An unvaccinated child in Texas has died from measles, authorities said Wednesday, marking the first US fatality from the highly contagious disease in nearly a decade as Health Secretary Robert F. Kennedy Jr. downplayed a growing outbreak.

The death comes as immunization rates decline nationwide, with the latest cases concentrated in a Mennonite religious community that has historically shown vaccine hesitancy.

It arrives at a delicate moment for US public health as Kennedy, who has long spread falsehoods about the measles, mumps, and rubella (MMR) vaccine, begins his tenure leading the Department of Health and Human Services.

"The school-aged child who was not vaccinated was hospitalized in Lubbock last week and tested positive for measles," the state health department said in a statement, with city officials adding the child died "within the last 24 hours."

This year more than 130 measles cases have already been reported in west Texas and neighboring New Mexico, the vast majority in unvaccinated children.

Around 20 have been hospitalized in Texas, and officials warn the outbreak is likely to grow.

During a meeting of President Donald Trump's cabinet, Kennedy downplayed the situation, stating, "It's not unusual. You have measles outbreaks every year."

He also stated the death toll as two -- but neither the Texas nor New Mexico health departments said they knew of any additional fatality.

The confirmed death "should serve as a reminder that there was a reason that the vaccine was developed and that the vaccine is valuable to individuals," infectious disease physician Amesh Adalja of Johns Hopkins University told AFP.

Lara Johnson, chief medical officer at Covenant Children's Hospital in Lubbock, Texas where the child was treated, told reporters that when she graduated from medical school in 2002, "I was confident I would never see a measles outbreak unless I chose to work internationally."

Religious exemptions

The outbreak's epicenter is Gaines County, home to a large Mennonite community, a Christian sect related to the Amish.

Texas law allows vaccine exemptions for reasons of conscience, including religious beliefs.

The Centers for Disease Control and Prevention (CDC) recommends a 95 percent vaccination rate to maintain "herd immunity."

However, coverage among kindergartners has dropped from 95.2 percent in the 2019–2020 school year to 92.7 percent in 2023–2024, leaving some 280,000 children vulnerable.

The last US measles-related death was in 2015 when a woman in Washington state died from pneumonia caused by the virus. She had been vaccinated but was taking immunosuppressive medication. Before that, the previous recorded measles death was in 2003.

Airborne threat

Measles is a highly contagious respiratory virus spread through droplets when an infected person coughs, sneezes, or simply breathes.

Known for its characteristic rash, it poses a serious risk to unvaccinated individuals, including infants under 12 months who aren't ordinarily eligible for vaccination, and those with weakened immune systems.

During outbreaks, about one in five infected individuals requires hospitalization, and one in 20 develops pneumonia. In rare cases, measles leads to brain swelling and can be fatal.

The good news is vaccination is exceedingly effective at conferring lifetime immunity -- with one dose estimated to be 93 percent effective, and two doses 97 percent.

Before the measles vaccine's introduction in 1963, it was thought that millions of Americans contracted the disease annually, and several hundred died. While measles was declared eliminated in the US in 2000, outbreaks persist each year.

The United States reported 285 measles cases in 2023, according to the CDC. The largest recent outbreak was in 2019, with 1,274 cases, primarily in Orthodox Jewish communities in New York and New Jersey, the highest national total in decades.

RFK Jr. has repeatedly and falsely linked the MMR vaccine to autism, a claim thoroughly debunked by scientific research.

In one of his first actions as health secretary, the federal health department postponed a routine meeting of an independent advisory panel that makes vaccine recommendations to the CDC.

AFP