Posted on 08/18/2026 4:45:33 AM PDT by Red Badger
In a recent opinion piece for The Wall Street Journal, CDC Principal Deputy Director Ralph Abraham argued that “framing measles as an American policy failure is inaccurate and misleading,” asserting that resources including vaccines and therapeutics have been surging nationwide and that the current measles situation reflects broader global trends rather than a uniquely domestic policy breakdown.
Citing a recent Measles, Mortality Weekly Report article, Abraham hinted that something else was failing. He fell short of mentioning waning immunity or vaccine failure.
The fact that 44.4 percent of secondary measles cases in the Colorado outbreak occurred in individuals who had received two documented doses of MMR vaccine stands in stark contrast to the expected vaccine failure rate. The MMR vaccine is widely cited as having ~94 percent effectiveness after two doses, meaning that only 6 percent of fully vaccinated individuals are expected to remain susceptible under typical exposure conditions.
A breakthrough rate approaching 45 percent suggests either disproportionate exposure intensity, selection bias in testing or detection, or non-representative denominator dynamics, not a random sampling of the vaccinated population. Without exposure denominators, the proportion of vaccinated cases cannot be directly interpreted as a failure rate—but its magnitude exceeds baseline expectations and underscores the need for more rigorous denominator tracking, as well as attention to waning immunity, viral load dynamics in vaccinated individuals, and enhanced surveillance sensitivity (e.g., the use of urine RT-PCR).
Publicly available Colorado Department of Public Health data for all 36 measles cases in Colorado during 2025 (which includes but is not restricted to the outbreak described in the MMWR) shows the age distribution for those 36 cases as:
0–4 years: 6 cases
5–17 years: 9 cases
18+ years: 21 cases
Total: 36 cases, of which 15 (42 percent) were children under 18.
Since the MMWR outbreak accounted for 10 of those cases, this broader Colorado surveillance suggests that children made up a substantial fraction of measles cases in the state in 2025 overall, though the exact number of children within the specific outbreak cluster described in the MMWR isn’t published directly in that report.
Vaccinated Individuals Are Being Diagnosed and Counted as Clinical Measles Cases For more than two decades, measles surveillance in the United States and other high‑income countries has operated in what might be called the vaccination era. Endemic transmission was declared eliminated in the United States in 2000, and routine immunization with two doses of measles‑containing vaccine became the cornerstone of prevention. In this context, a persistent source of public confusion has re‑emerged with each new outbreak report: vaccinated people are sometimes diagnosed with measles and are formally counted as confirmed clinical cases. This article explains why that observation is real, why it is epidemiologically unsurprising, and why misunderstanding it distorts both scientific interpretation and public discourse.
The core fact is simple and verifiable. Under current public‑health surveillance rules, measles case definitions are agnostic to vaccination status. If an individual meets the clinical criteria for measles and laboratory evidence confirms infection, that individual is counted as a measles case regardless of whether they received zero, one, or two doses of measles‑containing vaccine. This is not an anomaly or a loophole in the system; it is a deliberate design choice rooted in how infectious‑disease surveillance functions.
To understand why vaccinated cases appear in official counts, it is necessary to begin with how measles cases are defined and confirmed.
Measles surveillance relies on a standardized clinical and laboratory framework. Clinically, a suspected measles case is defined by a febrile illness accompanied by a generalized maculopapular rash and at least one of the classic prodromal features: cough, coryza, or conjunctivitis. This clinical picture does not differ in principle between vaccinated and unvaccinated individuals, although its severity often does. Laboratory confirmation may be achieved through detection of measles virus RNA by reverse‑transcription polymerase chain reaction (RT‑PCR) from clinical specimens, or through serologic evidence consistent with acute infection. Once laboratory confirmation is obtained, the case is classified as confirmed.
Critically, vaccination history plays no role in determining whether the case is counted. Surveillance systems are built to measure the presence and spread of infection, not to pre‑judge who should or should not become infected.
This principle is illustrated clearly in a recent outbreak investigation reported by the U.S. Centers for Disease Control and Prevention. In a Colorado outbreak linked to an infectious traveler, investigators identified nine secondary cases and one tertiary case among Colorado residents. Of the nine secondary cases, four occurred in individuals with documentation of having received two doses of measles‑mumps‑rubella vaccine before exposure. These individuals met the clinical criteria for measles and had laboratory evidence of infection. Accordingly, they were counted as confirmed measles cases in the official report.
Vaccination Status and Outcomes in Colorado Outbreak
The report provided clear documentation of case outcomes:
This distribution reinforces the pattern: all hospitalizations occurred in unvaccinated or unknown-status individuals, while all vaccinated cases had milder courses. However, this justification would seem to imply that the MMR does not prevent measles cases, and if it does prevent measles cases, it is a fair question: Does the MMR vaccine no longer prevent transmission?
