This week the nation’s measles elimination status is under review. What does this mean for California? The first flu deaths among children were announced in our state, and Californians have shared priorities for our elected leaders in our weekly health survey, The Pulse. Let’s dive in.

Holding the line on measles in California

This week, a panel at the Pan American Health Organization is deciding whether the U.S. has lost its measles elimination status. Most experts, including us, expect that it has. If so, measles will officially be “endemic” in America for the first time since 2000.

What does this mean for California? Elimination status is judged at the country, not state, level. If California were being evaluated independently, we would maintain elimination status, for one reason: we’ve been successful at controlling outbreaks, through high vaccination rates.

But losing elimination status signifies major federal backsliding, and means our defenses agaisnt measles outbreaks within California will be tested a lot more regularly.

What the panel is asking. If any single outbreak spreads for at least 12 months within its borders, a country loses elimination status. The outbreaks that moved through West Texas, Utah, and South Carolina were actually likely one connected chain, as they came from the same extended event. Genetic testing has revealed they shared the same lineage, called D8-9171.

That chain likely reached California. In February, an unvaccinated toddler returned from South Carolina’s outbreak and seeded a 19-case outbreak in Sacramento and Placer counties. But the “California branch” of the chain ended within weeks, and by June the local outbreak was over, while it gained momentum elsewhere.

That captures the essence of our story: while we have pockets of vulnerability, high vaccination rates overall have meant large outbreaks haven’t taken hold. We had a rough start to 2026, and activity came under better control in late spring. We’ve seen only two reported cases statewide in the past three months.

Two different pictures. Nationally, there have been 5,182 measles cases this year, the most since 1991. Ninety-six percent are outbreak-associated. California has had 60 cases, about one-tenth the national rate. About half were isolated cases among travelers that didn’t spread. The rest came from three small outbreaks, and each died out within weeks.

I think of community immunity like a firebreak. Sparks will land, like when a traveler returns home from a trip carrying measles. Whether those sparks start a full-blown wildfire is the question. With more than 95% of our kids vaccinated, the embers generally get extinguished before spreading.

How the nation got here. Vaccine coverage started slipping before 2025. But instead of reversing the slide, Secretary Kennedy helped accelerate it. He ended a CDC pro-vaccine messaging campaign and sent mixed signals about the MMR vaccine as outbreaks grew. Last school year national MMR coverage fell to 92.4%, well below the 95% we need to stop measles from spreading. In California, 96.1% of our kindergartners are vaccinated against measles.

The months-long outbreaks elsewhere grew in places where protection had declined. In Washington County, Utah, which was impacted in the latest outbreak, MMR coverage fell from 93% to 78% in a decade.

Domestic travel can carry risk. For years, when I was evaluating patients with measles symptoms, I started by asking about international travel. That question is too narrow now. Of the first 4,080 U.S. cases this year, only 18 were linked to international travel. Nearly everyone else caught measles within the U.S. So, for California, the sparks that could ignite an outbreak aren’t just drifting in from overseas anymore. They’re blowing in from next door.

California’s vulnerability: Still, California has its own vulnerable pockets. We have counties where fewer than 90% of kindergartners are vaccinated, and smaller communities with even less protection, often connected to schools. More than 9 in 10 of our cases this year were unvaccinated or of unknown status.

Every Californian should expect more risk of being exposed to measles. That calls for doubling our commitment to what has protected us:

• High vaccination coverage in every county and not just on average.
• Fast detection, with clinicians considering measles in any patient with fever and rash, whether or not they’ve left the country.
• Rapid public health response. Shasta County’s team traced more than 600 contacts and helped stop its outbreak at nine cases.

Community immunity, or herd immunity is like trust: hard to earn, easy to lose. Eliminating measles took more than 95% of us agreeing, together, to put this disease behind us. That’s changed, but the nation has done it before, and we can do it again. And California can help show the way.

Flu, and childhood flu deaths, early this year

Of all the announcements I made as a health officer, the one I dreaded most was the annual reporting of the first child lost to flu that season. This fall that announcement arrived ahead of schedule.

