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From the Chief Medical Officer: Key Takeaways from ASTHO’s HPAI Scientific Symposium hpai scientific symposium, highly pathogenic avian influenza, one health, public health, state and local public health officials, wild birds, human health, infectious diseases, disease control and prevention, centers for disease control, infected with avian influenza, symptoms of illness, domestic animals, working closely, united states, health department, food safety, public health practice, domestic poultry, contact with infected, health official, health risks, infect humans, dairy cattle, exposure to infected Marcus Plescia, Jessica Baggett, Meredith Allen A recap of ASTHO's Scientific Symposium on Highly Pathogenic Avian Influenza While only one human case of Highly Pathogenic Avian Influenza (HPAI) has been reported in the United States this year, the discovery of transmission of HPAI in cattle has led to an increase in the need for federal, state, and local public health agencies to enter a heightened phase of readiness. The risk to the general population remains low but this change signals the need for an increase in collaboration, research, and communication. Last week, ASTHO hosted a virtual symposium in partnership with the Infectious Diseases Society of America and the Council for State and Territorial Epidemiologists that featured public health leaders and scientists driving the U.S. government’s response to HPAI. Experts outlined potential actions for managing further spread and identified areas requiring additional investigation and guidance. Using a One Health Approach is Critical One Health recognizes that the health of people is closely connected to the health of animals and our shared environment. This is not a new concept but has become more important in recent years. The disciplines of public health and agriculture are inextricably linked. The symposium emphasized the importance of building and maintaining partnerships between CDC, USDA, FDA, ASPR, NIAID, and state and local public health departments. Recognizing the interconnectedness of these domains is essential for effective disease prevention and control. Public Health Recommendations will Evolve with the Science A key insight from the symposium was the dynamic nature of the situation. While we know a great deal about pandemic flu response, spread through dairy cattle is new. More in-depth epidemiologic studies will call out changes in transmission between cattle, people and cattle, and the potential for person-to-person spread. Collaboration between public health, agriculture, and farm owners will allow public health to gather epidemiologic data that can be translated into clear and data-supported recommendations to prevent continued transmission. As scientific understanding evolves and new evidence emerges, so must our public health response. As always, the public health community will commit to continuous learning, flexibility, and readiness to adjust strategies accordingly to ensure that interventions remain evidence-based and effective. Assessing the Current State of Readiness The supporting federal government response to HPAI appears to be well positioned; our federal partners don’t anticipate challenges with the commercial supply chain for personal protective equipment (PPE), vaccine, or therapeutics. The commercial system continues to be the primary source for PPE, but there are federal stockpiles available from ASPR, and the Food Safety and Inspection Service (FSIS) national veterinary stockpile. There is no indication of viral resistance to existing antiviral treatments and, in addition to commercial supplies, "tens of millions of courses" of Tamiflu area available through the strategic national stockpile should they be needed. CDC is providing ongoing surveillance of emerging flu strains and anticipates rapid availability of vaccine should infection begin to occur in workers in high-risk settings. State and Local Public Health Officials are Increasing Planning and Coordination The interface between public health agencies and state or local agriculture departments is critical. A public health response includes rapid situational awareness, laboratory testing, implementing public health recommendations around screening/isolation, and providing appropriate care (medications). Questions and planning scenarios specific to health officials may include the following: How will your team determine whether people are exposed and, importantly, symptomatic? Who will you dispatch to the farm to obtain testing for those symptomatic individuals? What is your approach to case investigations? How will you engage in symptom monitoring in this population? On the laboratory side, how will specimens be transported to the public health lab? Are your laboratories ready to receive/run those specimens, even if they are, for example, conjunctival? If positive, how will that specimen be sent to CDC for confirmatory testing? If positive, how will you communicate the result to the individual and counsel them on isolation? How will Tamiflu be provided (if indicated)? From what cache? What is your communications plan if positive? ASTHO will continue to work closely with our partners to monitor this situation and provide updates as they become available. website yes

