It’s been a year since a measles outbreak began in West Texas, and international health authorities say they plan to meet in April to determine if the U.S. has lost its measles-free designation.
Experts fear the vaccine-preventable virus has regained a foothold and that the U.S. may soon follow Canada in losing the achievement of having eliminated it.
The reevaluation is largely symbolic and hinges on whether a single measles chain has spread uninterrupted within the U.S. for at least 12 months.
Public health scientists around the country are investigating whether the now-ended Texas outbreak is linked to active ones in Utah, Arizona and South Carolina. But doctors and scientists say the U.S. — and North America overall — has a measles problem, regardless of the decision.
“It is really a question of semantics,” said Dr. Jonathan Temte, a Wisconsin family physician who helped certify the U.S. was measles-free in 2000. “The bottom line is the conditions are sufficient to allow this many cases to occur. And that gets back to de-emphasizing a safe and effective vaccine.”
Last year, the Centers for Disease Control and Prevention confirmed 2,242 measles cases across 44 states — the most since 1991 — and nearly 50 separate outbreaks.
The problem has been years in the making, as fewer kids get routine vaccines due to parental waivers, health care access issues and rampant disinformation. More recently, Trump administration health officials including Health Secretary Robert F. Kennedy Jr. have questioned and sown doubt about the established safety of vaccines at an unprecedented level while also defunding local efforts to improve vaccination rates.
“The most important thing that we can do is to make sure the people who aren’t vaccinated get vaccinated,” said Jennifer Nuzzo, director of Brown University’s Pandemic Center. “We have not issued a clear enough message about that.”
A Department of Health and Human Services spokesperson said Thursday that Kennedy has emphasized vaccines as the best way to prevent measles, adding that the CDC is responding to outbreaks and working to increase vaccination rates.
In a briefing Tuesday, department officials said they don't yet have evidence that a single chain of measles has spread for a year.
But CDC’s principal deputy director said he would consider the loss of elimination status to be the “cost of doing business" globally.
“We have these communities that choose to be unvaccinated," said Dr. Ralph Abraham. “That's their personal freedom.”
There is little room for error in trying to stop measles. The virus is one of the most contagious, infecting 9 out of every 10 unvaccinated people exposed. Community-level protection takes a 95% vaccination rate. The current rate nationally is 92.5%, according to CDC data, but many communities fall far below that.
The patient in Texas’ first known case developed the telltale rash on Jan. 20, 2025, according to state health department data.
From there, the outbreak exploded. Officially, 762 people fell ill, most of them in rural Gaines County, and two children died. Many more got sick and were never diagnosed: 182 potential measles cases among children in Gaines County went unconfirmed in March 2025 alone, state health officials said, a possible undercount of 44% in that county.
Such data gaps are common, though, making it especially hard to track outbreaks. Many people living in communities where the virus is spreading face barriers, including access to health care and distrust of the government.
Contact tracing so many cases is also expensive, said behavioral scientist Noel Brewer, who chairs the U.S. committee that will finalize the data for international health officials. Research shows a single measles case can cost public health departments tens of thousands of dollars.
CDC data on measles is still among the best worldwide, Brewer said, but “the U.S. has changed its investment in public health, so we’re less able to do the case tracking that we used to do.”
Genetic sequencing can fill some gaps.
Scientists have confirmed the same measles strain in Texas, New Mexico, Utah, Arizona, South Carolina, Canada, Mexico and several other North American countries, said Sebastian Oliel, a spokesperson for the Pan American Health Organization, which plans to make the final decision on U.S. measles elimination at an April 13 meeting.
But that's not always enough to say the outbreaks are connected. Genetically, the measles virus doesn't change as often as, say, flu.
“Within an outbreak, everybody is going to look the same,” said Justin Lessler, a University of North Carolina disease researcher.
The key question may then be how PAHO experts will navigate final data gaps, said Dr. Andrew Pavia, a Utah physician and longtime CDC consultant.
“My best guess is we will lose elimination status,” Pavia said. “The case for this not being continuous transmission is tenuous, and I think they are likely to err on the side of declaring it a loss of elimination status.”
Oliel said when there is a case of unknown origin in a country with ongoing local spread, “the most conservative approach is to consider the case part of the existing national transmission.”
