Editors’ Note: PCC interviewed Seth Kaplan on the West Texas measles outbreak in May of 2025. Dr. Kaplan has since written an update, shared below.
"While the West Texas measles outbreak was declared over in mid-August 2025, some cases continue to pop up in other areas of the United States. We have moved on to a period of even greater uncertainty, due to the constantly changing policies coming from the U.S. Department of Health and Human Services and the Centers for Disease Control, which can no longer really be relied upon as credible sources of science-based information. This has led to a proliferation of misinformation and disinformation that is understandably confusing to families. The American Academy of Pediatrics and other major medical organizations are doing everything they can to combat this mis- and disinformation, and to make sure that pediatricians are equipped with an evidence-based vaccine schedule, fact-checked information, and that parents have evidenced-based educational tools at their fingertips.
But the current environment surrounding vaccines will make the handling of the inevitable next outbreak of a vaccine-preventable disease that much more challenging to handle. Unfortunately, I fear that it is children that will pay the price for this. As pediatricians, we all must continue to stand up for science and clearly communicate with our patients and their families why vaccines are so important. We must also engage with our legislators and community leaders to make sure that decades of the life-saving benefits of vaccines are not undone and that the measles outbreak of 2025 is not repeated over and over again – and that other outbreaks can never take hold."
Dr. Seth Kaplan, September 2025
Measles, once eradicated in the United States by the MMR vaccine, has made numerous reappearances leading to illness and at least two child deaths as of April 6, 2025. Childhood vaccinations have gone down in the wake of the COVID-19 pandemic, with parents citing among other things, lack of faith in the science and doubt over their efficacy and ingredients.
Pediatricians now face a conundrum. While many are used to engaging in the often long and hard-won conversations that allay fears of vaccinations with vaccine-hesitant parents, decades of children have now passed through the doors of their community pediatrician without ever being diagnosed with measles. The disease was declared eliminated in 2000 by the World Health Organization. This means that pediatricians practicing today may have little to no experience with the disease, nor are they receiving clarity from health officials on the protocols that would protect their staff and patients from the highly infectious contagion. On top of this, new layers of complexity enter the exam room with patients from parents who have concerns with vaccines and want to try at-home, alternative methods for treating disease, such as vitamin A supplements.
We spoke to Dr. Seth Kaplan, whose Texas practice has just had its first confirmed measles case, to ask about what’s happening on the ground with communities. Dr. Kaplan is a pediatrician practicing in Frisco, Texas at the Cook Children’s Physicians Network. He is the former president of the Texas Pediatric Society, the Texas chapter of the American Academy of Pediatrics.
“[L]et me preface this by saying I am not an expert in this at all, but we're living through it,” he said of the measles outbreaks and the attention towards alternative medicines and supplements. “You know, I think there's a certain degree of magical thinking that something that's ‘natural’ is better than something that's not. So it's totally understandable that some parents would want to take that approach, because it's the info we're hearing from the people who are supposed to be leading our nation's most important health organizations with data. And [the data is] not necessarily there for the treatments they are suggesting.” 
“It's interesting,” he continues, “Because, of course, we just had our first case of measles. This child's not hospitalized, but the suggestion was that they do take vitamin A. There are good studies that if you're vitamin A insufficient, you may have a worse course with measles. So it's not that you're treating measles with vitamin A – you're trying to prevent complications of measles, is my understanding, by making sure that the vitamin A levels are good. That said, that's done in a very controlled fashion, and there's no good evidence, as far as I know, that says that taking vitamin A will prevent you from getting measles if you're not vaccinated.”
According to the Centers for Disease Control & Prevention, the best method for preventing measles is the measles vaccine, which comes in two doses and is 97% effective by the second dose (up from 93% for most people with one dose). Like many in his cohort, Dr. Kaplan (pictured) reports that the patient currently in his practice, who is under the direct care of his partner, is the only case of measles he has knowingly been in the vicinity of in his professional career.
Measles typically presents with a fever, cough, and runny nose, followed by the tell-tale blotchy rash that descends from the hairline that is the hallmark of the disease. As pediatricians are all too aware, these symptoms overlap in a host of childhood illnesses and diseases, and not all of them are measles.
“I think we're just being very cognizant about it,” Kaplan says of remaining vigilant for measles in his practice. “Particularly in our under-immunized kids, which thankfully, in my practice, we just don't have a whole lot of. We're also very cognizant about it in folks that are traveling internationally and coming home from other places.”
While pediatricians in Texas and beyond remain watchful, Dr. Kaplan says that one difficulty of this particular series of outbreaks comes from the sometimes conflicting messages he and his colleagues get from state, federal, and local health departments.
“This is kind of harkening back to the beginning of the COVID pandemic – although measles has been around a long time, and there's guidelines for exactly how you're supposed to test for it, we're getting conflicting information from our local infectious disease folks and from the Department of State Health Services about what the proper way to go about testing is, and so it's just hard to know exactly what to do.”
While doctors attempt to align conflicting instructions from health officials, they must also contend with criticism. Kaplan shares that at a recent annual leadership conference for the Texas Pediatric Society, the Texas chapter of the American Academy of Pediatrics, physicians from West Texas report struggling with both the physical concerns of their patients, as well as a maelstrom of criticism on social media.