Downstream Effects of CDC Adopting ACIP Recommendations for COVID-19 and MMRV Vaccines Downstream Effects of CDC Adopting ACIP Recommendations Susan Kansagra, Andy Baker-White, Meredith Allen, Kimberly Martin, Ericka McGowan Learn about the downstream effects of CDC adopting ACIP recommendations for COVID-19 and MMRV vaccines, as states examine how their policies and laws intersect. On Oct. 6, CDC adopted the recommendations that the Advisory Committee on Immunization Practices (ACIP) made in September — specifically, individual-based decision-making for COVID-19 vaccine and separate measles, mumps, and rubella vaccine, and the varicella vaccine in toddlers. The adoption of these recommendations now sets in motion a cascade of other processes that influence access to vaccines. In addition, several states have begun to examine how their state level policy and laws intersect with ACIP recommendations given the delay in adoption and the uncertainty of the process going forward. COVID-19 Vaccine Recommendation CDC adopted the recommendation for shared clinical decision-making for the COVID-19 vaccine for those six months and older. The adoption of this ACIP recommendation has a ripple effect on coverage and access: It enables states to begin ordering COVID-19 vaccine under the Vaccines for Children program. It allows state Medicaid programs that link coverage to ACIP recommendations to cover the cost of the vaccine. It enables pharmacists to provide the COVID-19 vaccine under the federal PREP act declaration — as opposed to or in addition to state law, which varies by state. Many state health departments issued standing orders and executive orders to enable pharmacists to administer in the meantime. It requires health insurers to cover the cost of the vaccine, as the Affordable Care Act ties insurance coverage requirements to ACIP recommendations. Though, prior to the meeting, health insurers indicated they would do so anyway this year. MMRV Recommendation The CDC also adopted the recommendation for separate varicella (V) and measles, mumps, rubella (MMR) vaccines rather than the MMRV vaccine (combined measles, mumps, rubella, varicella) for children under four years. As background, current guidance allows either MMRV or MMR + V to be administered to children 12-47 months. However, because of a small but higher risk of febrile seizures for dose one, they are recommended to be administered separately (MMR + V), unless families express a preference for MMRV. Only about 15% of children currently receive MMRV for the first dose, and the general consensus is that this decision will result in some changes but not significantly impact access to vaccines: The adoption of this recommendation means that VFC will no longer cover MMRV for children under four, but it continues to cover separate MMR and V vaccines. Since many state Medicaid plans tie vaccine coverage to ACIP recommendations, coverage of MMRV by state Medicaid will vary depending on this language, though separate MMR and V vaccines would continue to be covered. Private insurers can choose to cover MMRV and will likely continue to in the short term but are not required to. They are required to cover separate MMR and V vaccines. How States Are Preparing for the Future As it stands now, ACIP recommendations, particularly for respiratory viral season, are not that different than prior years – with influenza, RSV, and the COVID-19 vaccine recommended (the latter with shared clinical decision making). However, the delayed and unpredictable process has led many states to examine how closely they are tied to ACIP in law, regulation, or practice. Over 600 statutes across U.S. states and territories reference ACIP — whether for pharmacist vaccine authority, school entry, health care worker or other requirements. States have considered a variety of actions to ensure they maintain access to vaccinations for their jurisdictions including: Passing or introducing legislation that allows the state health department to use ACIP guidance from previous years or recommendations from other bodies (e.g., medical provider organizations) in state law, as it relates to school entry, pharmacist authority, and others. Issuing standing orders and executive orders to enable pharmacists to administer vaccines in the absence of ACIP recommendations. Examining Medicaid state plan language to determine how to interpret requirements when ACIP is referenced and considering updates to that language (e.g., North Carolina). Issuing state requirements for insurers on vaccine coverage (e.g., Oregon, California, Hawaii). Examining use of state funds to purchase vaccines. Supplemental Resources Tracking State Actions on Vaccine Policy and Access by KFF Vaccine Resources by the Common Health Coalition States Take Action to “Immunize” Vaccine Access by Mandy Cohen, Julian Polaris, and Liz Dervan Vaccine Integrity Project — Fall Immunization Information by the Center for Infectious Disease Research and Policy Special Thanks - Blog - Downstream Effects of CDC Adopting ACIP Recommendations Padding Block - Large Related Content - Blog - Downstream Effects of CDC Adopting ACIP Recommendations article yes

Every year on Nov. 22, ASTHO—and countless other agencies and organizations worldwide—take a moment to acknowledge the public health workforce on Public Health Thank You Day. Like so many other days of recognition, it has become a blip on our yearly calendar. And, simply put, that’s just not enough. This year, ASTHO leadership took pen to paper to share some of our feelings, fears, and—yes, our thanks—for everything the public health workforce has always done to protect us.

On Aug. 23, 2021, the FDA announced full approval of Pfizer and BioNTech’s mRNA vaccine for COVID-19. ASTHO has answers to five key questions about the approval and what it means for state and territorial health officials: What does the FDA’s approval approve; what did we learn from the FDA’s safety and efficacy review; How long did the approval process take, and when could we see more FDA-approved vaccines; What does FDA approval mean for vaccine confidence; What does FDA approval mean for employer and university vaccine mandates.

