Public Health Response
Notifying Caregivers of Children
Once notified of the first measles case on March 25, 2025, the child care facility director telephoned caregivers of all enrolled children. Communications were sent from the child care facility to all caregivers through email and text message on March 26. Staff members at the child care facility were informed in person and through email and text message. On March 28, 2025, LPH sent a letter to caregivers, providing information about measles, advice for contacting providers if they or their children experienced symptoms, and recommendations for MMR vaccination, available at LPH.
Reviewing Vaccination Status of Children and Staff Members and Offering Postexposure Prophylaxis
The child care facility reviewed the vaccination status of all enrolled children and reported 96% vaccination coverage with ≥1 MMR vaccine dose each among the 248 children aged ≥12 months. Ten children aged 6 months–6 years at the facility who were eligible for MMR vaccination had vaccine exemption forms on file with the child care facility and had not received any MMR vaccine dose; three of these children had measles during this outbreak. All staff members reported that they had received MMR vaccine; however, their vaccination status was not verified. No measles cases occurred among staff members. LPH offered MMR vaccine as postexposure prophylaxis to all persons who were exposed to measles at the child care facility. Immunoglobulin was offered as postexposure prophylaxis at local hospital facilities.
Separating Infants Aged <6 Months and Excluding Unvaccinated Children from Attendance
Starting April 3, 2025, six infants aged <6 months† were grouped into a single classroom with a separate entrance and were cared for by two designated staff members. All children and staff members remained in their assigned classrooms (15–20 students in each classroom) to minimize cross-classroom transmission; use of shared spaces, including the cafeteria, was suspended. LPH staff members contacted caregivers of the children aged <6 months to inform them of the separation of children and two staff members in a single classroom and to discuss risks and benefits for continued attendance at the facility. On April 3, 2025, LPH sent a letter to caregivers of unvaccinated children informing them their child could not return to the facility until 21 days had elapsed since their last measles exposure and recommending MMR vaccination for future protection.
Recommendation for Vaccination of Infants Aged 6–11 Months and Completion of MMR Vaccination Series
On April 7, 2025, the Texas Department of State Health Services (DSHS) issued a recommendation for an early dose of MMR vaccine for infants aged 6–11 months in an expanded list of outbreak areas, including Lubbock County and nine other counties. Children aged ≥6 months were required under the Texas school and child care attendance criteria to receive the first MMR vaccine dose if they were not vaccinated or to quarantine at home for 21 days after exposure, even in the absence of symptoms (1). Five unvaccinated children from four families had not received the vaccine and were quarantined at home. Children aged ≥6 months who had documentation of 1 MMR vaccine dose were encouraged to be vaccinated with the second dose ≥28 days after the first dose but were still allowed to attend the child care facility.
Ongoing Monitoring, Quarantine, and Return to the Child Care Facility
The child care facility instructed caregivers to keep children who received positive measles RT-PCR results at home; they were allowed to return to the child care facility after 4 days had elapsed since rash onset, if no other signs or symptoms (e.g., fever, vomiting, or diarrhea) were present. The facility continued to monitor children in attendance for fever, cough, coryza, and conjunctivitis. Children with symptoms were sent home immediately and required to remain home for 21 days or provide a negative RT-PCR test result to return. No staff members reported symptoms.
Increasing Community Awareness of the Outbreak
On April 11, 2025, a meeting with CDC (including members from the National Institute for Occupational Safety and Health), LPH, and DSHS was held to discuss potential approaches to continue to reduce transmission within the child care facility. CDC shared guidance on topics such as preventing infection in education settings, national standards on health and safety from Caring for Our Children (2), a set of voluntary safety standards for early care and education programs, and facility ventilation guidelines. A representative from LPH and the child care facility administrator were interviewed on television to inform the community about the outbreak. LPH also contacted 117 child care facilities in the area. None of these facilities reported measles cases.