Enhanced Detection through Urine Sampling
The same outbreak report documented an important additional detail. In two vaccinated patients, RT‑PCR testing of nasopharyngeal specimens was negative, while RT‑PCR testing of urine specimens was positive. In one patient with unknown vaccination status, measles virus RNA was detected via urine specimen 24 days after rash onset, a notably extended detection window. These data suggest that vaccine-modified infections may shed virus differently—and that routine respiratory testing alone may undercount such cases.
Contact Tracing and Resource Constraints
Investigators noted that resource limitations restricted the scope of contact tracing. Due to workforce and time constraints, agencies prioritized individuals eligible for post-exposure prophylaxis (PEP), which may have resulted in under-identification of tertiary cases or silent transmission. This means the surveillance data likely reflect a conservative lower-bound on case totals, especially among mildly symptomatic or vaccinated individuals.
Cross-Jurisdictional Spread
Beyond the ten Colorado cases, seven additional measles cases were reported in other U.S. jurisdictions, all epidemiologically linked to the same index case. This establishes the outbreak as multi-state, not localized. It further validates the need to count and report all confirmed cases—vaccinated or not—to track national transmission patterns.
CDC’s Policy Conclusion: Maintain Vaccination
The report’s policy recommendation is unambiguous, if unprecedented:
“All eligible persons should receive 2 MMR vaccine doses. Travelers should ensure that they are up to date with measles vaccination.”
This policy of “All eligible persons” is a policy declaration not recommended by ACIP, and not backed by the CDC Director’s endorsement. Look for an article on this move by the MMWR authors soon.
While the presence of vaccinated individuals among confirmed cases does not diminish the administration’s role of vaccination regarding reducing the severity of measles, it underscores the importance of asking the question: What’s happening to the MMR efficacy?
From an immunological standpoint, there is nothing paradoxical about measles infection in vaccinated individuals: Vaccines are not a physical barrier to exposure. Two distinct mechanisms are well recognized. Primary vaccine failure occurs when an individual fails to mount a protective immune response after vaccination. Secondary vaccine failure refers to waning immunity over time, particularly in the absence of natural boosting from circulating virus in elimination settings.
Both phenomena have been documented in the measles vaccination literature for decades. The mere occurrence of breakthrough infection does not imply that vaccination is ineffective at a population level, but the numbers are concerning: historically, 6 percent vaccine failure rate was expected. Now we have 44 percent of cases vaccinated? This is problematic, as it is epidemiologically unexpected given prior assumptions.
School mandates rely on the argument that the immunocompromised will be exposed unilaterally by the unvaccinated. This is clearly no longer the case.
We know that exposure intensity matters. Prolonged close contact, such as that occurring during long‑haul air travel or within crowded indoor settings, like schools, increases the probability that individuals will become infected. In such scenarios, infection may still occur, it is expected that immune memory induced by vaccination typically blunts viral replication and accelerates clearance. The result is a clinical picture that is often milder, sometimes atypical, yet still recognizable and diagnosable as measles.
However, this means that the vaccinated can, in fact, transmit measles virus. There is, therefore, no rational basis for any mandate for measle vaccination that keeps students from school on the basis of their vaccination status.
While vaccination alters disease expression, and vaccinated cases can appear to complicate interpretation of outbreak statistics, we can only say there are important questions here regarding the scale of the problem. Without denominators, raw case counts by vaccination status from a small sample are easily misread. Knowing that four vaccinated individuals were among nine secondary cases says something, but it cannot form the basis of a robust estimate of relative risk unless one also knows how many vaccinated and unvaccinated people were exposed and what percent of the population being studied was vaccinated. Surveillance reports rarely include those denominators, because they are difficult to reconstruct accurately in real‑world outbreaks. As a result, while that problem has show itself quite clearly, case series cannot be used to reliably estimate vaccine effectiveness or failure rates without additional analytic work.
CDC estimates the 2-dose efficacy of the MMR vaccine at 97 percent. That said, if 44 percent of cases in any vaccine-target disease are vaccinated, the vaccine efficacy would only be 91.3 percent. That’s below the FDA’s requirement for approval of a measles vaccine for use in the United States (about 97 percent seroconversion in non-inferiority trials). CBER has typically requested non-inferiority success criteria of Lower Limit of the 95 perce CI for SRR difference ≥ −5 perce for measles/mumps/rubella in that contextntnt.
It is important to point out that transmission from vaccinated individuals must be studied on its own. Surveillance reports may document that vaccinated people became infected, but they do not automatically show that those individuals were responsible for onward transmission. In the Colorado outbreak, tertiary transmission was linked to a household contact of a case with unknown vaccination status, not to a vaccinated case. While this does not mean that the vaccinated cases did not transmit, this distinction matters when communicating about transmission dynamics and public‑health risk.