A discussion with Meredith Allen, ASTHO’s Vice President for Health Security, about how the first shipments of the COVID-19 vaccinations have been a major turning point for the pandemic and a milestone moment for U.S. public health history.

The Public Health Response to Hantavirus: Key Actions, Perspectives, and Takeaways Public Health Response to Hantavirus: Key Takeaways Ericka McGowan, Sidnie Christian, Margaret Nilz Learn about the hantavirus outbreak from the MV Hondius and the ongoing public health response — including the important work of state and local health departments. On May 2, the World Health Organization (WHO) received notification of an international hantavirus cluster linked to passengers aboard the MV Hondius cruise ship, following reports of severe acute respiratory illness. Subsequent laboratory testing confirmed infection with the Andes strain of hantavirus, a rare zoonotic virus associated with hantavirus pulmonary syndrome. The event drew international public health attention because of the distinct challenges posed by the cruise ship setting, the need for multi-country coordination as exposed passengers returned home, and the involvement of the Andes virus — which can be transmitted person to person unlike other strains of hantavirus. In response, WHO and U.S. health authorities initiated contact tracing and surveillance to monitor for additional cases. Despite international attention, the risk to the public is low at this time. However, it remains crucial for state and territorial health officials to stay up to date on this developing threat, which serves as an important reminder that public health preparedness is more critical than ever. What Is Hantavirus? Hantaviruses belong to the family Hantaviridae within the order Bunyavirales and are primarily spread through contact with infected rodents (i.e., via exposure to their urine, droppings, saliva, or contaminated surfaces). Various strains exist globally, including the Sin Nombre virus, predominant in North America, and the Andes virus, predominant in South America. In humans, clinical signs are non-specific, including fever, fatigue, muscle aches, headache, and gastrointestinal symptoms. In severe cases, infection may progress to hantavirus pulmonary syndrome, with rapid onset of cough, shortness of breath, and fluid accumulation in the lungs. The recent cases raised concerns as the cruise ship setting likely facilitated exposure among passengers and crew. Additionally, the expedition's international nature meant potential exposure across multiple countries, with passengers disembarking before confirmation that illnesses on board were due to Andes virus — thus requiring coordinated surveillance, contact tracing, and risk communication among national health agencies. The particularly long incubation period of the Andes virus, 4-42 days after exposure, further complicates monitoring. MV Hondius Hantavirus Outbreak: Key Insights Timeline In early April, the MV Hondius ship departed Argentina. On April 11, the first case died on board, and a close contact died shortly after. On April 28, a passenger experienced onset of symptoms, later presenting with pneumonia, and died on May 2. On May 2, the United Kingdom reported a cluster of passengers with severe respiratory illness to WHO. At the time of reporting, 147 passengers and crew were on board while 34 passengers had disembarked. On May 2, PCR testing confirmed hantavirus infection of a probable case. On May 10, the MV Hondius was permitted to dock and let passengers disembark in the Canary Islands off the coast of Spain. Passengers were then transported to their home countries via non-commercial means. On May 11, U.S. passengers arrived at the National Quarantine Unit (NQU) in Nebraska for evaluation and monitoring. WHO and CDC continue to provide updates as the situation evolves. Risk to the Public While the risk to the public remains low, it is important for public health authorities to assess and monitor contacts closely during the 42-day period for symptoms, as deterioration can occur quickly. Monitoring and assessment are collaborative efforts supported by CDC and led by state and local health departments. CDC released interim risk assessment guidance to support health departments in managing people with potential exposure related to the MV Hondius. It provides definitions of high- and low-risk contacts, recommended care, monitoring, and guidance to reduce the risk of transmission and exposure. A Coordinated Public Health Response This outbreak punctuates the importance of international and federal agencies, state and local health departments, laboratories, health care systems, and specialized treatment centers working together to manage emerging threats. Shared guidance and regulations were necessary to help standardize monitoring and response efforts. WHO coordinated with 10 countries to ensure timely information sharing, response, repatriation, and contact tracing. Domestically, the U.S. Department of State, Health and Human Services Administration of Strategic Preparedness and Response (ASPR), and CDC coordinated to form the domestic hantavirus taskforce. Together, the agencies have managed: U.S. passenger transport and repatriation. International coordination and communications. Access to health care and treatment structure. Quarantine and preparedness assets. Disease surveillance. Epidemiologic support. Risk assessment. Public communication. Coordination with state and local public health departments. This response highlights the expertise, logistics, and coordination required to manage high-consequence public health threats. Specialized Response Systems Responses to high-consequence infectious diseases (HCID) often require specialized