Epidemic hazard

In early February 2026, PAHO issued an Epidemiological Alert following the confirmation of over 1,000 measles cases across the Region of the Americas within the first few weeks of the year. This marks a stark escalation compared to the 23 cases reported during the same period in 2025. According to official data, the majority of current cases are concentrated in Canada, Mexico, and the United States—the host nations for 2026 FIFA. To support risk assessment efforts, an RFI was dispatched to EpiCore members across the Region to gather reliable updates and technical insights on local measles dynamics. The network has reminded that, in anticipation of the event, PAHO has urged Member States to heighten surveillance sensitivity to ensure the rapid detection of measles (and rubella). The following country-specific feedback regarding these efforts has been provided. CANADA The EpiCore network informed that the Country lost its measles-free status in late 2025 due to a major (ongoing) outbreak, mostly among unvaccinated children. The outbreak began in October 2024 and continues into 2026, with nearly 5,500 cases reported in 2025 and 192 as of February 7, 2026. While the outbreak is "national", the impact varies by province and active transmission is currently limited to Manitoba, Alberta, Quebec, British Columbia, Nova Scotia, and Saskatchewan. Health authorities attribute the resurgence of cases to low vaccination rates (the national coverage for the two-dose MMR vaccine dropped to 82.5%) initially sparked by imported travel cases Regarding the risk in relation to the upcoming FIFA 2026 World Cup, the network reminded that matches will be held only in Toronto (Ontario) and Vancouver (B.C.). In Ontario, the measles outbreak was declared over in late 2025 however, sporadic new cases linked to other provinces are expected. While Toronto maintains relatively high vaccination rates, an outbreak there would have a major impact, prompting enhanced surveillance. In British Columbia, 15 cases have been recorded in 2026—several of which are travel-related—with the most recent case reported in late January. Authorities remain vigilant due to past outbreaks after major events (e.g. 2010 Winter Olympics). MEXICO The EpiCore network notes that according to official data, the measles outbreak in Mexico has reached more than 26,000 probable cases and nearly 10,000 confirmed cases in 2025–26, resulting in 31 deaths. According to the latest 2026 update, more than 11,000 probable cases and 3,751 confirmed cases, including four deaths, have been recorded to date. The highest incidence rate is among children under one year old (50.41 cases per 100,000 inhabitants), followed by the 1–4 (15.48) and 5–9 (10.28) age groups. Based on the feedback provided, the current outbreak began in February 2025 and has rapidly become one of the most significant in recent decades. Consequently, Mexico is at high risk of losing its official measles-free status (PAHO evaluation planned for April 2026). The network reminded that while 2025 cases were localized mainly in the northern state of Chihuahua, the 2026 data show that the highest incidence rates have shifted to the central states including Jalisco, which is one of the three states hosting FIFA 2026 FIFA. Specialists warn that low vaccination coverage and incomplete immunization schedules have fueled the spread and authorities have reiterated the urgent call for the public to complete their vaccination schedules, with a focus on minors. In preparation for FIFA 2026, the network suggests all attendees to ensure their vaccination status is complete, noting that there is still sufficient time for fans to act and avoid contributing to local transmission chains. The network informs that an intensive vaccination campaign is planned nationwide prior to the tournament's start. Immunisation target activities will prioritize the federal entities of the three host cities: a) CDMX (Mexico City, limited cases but high transmission risk due to extreme population density, with media reporting that local authorities may require visitors to prove their vaccination status); b)Jalisco State (Guadalajara, current epicenter of the outbreak); and c) Nuevo León (Monterrey, currently managing imported cases through enhanced control activities). UNITED STATES of AMERICA The EpiCore informed that the US is currently experiencing its most significant measles resurgence in over 30 years. with a major spike in 2025 and a further spread of cases across several states in early 2026, with infants under 5 years old counting for 25% of all cases. US CDC has confirmed this year already 910 cases (including 6 international visitors) by 24 jurisdictions while during the whole 2025 a total of 2,276 cases (25 visitors) were reported by 45 jurisdictions. The country has maintained its "measles-eliminated" status since 2000 however PAHO has scheduled a new country evaluation in April 2026. South Carolina is currently managing the largest outbreak with more than 60% of cases among children aged 5–17. The situation is worsening with several outbreaks reported in other States linked to travel to and from this state. Currently the most affected areas include both States not hosting FIFA 2026 (e.g. Utah and Arizona, same transmission chain) and others actively involved in the event, as Florida, California and Texas. Florida (Miami hosting city with a high international travel volume) currently ranks among the top five states for confirmed cases with transmission that has recently shifted from sporadic travel cases to localized clusters mainly at university/campus level. California (Los Angeles and San Francisco hosting) is experiencing emerging localized outbreaks with cases reported across five counties despite high baseline vaccination rates. The state is seeing its highest activity since 2019 with cases involving unvaccinated individuals (or people with unknown vaccination status). Several local alerts have been recently issued due to contagious individuals visiting specific popular public places. In Texas (Dallas and Houston hosting) this year only sporadic cases have been reported (mainly imported): authorities were able so far to contain transmission through control measures including aggressive monitoring, contact with hospital partners, fast reporting and fast turnaround on testing. New York (NY hosting city), Washington (Seattle) and Pennsylvania (Philadelphia) are currently experiencing limited outbreaks and local authorities have increased their control activities. Finally, no or very limited cases have been so far reported this year in Massachusetts (Boston hosting city), Georgia (Atlanta) and Missouri (Kansas City). BRAZIL Based on the network feedback, after being declared measles-free in 2024, Brazil is facing this year a renewed risk of reintroduction driven by the ongoing outbreaks in North America and in some neighbouring countries. In 2025, Brazil confirmed 38 cases across the Federal District and six states. Most of these cases (25) have occurred in Tocantins and were linked to imported cases from Bolivia within a community where vaccination coverage was extremely low due to religious reasons. This year, as of late February 2026, Brazil has not recorded any new infections however, in response to the recent PAHO Epidemiological Alert, the health authorities are boosting surveillance in transit and border areas, advising travellers to get two MMR doses and vaccinating infants aged 6–11 months in regions with suspected transmission Preventive activities have been underway since 2025 in states at high risk of reintroduction. The network informed that Acre, for instance, identified an imminent threat already in mid-2025 due to the significant surge of cases in Bolivia that declared in July 2025 a public health emergency. Following this alert, Acre health authorities have immediately established vaccination points in border municipalities and enhanced surveillance at strategic transit locations. The RFI has been supported by relevant contributions and technical comments in relation to the measles situation in the three FIFA hosting countries (Canada, Mexico, US) and Brazil. This summary may be updated in case of further contributions received from the network from other countries in the Region. 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