Counting vaccinated individuals as measles cases is certainly a positive mark for the integrity of the surveillance system, not a flaw in vaccination policy. A system that excluded vaccinated people by definition would underestimate incidence, obscure transmission chains, and bias severity assessments. Public health surveillance counts infections because infections are what propagate outbreaks.
The Efficacy Lifecycle of the MMR Vaccine: Has Selection Caught Up?
The MMR vaccine was first licensed in the United States in 1971 and has now been in widespread use for over five decades. With most children receiving two doses by early elementary school, this vaccine has achieved exceptionally high coverage in many cohorts across multiple generations. In terms of evolutionary opportunity, that represents more than 100 selective generations of viral passage—accounting for both real-world exposure to wild-type measles virus and the laboratory-grown strain used in the vaccine itself.
While measles virus is not as mutable as influenza or SARS-CoV-2, it is not genetically inert. The sustained, population-wide immune pressure created by near-universal vaccination exerts continuous selection against the wild-type virus. Over time, even a low mutation rate accumulates genomic diversity, and selection—unlike mutation—is not random. In a context of high immunologic uniformity, selection acts hard on even modest viral variation, especially at immunodominant epitopes. The longer the interval of widespread immune pressure, the more likely that viral variants capable of partial immune escape, altered tropism, or modified replication kinetics will be favored.
In short: slow evolution under hard selection pressure is still evolution. And the MMR vaccine has been pressuring the measles virus continuously for over 50 years.
Furthermore, the vaccine strain (Edmonston lineage) is derived from a wild-type virus isolated in 1954. It has not been updated. The immune response it trains may no longer provide complete sterilizing protection against all circulating measles variants—especially in populations that have not seen natural boosting for decades. This may explain why we are now seeing higher-than-expected breakthrough rates in high-intensity exposure settings.
The PCR testing for measles is not the non-quantitative RT-PCR rife with false positives used for COVID19, and some back-of-envelope calculations show that waning immunity must be in play to explain 44 percent unvaccinated among the cases even if the PCR has a 6 percent false positive rate (not shown, we may publish that analysis later).
It is also reasonable to ask whether the current vaccine has reached the outer limit of its functional lifecycle, at least as a blocker of transmission. If so, the implications are significant:
* Mandates predicated on blocking spread may need re-examination.
* Vaccine strain updates (analogous to flu vaccines) may need exploration.
* Surveillance systems must monitor genetic drift in measles virus more carefully.
Even a highly effective vaccine can be outpaced—not by rapid viral chaos, but by quiet, cumulative selection across generations of universal application. What we’re seeing may not be a failure of the MMR, but a signal that it is doing exactly what evolutionary theory predicts under hard selection at scale: forcing its target to shift.
The broader policy implications follow directly from this logic. Vaccination remains a primary tool for reducing disease severity when infections occur. The question of whether MMR vaccination still affords protection from infection has earned its time in the limelight.
At the same time, elimination‑era epidemiology requires clinicians and public health agencies to remain alert to the possibility of measles even in vaccinated patients, particularly during outbreaks or after international travel. Diagnostic vigilance, including appropriate specimen collection, ensures that cases are detected and managed promptly.
Transparent communication is essential. When reports state that vaccinated individuals were diagnosed and counted as measles cases, the statement is factually correct. When that fact is presented without context, however, it invites misinterpretation. Breakthrough cases are expected in any large vaccinated population facing a highly contagious virus. Questions remain on the matter of efficacy, however, when a large percentage of cases in a transmission chain are in the vaccinated.
Recognizing this problem and demanding a review of the basis of claims of efficacy by Merck will allow discussions about measles to move beyond misleading binaries and toward a more accurate appraisal of how vaccines, infections, and surveillance systems actually interact.
Watch this space for developments.
Republished from the author’s Substack
=========================================================================================
Author
James Lyons-Weiler
Dr. James Lyons-Weiler is a research scientist and prolific author with over 55 peer-reviewed studies and three books to his name:
Ebola: An Evolving Story,
Cures vs. Profits, and
The Environmental and Genetic Causes of Autism.
He is the founder and CEO of the Institute for Pure and Applied Knowledge (IPAK).
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Ping!.............
Is the Big Pharma vaxx gravy train coming to a stop?
We can hope.
Vaccination, from a public health standpoint, is not about preventing transmission, it’s about the government not spending as much money on hospitalizations of those who may not be able to pay the bill.
A slightly different question.
In what population type in the US can there possibly be 40% (4 out of 10) of unvaccinated, and 2 more people of unknown status?
This is virtually mandatory for US born individuals.
And no discussion of the “traveler” who infected them?
Is this some type of Roma camp existing in Colorado that we aren’t supposed to talk about?
Camp of the Saints, camp...................
I decided to read the entire article (I know - not very FReeperish) but I am as confused now as before I read it.