In late October, San Diego County confirmed two pediatric flu deaths: an 11-year-old with no prior health problems and a 6-month-old with complex medical needs. Then San Bernardino County reported a third, a medically fragile child not yet old enough for a flu shot.

Looking back at 2025–26. Across the country, 202 children died from the flu last season. That’s fewer than the record 289 the season before. Where vaccination status was known among eligible children, roughly 85% of those who died had not been fully vaccinated. In California, 16 children lost their lives to flu last season.

Children are at risk for flu-related brain disease. We know the flu is a respiratory virus, but recent studies are showing neurological problems are more common than we’d known. In 2024–25, 109 children in the U.S. developed severe flu-related brain inflammation, and one in five of them did not survive. Vaccination is protective against any serious outcome.

Risk at both ends of life. Numbers like these make me wonder whether we in public health have undersold how dangerous flu can be for children. Seniors carry the greatest risk of mortality, but vulnerability peaks at both ends of life. Our immune defenses are at their weakest when we’re very young and when we’re old.

This season, the West Coast Health Alliance (California, Oregon, Washington, and Hawaii) advises a flu vaccine for everyone age 6 months and up. We’re a long way from there for our children. So far, fewer than one in three kids have gotten this year’s flu shot.

Kids between 6 months and 8 years old receiving their very first flu vaccine need two doses spaced at least four weeks apart. For the youngest children, that means the clock is already running.

 

Covid-19 activity continues to decline

Two months post peak, we’re still in a period of elevated activity, but it’s dropping week to week and is now “low.” You’re still at risk of exposure to both Covid and flu when you’re out and about. The upcoming holiday gatherings could boost that risk. Vaccines are our best line of defense.

A message for our elected leaders

One of the ways we listen to you in California communities is through The Pulse, a weekly health survey. Hannah Totte leads the survey, and as we move to action following the midterm elections, she has a note for our health leaders. Take it away, Hannah!

In all the health-related buzz out there, I’ve heard one theme repeatedly in coffee shops, bars, urgent care clinics, and around the table. And I’ve seen it again and again in The Pulse, our weekly survey on health concerns.

Californians are expecting leaders to improve access to our health care system. Across nearly 1,500 responses from Californians since June, funding of care—from medication and procedure costs to provider shortages and Medicaid changes—remains the top concern.

We see quotes like these, about what health leaders should be paying more attention to:

• “As always, making health care more affordable and accessible” (Los Angeles County)
• “People are putting off care because they can’t afford it.” (Yolo County)
• “Health leaders should pay more attention to making health care affordable and easier to access, especially for people who struggle to get appointments or pay for medication.” (Los Angeles County)

When people describe health care access, they often mean affordability, reliability, and convenience. From a public health perspective, health care access ties back to prevention. When people struggle to afford fresh food, skip screenings, and spread preventable illnesses, we see expensive, adverse health effects down the line.

When asked which services they’ve put off or the most frustrating problems in access, respondents told us about:

• Dental care: “Why is dental not part of health insurance? Why do so few dental offices accept Medicaid? (Do they somehow have even worse reimbursement rates than doctors?)” (San Diego County)
• Screenings: “My last full physical was in 2017… I am overdue for all/most screenings beyond that.” (San Francisco County)
• Procedures: “So many deductibles and co-insurances make patients unsure of the cost of appointments/procedures and afraid to get bills that they can’t pay.” (Butte County)

One person, a caregiver for a parent, shared that

“when having to navigate the system for my mom this past week… We end up being forced to choose between medical treatment, well-being, and bankruptcy.”

California has some of the most advanced healthcare systems in the world, and technology is advancing quickly. Regular people are reminding leaders that none of that matters if they can’t be accessed, and it’s time to refocus. What they need to see next is action.

That’s all for now. Thank you Hannah for those marching orders!

Be well, and I’ll see you next week.

Love,

Matt

Hannah Totte, MPH, is an epidemiologist and YLE Community Manager.

Dr. Matt Willis is the author of Your Local Epidemiologist in California. A California native, he’s served as a primary care physician, CDC epidemiologist, and public health officer for Marin County, where he guided the pandemic response. He lives in Marin with his family and their dogs, Teddy and Ramona.