PAHO will review Mexico's measles-free status alongside the U.S., Oliel said. The country's largest outbreak has roots in Texas. It started when an 8-year-old boy from Chihuahua state got sick after visiting family in Seminole, Texas. Since last February, 6,000 people have gotten sick in Mexico, and 21 have died in Chihuahua state.
But under PAHO's definition of elimination, borders matter. If, for example, the chain of measles that started in the U.S. spread to Mexico and then returned to the U.S. anew, it would be considered a new chain, experts said. Still, many experts call that standard outdated.
What's clear is that measles found ample ground in the U.S. in 2025, infiltrating schools and day cares, churches, hospital waiting rooms and a detention center. New Mexico logged 100 cases and one adult died. Kansas officials spent seven months trying to control an outbreak that sickened nearly 90 people across 10 counties. Ohio confirmed 40 cases. Montana, North Dakota and Wisconsin each had 36.
Now, more than 800 people have gotten sick across Utah, Arizona and South Carolina since late summer, with no end in sight.
“2025 was the year of measles,” Brewer said. “Will 2026 be the year of rising or falling measles cases? Does it get worse or does it get better? No one knows the answer.”
The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.
FILE - Health department staff members enter the Andrews County Health Department measles clinic carrying doses of the measles, mumps and rubella vaccine, Tuesday, April 8, 2025, in Andrews, Texas. (AP Photo/Annie Rice, File)
Manchester City lost 3-1 at tiny Norwegian club Bodø/Glimt in one of the biggest upsets in Champions League history on Tuesday, while defending champion Paris Saint-Germain also was on the end of an unexpected defeat at Sporting Lisbon.
Vinícius Júnior turned jeers from his own fans to cheers by scoring for Real Madrid in a 6-1 win over Monaco and Arsenal became the first team to secure direct qualification for the round of 16 after a 3-1 victory at Inter Milan, maintaining its 100% record in the league stage after seven rounds.
Pep Guardiola's squad of City superstars was humbled inside an 8,000-capacity stadium in Bodø, a Norwegian fishing town north of the Arctic Circle whose soccer team is playing in the Champions League for the first time this season.
City fell 3-0 behind at one point and had 2024 Ballon d'Or winner Rodri sent off in the second half.
“In the end, it’s embarrassing,” said City’s Norwegian striker Erling Haaland, whose team was coming off an abject derby loss to Manchester United in the Premier League on Saturday.
After Kasper Høgh's first-half double for Bodø/Glimt, Jens Petter Hauge curled into the top corner in the 58th to make it 3-0. City replied through Rayan Cherki but hopes of a comeback were damaged soon after by Rodri collecting two yellow cards in quick succession.
City didn’t look like a team that has had $500 million spent on players over the last 12 months, with its flimsy, injury-hit defense constantly pierced on the counterattack. The hosts had two would-be goals disallowed for narrow offside decisions and also hit the crossbar.
Add this upset to the most unlikely results down the years in the Champions League. They include Moldovan club Sheriff beating Real Madrid 2-1 in 2021, Rubin Kazan winning 2-1 at Guardiola’s Barcelona in 2009, and Swiss underdog Basel beating Alex Ferguson’s Manchester United by the same score in 2011.
Colombia international Luis Suarez's 90th-minute goal earned Sporting a 2-1 win over PSG, which — like City — now has work to do in next week's final round to qualify automatically to the last 16 by finishing in the top eight and avoid needing to go through the two-legged playoffs for a second straight season.
That was Suarez's second goal of the game. He put Sporting ahead before an equalizer by substitute Khvicha Kvaratskhelia.
PSG, which became European champion for the first time last season, dropped to fifth and City to seventh — and they are likely to slip lower after Wednesday's games.
Alvaro Arbeloa, Madrid's new coach, was taking charge of a Champions League game for the first time and it was again an unusual atmosphere at Santiago Bernabeu Stadium.
Part of the crowd jeered Vinícius nearly every time he touched the ball, like during Saturday's win over Levante in the Spanish league. The Brazil forward has been having an underwhelming season and some fans view him as one of the reasons why coach Xabi Alonso was replaced last week.