“They're dealing with this on an everyday basis,” Kaplan shares. “One of the frustrating things for them is that some information will get out into social media and they can't talk about specific cases. So there's a lot that's obviously myth that gets out there, and it's on social media. [Social media users] won't have a problem mentioning specific physicians and information about specific patients, but physicians feel helpless to do anything about it. Even though they know they've done the best they can, and done what they think is the right thing, their names are being dragged through the mud in inappropriate ways.”
The plight of physicians in Texas and beyond has not gone unnoticed. Kaplan expressed gratitude for the American Academy of Pediatrics’ (AAP) moves to protect physicians who will not and cannot, because of HIPAA protections and ethical concerns, reveal the nature of their care for specific patients and therefore cannot defend themselves against targeted social media attacks.
The AAP’s Fact Checked campaign details myths about measles and the MMR vaccine and fact checks them against common claims, such as that vaccines contain fetal tissue (they do not), that they are under researched (they are tested extensively before being released to the public), that vitamin A prevents measles (it doesn’t), and that because the DTaP vaccine is a multi-dose series, it isn’t effective (it is).
Unfortunately, DTaP vaccines are perhaps the next wave in vaccine hesitancy. Kaplan reports that vaccine hesitancy conversations are by no means new at his practice, but there has been a shift of late towards doubt around the DTaP series of vaccines, which protect against diphtheria, whooping cough (pertussis), and tetanus, as well as HPV vaccines in pre-teens.
“We're in the midst of a huge outbreak of pertussis down here,” Kaplan says. “I have diagnosed more cases of pertussis in the last year than I have in my entire career, and part of that is that I'm thinking about it more because I know it's out there and I'm looking for it, but at the same time, this is just kind of crazy. Usually we see it in the 9 to 11 year olds right before they get their Tdap, or we see it in the 16 to 19 year olds who haven't gotten a booster of Tdap yet. But now we're starting to see it in more ages, because we're starting to have more kids for whom that is a vaccine that, for some reason, they don't want to get. It’s painful, because then it puts our youngest patients at risk, because if they're exposed to pertussis, they get sick. Really sick. I mean, the bigger kids who get it are still coughing for two, three months, and even that doesn't convince [their caregivers] that they need a vaccine.”
When asked if perhaps vaccine hesitancy might be caused by displaced anxiety from pandemic times, Kaplan concurs:
“I think so, though one of the big differences is that for measles and pertussis, these are vaccines that have been used for decades. A lot of the issue with the COVID vaccine was that it seemed unknown. And there's reasonable questions about what the long term effects of an mRNA vaccine are. But data around [DTaP and HPV vaccines] is not unknown. These are vaccines that have been studied forever and ever and ever, and whose track records are outstanding.”
The science is clear, but human feelings are more complicated, and often overlap with varying results, just like the common childhood disease symptoms that might turn out to be measles. The ideology, beliefs, social pressures, and emotions one person experiences can prompt them to choose vaccines for their child and another person to choose to delay or skip them. The AAP and pediatric community know this, and continue to fight misinformation and provide reassurance to families in pursuit of the best care. Trust and patient relationships remain a pillar of pediatric practice, as Kaplan notes, even if doubts are more present than before.
“We try to keep a very open attitude towards things, and let families know that we really view this as an ongoing conversation, that we are going to bring [vaccines] up every single time we see them. Not to pester them, but just to make sure that they have all the relevant information at their fingertips, and why this is so important to us, for them and for the public health.”
Pediatricians are human too, after all, and many are experiencing burnout and fatigue from the added pressure of vaccine hesitancy and social media misinformation. Dr. Kaplan has experienced his own journey through burnout and subsequently, recovery from a cancer diagnosis. He offers this advice for pediatricians:
“One, stay calm. This is a marathon, not a sprint, even though right now it can feel like a sprint.” (Dr. Kaplan ought to know, as he is a marathon runner!) “Spend some time learning motivational interviewing techniques, because I think they can be really, really helpful as you're having these conversations, to meet patients where they're at and to have families come to the conclusions that you want them to come to in a way that empowers them to feel like they're making the best decision for their their child.”
He goes on to explain that there are many industry experts to add to a support network, and to learn from. “I make sure I learn all the time too, just to keep an open mind.”
Dr. Kaplan also wants pediatric residents, fellows, and trainees especially to know that what’s difficult today will not always be difficult. Relationships and trust take time to flourish. “Primary care pediatrics is a relationships game, and right now, the relationships are a little bit frayed at times. But ultimately, relationships are what makes it work. And so at the beginning of your career, that may be a little more frustrating, because you don't have those relationships already built, but over time, they're going to come, and it makes some of those conversations easier and easier and easier.”
He relates one of the stories he likes to tell when teaching, about addressing patients with anxiety or depression. Such conversations can be daunting, but Kaplan reports that relationships make even these tough conversations both efficient and worthwhile for everyone. “You know the child, you know the family, you know where they're coming from.” He encourages trainees – and his fellow pediatricians – to focus on what they’re good at, and trust that the work now will pay dividends in years to come.
“Knowing that you're going to be building those relationships is going to make what may seem really, really challenging and difficult a lot easier with time and wisdom and experience.”
