Debra Eichenbaum had not thought about the measles virus for 20 years when she got her two young children vaccinated against the highly contagious disease.

But then cases across the US began to climb this year, and the 62-year-old worried about how best to protect her husband, David, who is immunocompromised after surviving pancreatic cancer.

So she got another measles shot, and emailed friends her age, encouraging them to check with their doctors to make sure they were still immunised.

“There’s no downside to it,” she said. “For me, that was a no-brainer.”

Ms Eichenbaum is just one adult who debated an extra shot when cases spiked across the US. Others are thinking about their children, who may not yet have been immunised against the virus.

“There is a lot of confusion out there right now, especially in light of differences in how different age groups of the population have been vaccinated based on what the recommendations were at the time of their vaccination,” said Donald Dumford III, an infectious disease specialist at Cleveland Clinic.

The US declared it had eliminated measles from the country in 2000, after decades of access to a safe and effective vaccine. But since the Covid-19 pandemic and an increase in vaccine scepticism, the number of measles outbreaks has risen.

There have been over 300 cases in 2025 across more than a dozen states. This year, the US saw the first measles death in a decade: a 6-year-old girl in western Texas, the epicentre of an outbreak that has spread to neighbouring New Mexico and Oklahoma.

Measles is a dangerous virus that has no cure and can lead to a host of complications, including pneumonia and brain swelling. It can be deadly.

Vaccination rates must be 95% or higher for the broader population to be protected, but several communities where the virus is spreading have rates well below that. Measles is one of the most contagious diseases that exists, spreading very easily if people are unprotected, according to the US Centers for Disease Control and Prevention (CDC).

Health Secretary Robert F Kennedy Jr, a vaccine-sceptic, has sent mixed messages about the outbreak, at times encouraging people to talk to their doctor about vaccines, and at other moments, promoting alternative treatments not recommended by public health experts.

The federal government has not offered any guidance about whether certain adults should talk to their doctor about getting another shot – or whether parents in hotspots should consider getting their young children vaccinated sooner.

Asked for comment, the US Department of Health and Human Services referred the BBC to existing measles vaccine guidance from the CDC.

Ms Eichenbaum decided on another measles vaccine over concerns that some people vaccinated in the 1960s may have received a less effective dose.

Those vaccinated between 1963 and 1967 may have received what is known as an inactivated measles vaccine, and should consider getting an additional shot, said Melissa Stockwell, a professor of paediatrics at Columbia University Mailman School of Public Health.

Those who are unsure about their vaccination status can either search for their written vaccination records or have their antibody levels checked with a blood test, doctors say.

Adults born earlier than 1957 likely had measles as a child and are considered immune, Dr Stockwell said.

“The recommendation is that anyone who does not have presumptive immunity should be vaccinated,” she said.

For weeks before his new baby was born, Kyle Rable and his pregnant wife exchanged anxious messages throughout the day, wondering how they could best keep their future son safe from measles.

“It’s basically both of our constant thoughts all the time,” said Mr Rable, whose wife gave birth to their son, Steven, earlier this month in the same hospital in Lubbock, Texas, where a child died of measles just a week before.

The outbreak in western Texas has raised the alarm for parents across the state and in the wider region, especially those who have young babies who cannot yet be immunised.

The measles vaccine is not generally recommended for children who are under a year old because the shots do not work as well before that age, doctors say.

It is a two-dose vaccine. Typically, children are given their first shot between the ages of 12 and 15 months, and then another between ages 4 and 6.

But for young children who live near a measles outbreak, paediatricians may recommend a shot at an earlier age, between six and 11 months, said Stuart Ray, professor of infectious diseases at Johns Hopkins Medicine.

Mr Rable plans to ask about vaccination plans at his son’s two-week checkup, and will “100%” vaccinate his child early if the doctor recommends it.

Children vaccinated before they are a year old still need two additional standard doses of the measles vaccine later on, Dr Ray said.

“There’s no harm in getting the additional doses,” said Tony Moody, a paediatrics professor at Duke University School of Medicine. “The decision about getting an early MMR (measles, mumps and rubella) should be a conversation between the family and their paediatrician.”

Children can get a second dose as soon as 28 days after their first shot.

“The vaccine starts providing some protection within weeks of the first dose,” Dr Ray said.

Parents hoping to get their children vaccinated against measles, or adults looking for another dose, can make an appointment at a pharmacy.

However, some pharmacies – especially in Texas, the epicentre of the outbreak – have seen vaccine shortages because of higher demand.

The CDC has provided thousands of doses to the state.

Local health departments in western Texas also are holding vaccination clinics, while many across the US offer the shot free of charge.