However, the home fans were applauding Vinícius after his solo goal that made it 5-0 in the 63rd minute. Kylian Mbappé, with a double against his first club, and 18-year-old Franco Mastantuono had already scored for Madrid and Jude Bellingham grabbed its sixth goal.
Madrid, the record 15-time champion, climbed to second place.
Arsenal is now on its longest-ever winning streak in the Champions League and is guaranteed a top-two finish.
Gabriel Jesus scored the first two goals for the Premier League leaders and the man he started ahead of — Viktor Gyokeres — came off the bench to net the third.
Petar Sucic had made it 1-1 with a goal for Inter, the heavily beaten finalist last season which has lost three straight games in the competition for the first time.
Inter slipped to ninth place.
Eleven teams in the Champions League have changed coaches already this season and Tottenham manager Thomas Frank was being tipped as the next to go heading into a home match against Borussia Dortmund.
However, Spurs won 2-0 against the 2024 runner-up, which had midfielder Daniel Svensson sent off in the first half, to give Frank some respite and move into fourth place.
The Dane has been jeered by Tottenham’s own fans in recent games.
Cristian Romero and Dominic Solanke scored Tottenham’s goals.
The Italian champions are in danger of elimination.
Napoli was held to a 1-1 draw at 10-man FC Copenhagen and dropped to 23rd place before Wednesday’s games. Those finishing 25th or lower in the 36-team standings won’t even qualify for the playoffs.
Copenhagen had captain Thomas Delaney sent off after a VAR check in the 35th and went behind to Scott McTominay’s goal four minutes later. Jordan Larsson equalized.
It’s turning into a miserable debut in the Champions League for Kairat Almaty, which lost 4-1 to Club Brugge to stay in last place in the 36-team standings and is one of three teams without a win so far.
Another is Villarreal, which conceded in the 89th to lose 2-1 to Ajax.
Steve Douglas is at https://twitter.com/sdouglas80
AP soccer: https://apnews.com/hub/soccer
Real Madrid's Kylian Mbappe celebrates with Vinicius Junior his side's second goal during the Champions League opening phase soccer match between Real Madrid and Monaco in Madrid on Tuesday, Jan. 20, 2026. (AP Photo/Jose Breton)
Sporting's Luis Suarez, left, celebrates after scoring his side's second goal during the Champions League opening phase soccer match between Sporting CP and Paris Saint-Germain, in Lisbon, Tuesday, Jan. 20, 2026. (AP Photo/Armando Franca)
Glimt's Kasper Hogh, left, scores during the Champions League soccer match between Bodo/Glimt and Manchester City in Bodo, Norway, Tuesday, Jan. 20, 2026. (Fredrik Varfjell/NTB via AP)
Manchester City's Rodri is shown a red card by referee Sven Jablonski during the Champions League soccer match between Bodo/Glimt and Manchester City in Bodo, Norway, Tuesday, Jan. 20, 2026. (Fredrik Varfjell/NTB via AP)
Manchester City goalkeeper Gianluigi Donnarumma after letting in a goal during the Champions League soccer match between Bodo/Glimt and Manchester City in Bodo, Norway, Tuesday, Jan. 20, 2026. (Fredrik Varfjell/NTB via AP)
Glimt's Kasper Hogh celebrates after scoring during the Champions League soccer match between Bodo/Glimt and Manchester City in Bodo, Norway, Tuesday, Jan. 20, 2026. (Fredrik Varfjell/NTB via AP)
Arsenal's manager Mikel Arteta speaks during a press conference in Milan, Italy, Monday, Jan. 19, 2026, ahead of the Champions League opening phase soccer match between Inter Milan and Arsenal. (AP Photo/Antonio Calanni)
Manchester City's Erling Haaland reacts during the English Premier League soccer match between Manchester United and Manchester City in Manchester, England, Saturday, Jan. 17, 2026. (AP Photo/Dave Thompson)
PSG's Ousmane Dembele celebrates after scoring his side's second goal during the French League One soccer match between Paris Saint-Germain and Lille in Paris, France, Friday, Jan. 16, 2026. (AP Photo/Michel Euler)
Real Madrid's head coach Alvaro Arbeloa looks skywards before the start of the Spanish La Liga soccer match between Real Madrid and Levante in Madrid, Spain, Saturday, Jan. 17, 2026. (AP Photo/Jose Breton)