infrastructure beyond routine health care. During events like this Hantavirus cluster, quarantine facilities, treatment centers, and coordinated health care networks help safely manage potentially exposed travelers while supporting health care system readiness. Together, these specialized preparedness systems help ensure that patients can be safely evaluated and treated while minimizing disruption to broader health care operations during HCID emergencies: The NQU at the University of Nebraska Medical Center and the Global Center for Health Security is a key component of this infrastructure. This unit is specifically designed to support quarantine and individuals exposed to HCIDs. U.S. passengers returning from the cruise ship were transported to Nebraska for assessment and monitoring, including one asymptomatic passenger who was admitted to the Medical Center’s Biocontainment Unit for further evaluation but has since been cleared to return back to the NQU. Regional Emerging Special Pathogen Treatment Centers (RESPTCs) serve as specialized hubs within the National Special Pathogen System. ASPR funds 13 RESPTCs in the United States to support management of care related to high consequence pathogens. The system is designed to distribute specialized care, offset operational burden, and maintain national surge capacity during complex infectious disease responses. ASPR’s Hospital Preparedness Program provided additional preparedness aid. This program supports health care coalitions and strengthens coordination among hospitals, emergency management agencies, public health departments, and health care partners. By advancing planning, training, exercises, and regional coordination, it helps health care systems maintain surge capacity and preparedness for complex emergencies. The Laboratory Response Network, which supports responses to biological threats, emerging infectious diseases, and other public health emergencies, plays a role in public health responses by supporting epidemiologic investigations and providing timely laboratory information to guide monitoring and response activities. In response to this Hantavirus cluster, the Association of Public Health Laboratories activated its Incident Command System to help support a coordinated laboratory response to the Andes virus. The Role of State and Local Health Departments State, territorial, and local public health agencies play a central role in infectious disease responses, especially when exposed travelers cross jurisdictional boundaries. For this response, agencies coordinated contact tracing, symptom monitoring, health care communication and preparation, laboratory coordination, and public risk communication. State and Territorial State and territorial health agencies serve as the primary lead for investigating and managing public health emergencies within their jurisdictions. In addition to coordinating with federal partners, health care systems, and laboratories, state and territorial health agencies may exercise legal authorities (i.e., isolation and quarantine) when necessary to help contain infectious disease threats. Their role helps translate national guidance into coordinated, jurisdiction-specific response activities. Local Local health departments also play a multifaceted role in outbreak response through community-level coordination, health care access, communication, and follow-up for potentially exposed individuals. In some states, local health departments also have the authority related to quarantine and isolation to prevent spread of public health threats. Local health departments help connect public health agencies, health care, emergency management partners, and community organizations to facilitate operational coordination and timely information sharing. Support from the Public Health Emergency Preparedness Cooperative Agreement Many of these preparedness and response capabilities are supported by the Public Health Emergency Preparedness cooperative agreement, which has helped health departments across the country strengthen their ability to respond to infectious disease outbreaks, natural disasters, and other public health emergencies since 2002. It supports surveillance capacity, emergency coordination, epidemiology staffing, and risk communication capabilities while helping jurisdictions build flexible and adaptable preparedness systems before emergencies occur. Events like this recent Hantavirus

The Cost of Measles and Public Health Implications The Cost of Measles and Public Health Implications Geetika Nadkarni Understand the cost of measles, from a financial, health, and societal standpoint. Also, learn the best preventative measures while planning for impact. Measles is a highly contagious infectious disease that was once rare in the United States. Per CDC, high MMR vaccination coverage in communities is important because a single person with measles can spread it to 90% of the people around them who are unvaccinated — simply by being in the same room. Due to historically high MMR vaccination coverage, the United States achieved measles elimination status in 2000. Unfortunately, outbreaks have increased since the COVID-19 pandemic amid declining vaccination rates, and it is now at risk of losing this status. In 2025, there were 49 measles outbreaks and a total of 2,280 cases in the United States, with 93% being in unvaccinated individuals or those with an unknown vaccination status. These outbreaks take a toll on children, as they have the potential to cause severe health complications and lead to missed time at school. In addition, these outbreaks have financial and other associated costs to public health, health care, and society. Estimates on the Cost of a Measles Outbreak Researchers