There is one important figure missing: What is the percentage of people vaccinated (mainly children)?
In this outbreak it appeared that it was mainly children who were affected.
Given the figure cited in the article that one can expect a 6% failure rate of the vaccine, assume that 1000 children were exposed to measel virus and let’s also assume that 93% had been vaccinated. Then 70 of those 1000 children who were exposed for the virus were not vaccinated and would come down with measels (assuming no inherent immunity).
Also, 930 children who have been vaccinated will be exposed, but given a failure rate of 6% 56 of those children will fall ill with measels (930 x 0.06 = 55.8).
So out of the sick children (56 + 70) 56/126 have been vaccinated, ie ≈ 44%.
That is the same figure that was discussed in the paper. Do you know what frequency of children are vaccinated? Is 7% a too low or too high figure for unvaccinated?
Brave AI:
Nationally, approximately 92.4% of kindergarteners in the U.S. received the measles, mumps, and rubella (MMR) vaccine for the 2025–2026 school year. This is down slightly from 92.5% the previous year and remains below the ideal 95% threshold required to maintain community herd immunity. -ArsTechnica
Thanks!
That means that my guess of 7% unvaccinated was not unreasonable.
So, the number to follow (in this instance) is not the ratio of vaccinated to unvaccinated children who fall ill, but how many vaccinated who fall ill relative to the total number of vaccinted children.
We can also assume that every man, woman and child coming into the US illegally is NOT VACCINATED for anything. They bring in new slightly different strains of the diseases that are native to their home and the vaccine we use in totally useless........
That’s true and is of course a problem (among others concerning illegals) that needs to be controlled.
Good article - thanks for posting.
The key lines (IMO):
“In short: slow evolution under hard selection pressure is still evolution. And the MMR vaccine has been pressuring the measles virus continuously for over 50 years.
“Furthermore, the vaccine strain (Edmonston lineage) is derived from a wild-type virus isolated in 1954. It has not been updated. The immune response it trains may no longer provide complete sterilizing protection against all circulating measles variants—especially in populations that have not seen natural boosting for decades. This may explain why we are now seeing higher-than-expected breakthrough rates in high-intensity exposure settings.”
Too many people lump all vaccination policy (and all vaccinations) in the same barrel, as a ‘good thing’ or a ‘bad thing’ - but different diseases have different susceptibilities to control by vaccination.
Some, like smallpox and polio are caused by viruses that change only slowly by mutation over time - vaccination works great with them.
Some have rapid mutation rates - the spread of the flu is affected by vaccination, but it’s not going to be stopped by vaccination - the flu virus mutates too rapidly to get shut down. That’s one of the things that idiots like Colbert (and his dancing syringes) didn’t realize about Covid.
What this article suggests is not that the MMT vaccine is ‘bad’, because some of the vaccinated are getting mild cases of measles, but that measles virus is slowly mutating into a form that can partially elude a vaccine that’s been working well for over 70 years, so that it might be a good idea to update that treatment.
I imagine many of the infected came into the country illegally.
I refuse all shots because I don’t want that poison in me.
When I was a kid, I was told that I was going to get chickenpox and two cases of measles, Rubella being “German measles.” It was guaranteed. I did, which of course means that I’m at risk of expressing shingles in old age. Hence, I did that that vaccination. I just don’t have time for that disease.
I wonder if the vaccination rate today has so greatly reduced the airborne probability of coming in contact with the Rubella virus that the probability one will contract it will be later in life when the damage can do is liable to be much more severe.
It is probably more likely that the virus will mutate to a point that the MMR vaccine will no longer be adequate and we will start the cycle all over again............
Good thought. It might make more sense to inoculate with the present virus at an appropriate age and time and just take our lumps programmatically.
I had measles as a kid, and chicken pox. Got the sugar cube polio vax, and the Smallpox vax scar.
Didn’t have mumps or Rubella, however I was in the Marines and we were vaxxed for everything even plague and no telling what else......
I went through that schedule too. I remember well the helicopters blaring speakers that we were to take our polio sugar cube. I’m guessing that was 1961 or ‘62.
Maybe we should take our lumps from mumps ;-) Don’t know.
Smallpox on the other hand is no joke. Worse, it was the Soviets who proposed the worldwide UN program to eradicate it and then the UN proposed to destroy all laboratory stocks of the virus. All that time, Biopreparat on an island in the Aral Sea was developing more lethal strains. Thank heaven Carter refused. It could be the one decent thing he did.
We are now beyond the protective value of that vaccination, and of course children are no longer getting it. As far as I’m concerned the aegis of that risk is intentional. Meanwhile, the Aral Sea is drying out.
Oh, boy...
I just took a quick cruise looking at recwnt papers for therapeutics for rubella.
It’s not just vaxxes.
mRNA therapeutics are in development, too.
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