intensive care unit three times in her young life so far because of respiratory syncytial virus (RSV) and even the common cold.

“The smallest triggers get her pretty sick,” Perez said. “We have to be very cautious about being out in public.”