By Cory Franklin

April 15^th, 2026

In my ongoing review of America’s measles outbreaks, which I discussed here last month, I thought I might look ahead on what might happen in the country for the rest of 2026.

How serious is the 2025-2026 measles outbreak that has gripped the US and what can be done to quash it? The dramatic rise in measles cases in the last 15 months requires action. But is this the calamitous public health emergency that some public health officials and media have proclaimed?  Not when you put the numbers in context.

With the first quarter of 2026 over, it is possible to extrapolate the likely US figures for measles cases, hospitalizations and deaths for the year. The extrapolation is a rough estimate and measles cases will fluctuate depending on several factors including seasonal factors and whether school is in session.  The numbers could change. But here are the projected estimates for 2026 based on current figures from the U.S. Centers for Disease Control and Prevention:

Expected total 2026 measles cases nationwide: Between 5,000 and 7,000. Adjusted for the current American population, this means 12-20 measles cases/million population.

In 2025 there were 2,300 cases for the entire year, or 6 cases/million, so there is an undeniable upward trend.

This is notable because there was less than 1 case/million annually in the first decade of the 21^st century. Vaccination rates fell concurrently during this interval.

But some perspective is necessary: While measles vaccination rates in the US are below the desirable 95% herd immunity threshold, the current relatively high vaccination rate of 91% means the US caseloads shouldn’t begin to approach the immediate post-World War II period, before the introduction of the measles vaccine, when cases were 200 times higher per capita than they are today.

Contrast this also with the present high rate of measles cases in Canada. In 2025, there were 160 cases/million people in the country – 25 times as many cases per capita as the US experienced. This year Canada is again on pace to exceed the US with three to four times as many cases per capita.

Expected total 2026 US hospitalizations for measles: Between 300 and 500 patients, that is, 1 hospitalization/million population. This would mean in 2026 on average each day only one person will enter the hospital to be treated for measles in the US, posing no strain on hospitals.

The figure is based on the current hospitalization rate of 5% of all measles cases – substantially below the often cited 20% hospitalization rate the CDC currently quotes on its website.  Why so? Because the agency’s calculation has overstated current real-world numbers.

The “new normal” of most measles cases, being treated with outpatient care, seems stable – hospitalizations were only 6% of cases in 2025 and in the first quarter of 2026, there was essentially one hospitalization/day nationally: 91 in 92 days.  The reason for the declining hospitalization rate is unknown; one theory is the older cohort infected with measles today handles infection better than infants and young children do.

Expected total 2026 deaths from measles: 3 to 6, with a potential range of about 0-10. Put another way: at least a possibility we will see no deaths from measles this year and it is unlikely we will see more than 10, barring unforeseen circumstances.

The current mortality rate of measles is slightly under .1%, so based on the number of expected cases, the number of deaths will be 1-2/100 million of the country’s population.

Measles has become a far less life-threatening condition, with mortality falling off drastically in the first half of the 20^th century, even before the introduction of measles vaccine (which subsequently reduced the mortality further to its current fractional level).  Again, the reasons are uncertain – possibly a combination of better nutrition and population immunity or a less lethal iteration of the virus.

Measles can still be a serious life-threatening condition – the rare neurologic complication and late-life complications including loss of immunity still occur. But even in the current outbreak, deaths from measles this year are likely to be on the same order as fatal snake bites, and fewer than deaths from lightning strikes or insect stings.

While not a dire emergency, measles remains a problem that requires better management to avoid the morbidity, mortality, economic and human costs of infection. Because the vast majority of cases occur in the unvaccinated, increasing vaccination rates with the goal of at least 95% of the population is obviously the key. This involves four approaches:

First, better public messaging. In any risk-benefit equation, measles vaccine makes sense. Decades of experience clearly indicate the risks of the vaccine are virtually negligible and far less likely to occur than the benefit conferred by preventing infection.  U.S. Department of Health and Human Services director Robert F. Kennedy Jr. and Surgeon General nominee Casey Means deserve reproach for not advocating for measles vaccine more vigorously.

Contrary to many opinions, RFK Jr. is not to blame for the epidemic – the majority of cases are in patients older than age 5, so their lack of early-childhood vaccination occurred well before Kennedy’s tenure. But his rhetoric has been contributory and should stop.

Second, consider tightening school requirements mandating vaccination before attendance.  The trend has been the other way -increasing medical and religious exemptions and the result has been a suboptimal vaccine rate for kindergartners in many states. This demands a reexamination of immunization exemptions at all levels, from preschool to university.

When California abolished personal-belief exemptions, measles coverage in incoming kindergartners increased in two years from 92.8% to 95.1%. When to allow vaccine exemptions – religious, medical or personal – is a difficult question but one that deserves greater public attention.

Third, a rapid response team should be in place when a local outbreak occurs. This is better coordinated at the state rather than the federal level and should include prompt reporting, immediate isolation of cases, contact tracing and targeted vaccination in vulnerable communities, including holding emergency immunization clinics. Fortunately, this is occurring in most outbreaks today and is probably the best aspect of our measles response.

Fourth, better screening of new residents from other countries where there are suboptimal vaccination rates. The 2024 measles outbreak in Chicago, and the West Texas federal detention and Spartanburg, S.C. outbreaks earlier this year all involved travelers or immigrants from other countries. (Spartanburg has the highest percentage of Ukrainian immigrants of any metropolitan area in the US and Ukraine has one of the lowest vaccination rates in Europe.)

Because vaccination standards vary wildly around the globe, new arrivals to this nation are a high-risk group by definition.  Screening for measles vaccination should be mandatory for those from other countries seeking to live in the US. Many have not been vaccinated.

Measles 2026 in the US is not COVID 2020 or influenza 1919. It is far less of a problem, but we have the resources to stop the spread of the disease. This will require less hyperbole and more resolve.

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Cory Franklin, physician and writer, is a frequent contributor to johnkassnews.com. Director of Medical Intensive Care at Cook County (Illinois) Hospital for 25 years, before retiring he wrote over 80 medical articles, chapters, abstracts, and correspondences in books and professional journals, including the New England Journal of Medicine and JAMA. In 1999, he was awarded the Shubin-Weil Award, one of only fifty people ever honored as a national role model for the practice and teaching of intensive care medicine. 

Since retirement, Dr. Franklin has been a contributor to the Chicago Tribune op-ed page. His work has been published in the New York Times, New York Post, Washington Post, Chicago Sun-Times and excerpted in the New York Review of Books. Internationally, his work has appeared internationally in Spiked, The Guardian and The Jerusalem Post. For nine years he hosted a weekly audio podcast, Rememberingthepassed, which discusses the obituaries of notable people who have died recently. His 2015 book “Cook County ICU: 30 Years Of Unforgettable Patients and Odd Cases” was a medical history best-seller. In 2024, he co-authored The COVID Diaries: Anatomy of a Contagion As it Happened.

In 1993, he worked as a technical advisor to Harrison Ford and was a role model for the physician character Ford played in the film, The Fugitive.