from the International Vaccine Access Center at the Johns Hopkins School of Public Health conducted a systematic review of all measles outbreaks in the United States between Jan. 1, 2000 and Oct. 7, 2025. As a result, they have released updated cost estimates for a measles outbreak in the United States, including: The average fixed cost of an outbreak response. The average cost per case. The average cost per contact of each case. Analysis from the public health perspective included evaluation of the direct medical costs of treatment, quarantine protocols, and other response activities (e.g., contact tracing and vaccination campaigns). The study found that the average cost of a measles outbreak to public health agencies was $766,013.80 (ranging between $891.85 and $10,614,192.40). This figure includes the average fixed cost of approximately $244,480, which reflects the resources required to initiate an investigation. The health department then incurs an incremental cost per additional case at approximately $16,197. The analysis also found cost per case ranged from $9,430.90 to $243,614.79, and cost per contact ranged from $98.46 to $910.39. These updated estimates can help public health agencies emphasize the need for robust immunization policies and programs as well as fiscal planning should an outbreak occur in their jurisdiction. Public Health Implications Given the new estimates, a public health department can face high costs when initiating an investigation even for a single measles case. These investigations include activities such as ramping up surveillance, testing, and communication, and the labor costs of mobilizing a response. Measles outbreaks, which can include exposures throughout a community, not only put the health and safety of many individuals at risk but also incur a heavy financial burden on public health agencies. These outbreaks also divert staff and resources from other public health services. In addition, there are societal costs such as the cost of treatment, transportation, caregiver time, and loss of short- and/or long-term productivity (i.e., days lost at work and school). Preventing Outbreaks and Planning for Impact Maintaining high vaccination coverage remains the most cost-effective means of preventing outbreaks and protecting public health investments — not just for measles but for many diseases of public health concern. As vaccination rates decline in some areas of the United States and outbreaks continue to rise in 2026, understanding the cost of a response is increasingly important for public health officials, legislators, and other decision-makers. Public health agencies should prioritize increasing vaccination coverage by… Addressing misinformation through trusted messengers. Improving vaccine-related health literacy among their community members. Maintaining strong vaccination policies that limit non-medical exemptions. While there were study limitations (i.e., a wide variability in cost reporting and cost breakdown), agencies must plan for the potential budgetary impacts of one or more outbreaks in their jurisdictions — particularly in areas with lower vaccination rates. This information can help educate lawmakers and the public on the cost of an outbreak and the cost-effectiveness of vaccinations. This is of utmost importance in jurisdictions considering legislation that would weaken school entry vaccination requirements. Ultimately, these cost estimates combined with accurate information on vaccine safety and the health risks of measles (and other infections) can mobilize policymakers and the public to increase and sustain vaccination coverage in their communities. Reviewed by - Meredith Allen article yes

Understanding Current U.S. Measles Outbreaks and Elimination Status Current U.S. Measles Outbreaks and Elimination Status Jessica Baggett, Susan Kansagra, Meredith Allen, Kimberly Martin Understand current U.S. measles outbreaks and the country's elimination status, following recent outbreaks and the highest case counts in decades. In 2016, the Pan American Health Organization (PAHO) declared the elimination of measles in the Region of the Americas, marking a monumental public health achievement. But in 2025, that progress came under threat and remains at risk at the top of 2026 — as recent measles outbreaks have driven the highest case counts in decades, prompting health agencies to reassess elimination status. Current Outbreaks Jan. 21 marks one year since the first U.S. measles outbreak of 2025 was reported. The United States went on to experience its worst year for measles in over three decades, with 2,144 confirmed cases. According to CDC, there were 49 outbreaks in 2025 and 88% of confirmed cases (1,884 of 2,144) were outbreak-associated. For comparison, 16 outbreaks were reported during 2024 and 69% of cases (198 of 285) were outbreak-associated. Most 2025 cases occurred in unvaccinated (93%) or under-vaccinated (3%) individuals, and three deaths were confirmed. Measles Elimination These outbreaks put the United States at risk of losing elimination status if transmission of the same strain continues for 12 months uninterrupted. In public health terms, “elimination” means that a disease’s continuous (endemic) spread within a region has ceased for at least 12 months. While it doesn’t necessarily mean zero cases, it does mean that local chains of transmission have been interrupted. The United States achieved elimination status in 2000 due to high coverage with the measles, mumps, and rubella (MMR) vaccine, strong disease surveillance, and public health response to isolated cases. Other countries in the Americas followed similar paths. As a result, PAHO verified the region as measles-free for years. Why Elimination Status Matters