Last fall, I diagnosed mumps in a family member. At first, I thought maybe I was wrong. From what I can remember, I had not seen mumps in my career, and I could only remember what it looked like based on pictures from medical school. Not only that, but there were only 357 cases of mumps in the United States in 2024, according to the Centers for Disease Control and Prevention (CDC).¹

It seemed highly improbable that someone I knew had mumps. After we got the confirmatory test back, I was somewhat flabbergasted. How could my family member (who is an older adult) have come across the mumps? Of course, the health department was involved, and ultimately, we were never able to trace it.

Last month, while working in Texas, we treated a child suspected of having measles. Once again, this was a disease I had never encountered in my practice, only having studied it in textbooks. I found myself refreshing my memory on the “three Cs” of measles—cough, coryza, and conjunctivitis—though I was pleased I was able to recall the significance of Koplik spots. Unfortunately, this will likely not be the last time I have to consider measles as a diagnosis.

Across the nation, we are seeing a troubling resurgence of vaccine-preventable diseases, including measles, mumps, and whooping cough. These outbreaks present significant challenges for health care systems, particularly emergency departments (EDs) where the acute consequences of these diseases are most pronounced. The intersection of these outbreaks with health equity issues demonstrates the disparities in vaccination rates and access to health care that disproportionately affects vulnerable populations.

The Current Landscape of Outbreaks

Recent data show a resurgence of cases of measles and mumps in several countries, which have usually been attributed to low vaccination coverage. Here in the U.S. , measles cases have increased to their highest levels in more than 20 years, according to the CDC. Outbreaks are concentrated in communities with low vaccination coverage. As of this writing, 308 cases have been reported in 2025, which is the greatest number of reported infections in any one year since 2019.² Similarly, mumps has made a comeback, especially in places with lagging vaccine coverage.

Whooping cough, or pertussis, is another disease that has seen increased incidence, with outbreaks reported in various states. These diseases not only pose health risks to the individuals infected but also threaten public health efforts aimed at maintaining herd immunity.

Health Equity and Differences in Vaccination

Rates of vaccination are highly disparate, with different demographic groups and geographical places showing high and low levels of acceptance, often reflecting status, availability, language barriers, and cultural views of immunity and vaccination.

Consider, for instance, that misinformation regarding vaccines is most prevalent amongst marginalized communities and likely to lead to vaccine hesitancy.³ There are also barriers such as language differences and cultural differences that can affect how people perceive messaging related to the importance of vaccinations and available resources.⁴ These gaps not only increase the likelihood of outbreaks but also worsen health outcomes for the people who do get sick because of those inequities.

Implications for EDs

The resurgence of measles, mumps, and whooping cough has large implications for EDs. During outbreaks, emergency health care personnel often serve as the frontline responders by managing acute presentations, manifestations, or complications from these diseases. During outbreaks, increased patient volumes can overwhelm ED resources, resulting in longer wait times and decreased quality of care.

In addition, these diseases and their complications also pose a higher risk for children and people who are immunocompromised, pregnant, malnourished, or very old. In the case of measles, complications have been seen in as many as 40 percent of patients in various systems. Otitis media is the most common complication of measles that can lead to hearing loss. The most common severe complication of measles is pneumonia, which accounts for most measles-related deaths.³

Emergency physicians need to be familiar with the recognition and management of these diseases, which frequently require timely diagnosis and treatment to prevent serious complications. In addition, it is vital to have effective triage and isolation protocols in place to prevent the spread of infections within the ED. Also, it is advised to avoid using contaminated rooms for two hours after the patient’s exit, as the virus remains infectious on surfaces and in the air during that time. This will lead to fewer available rooms for patients and will affect ED flow.³

EDs are vital components of outbreak response, but emergency physicians also have a crucial role in responding to the resurgence of measles and mumps by advocating strongly for vaccination in their communities.

First, routine vaccination screening can be a part of patient visits, so that patients—especially children—are brought up to date on vaccines before they are presenting for acute illnesses. By doing so, we can spot coverage gaps and take immediate action.

Also, emergency physicians can participate in outreach initiatives and can get involved in community outreach programs. These include working with local health departments to set up vaccination clinics, or informational sessions aimed to educate families on the importance of vaccines and dispel myths regarding the safety of vaccines.

Finally, emergency physicians play a crucial role in the identification of measles—and mumps—like illnesses through accurate documentation and reporting. This is vital to surveillance efforts that inform decisions by public health officials around our priorities, and resources to reduce the spread of these vaccine-preventable diseases. However, effective public health responses must also consider the broader context of health equity.

Strategies to Address Health Equity

Tackling the inequities in health that drive differential vaccination coverage is key to national measures to curb the resurgence of vaccine-preventable disease. Here are some of the tactics that can be used:

1. Outreach and Education at the Community Level: Health departments and organizations should partner with local community leaders to disseminate facts about vaccines as well as address any hesitations. Educational campaigns that are culturally tailored can be an effective way to build trust and increase the uptake of vaccines.⁵
2. Increasing Access to Vaccination Services: Programs to provide free or low-cost vaccinations in underserved communities may help eliminate barriers to access. Mobile clinics and partnerships with schools and community organizations can help reach vulnerable populations.⁶
3. Addressing Misinformation: Misinformation about vaccines is rampant, so it is vital that targeted communication strategies are employed to combat misinformation. To spread accurate information, use social media campaigns and work with trusted community members.⁷
4. Policy Advocacy: Encourage policymakers to implement policies that ensure equitable access to health care and vaccines. This includes backing legislation that mandates vaccinations for school entry and funding public health efforts in underserved populations.

Conclusion

The outbreaks of measles, mumps, and whooping cough highlight why health equity needs to be a top priority to prevent vaccine-preventable outbreaks. Although EDs are critical in responding to outbreaks, the answer to the long-term solution lies in addressing vaccination rates among high-risk populations. In doing so, we can create a future where all children have equitable vaccine access, and we can diminish the toll these preventable diseases take on public health.

Dr. Kendall is the chief of clinician engagement at US Acute Care Solutions and has 15 years of emergency department leadership experience. She is the chair of the USACS diversity, equity, and inclusion committee, the social issues and equity in medicine committee co-chair, and leads physician leadership development for USACS.

References

1. Centers for Disease Control and Prevention. Mumps Cases and Outbreaks. https://www.cdc.gov/mumps/outbreaks/index.html. Accessed June 9, 2025.
2. Tin A. U.S. records most measles cases in single year since record 2019 wave. CBS News. https://www.cbsnews.com/news/measles-outbreak-2025-most-cases-since-2019/. Published March 14, 2025. Accessed June 9, 2025.
3. Blutinger E, Schmitz G, Kang C, et al. Measles: contemporary considerations for the emergency physician. J Am Coll Emerg Physicians Open. 2023;4(5):e13032.
4. Larson R. Linguistic and cultural barriers to Hispanic immigrant vaccination. Undergraduate Honors Theses. 354. https://scholarsarchive.byu.edu/studentpub_uht/354/. Published March 5, 2024. Accessed June 9, 2025.
5. Datta S, Martinón-Torres F, Berdzuli N, et al. Addressing determinants of immunization inequities requires objective tools to devise local solutions. Vaccines. 2023;11(4):811.
6. FEMA.gov. Mobile vaccination centers improve vaccine accessibility. https://www.fema.gov/blog/mobile-vaccination-centers-improve-vaccine-accessibility Published May 10, 2023. Accessed June 9, 2025.
7. Rodrigues F, Ziade N, Jatuworapruk K, et al. The impact of social media on vaccination: a narrative review. J Korean Med Sci. 2023;38(40):e326.