Elimination is more than a label. It reflects protective immunity within a population and the capacity of the public health system to prevent sustained outbreaks. When elimination status holds: Transmission is less likely, preventing widespread illness and death. Health care systems avoid unnecessary strain from preventable care utilization. Public health systems circumvent the toll of managing large outbreaks. Vulnerable groups (i.e., infants too young for vaccination, immunocompromised people) are better protected. Public confidence in immunization programs remains strong. What Happens if Elimination Is Lost? In November 2025, PAHO announced that the Region of the Americas — including the United States and Canada — lost measles elimination status after endemic transmission persisted, especially in Canada, for more than 12 months. This means that measles is once again circulating continuously within the region rather than only in isolated imported cases and quickly contained outbreaks. CDC is currently working with state and local health officials to analyze data and determine individual U.S. status, assessing if the various outbreaks are linked, which would signify ongoing transmission rather than individual introductions of disease. In November 2025, Canada officially declared their lost elimination status following prolonged transmission in 2024-2025. Ongoing outbreaks in Mexico and other parts of the Americas further contributed to the rise in regional case counts. Finally, PAHO invited both the United States and Mexico to a virtual meeting on April 13 to review their current measles elimination status. Endemic transmission makes outbreaks larger and more frequent, and increases the number of people who become ill, particularly those not protected by vaccination. Ongoing measles transmission also requires additional public health resources including expanded surveillance, outbreak response, and efforts to raise vaccination coverage, especially in communities with low immunization rates. This adds strain to health departments which often have fixed resources, with one study estimating the average cost per measles case at nearly $60k when including the public health perspective. Measles transmission in the United States has disproportionately impacted communities with lower vaccination rates. Therefore, the loss of elimination status could necessitate greater attention to vaccination recommendations for international travelers coming to the United States, particularly for infants. For example, similar to U.S. recommendations for those traveling internationally, Australia suggests that infants 6-11 months traveling to areas where measles is endemic or having an outbreak can get assessed for an earlier dose of the measles vaccine. Response Strategies for Public Health Departments While the United States works to determine its official status, there are many activities state and territorial public health departments continue to implement to prevent the spread of measles: Vaccination Campaigns The MMR vaccine is highly effective in preventing measles, with CDC reporting 93% protection after one dose and 97% after two doses. Herd immunity is a critical preventive measure that interrupts transmission and requires approximately 95% of the population to be vaccinated. Despite this strong science, falling vaccination rates driven by hesitancy, misinformation, and gaps in access have left pockets of the population vulnerable. Boosting vaccination is the most effective way to stop outbreaks, protect children and adults (particularly those who can’t get vaccinated), and prevent hospitalizations and deaths. Examples of vaccination campaigns include New York’s “Immunization Is Protection” and Minnesota’s reminders about immunization importance. Analyzing Local Data to Identify High Risk Sub-Populations Public health departments are evaluating local Immunization Information System data to identify sub-populations with lower measles vaccination rates, areas with high exemption rates, and settings with persistent under-immunization. Examples include Illinois’ Vaccination Coverage Dashboards, Washington’s Immunization Measures by County Dashboard, and American Immunization Registry Association’s Small Area Analysis. Understanding which populations are at higher risk can inform education and outreach activities. Establishing Relationships with Trusted Community Messengers Identifying under-vaccinated sub-populations is only beneficial when health departments build trust and authentic engagement within communities. They must work with trusted messengers such as faith leaders, community health workers, and local organizations to co-develop and amplify messages about measles risks and the importance of MMR vaccination. In addition, it is important to tailor communication materials to reflect community languages, values, and concerns. Communities are more likely to accept and act on respectful, relevant messaging. Examples of successful community partnerships include the Palmetto Community Action Partnership, the Enrichment Services Program, and the Community Action Program for Central Arkansas. Read ASTHO’s “Championing Change” Toolkit for more information and examples. Supporting Health Care Systems and Providers Clinicians remain highly trusted voices within communities. Health departments equip providers with up-to-date information and resources to ensure they are prepared to recognize, test, report, and manage measles cases effectively. Examples of these resources include CDC’s Be Ready for Measles Toolkit, Arizona’s Measles Surveillance Toolkit, South Carolina’s Measles Clinical Assessment Guide, and North Carolina’s Measles (Rubeola) Resources for Health Care Providers. article yes