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Randy Smith comes home from selling tires to a divided apartment. He sees Carmen, his wife of 33 years, but he doesn’t get to hug her or get too close. 

After receiving two kidney transplants, Carmen Smith has a compromised immune system from the medication that helps her body accept those new organs. And during the 

“If we know there’s something going on , we basically separate our life,” Randy Smith said. “We see each other, we just don’t come within contact of each other.”

He’s immunocompromised, too, following his cancer diagnosis two years ago. 

People who have compromised immune systems are at a higher risk of getting a severe case of measles and dying from it. So they depend on other people being vaccinated with the measles mumps and rubella vaccine, or MMR.

But vaccination rates are declining. In North Dakota, 

 of the most recent group of kindergartners were vaccinated.

“Although 89 percent sounds really high, because measles is so contagious you really need a 95 percent vaccination rate to prevent outbreaks in a community,” said Molly Howell, director of Disease Control and Forensic Pathology at the North Dakota Department of Health and Human Services.

Just 87 percent of kindergartners had the MMR vaccine in 2024, down from 92 percent in 2019. 

Before 2025, Measles had been eradicated from North Dakota, the last case happening in 2011. Last year, the state saw 36 cases and is already at 

“I think it was truly only a matter of time,” said Kylie Hall, who works at North Dakota State University’s Center for Immunization Research and Education. “The reason I say that is we have been tracking for many years, especially post-COVID, a small but gradual decline every year in our MMR vaccination rates.”

Hall said vaccine skepticism surged during the COVID pandemic, in part because people were concerned at how quickly that vaccine was made. She also attributed it to overly simplistic public health communications.

“(Some) don't want to just hear that a vaccine is safe, they maybe want some more nuance around that,” she said. 

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Hall’s work involves vaccine education and combatting miseducation, which has run rampant in the last few years as people increasingly turn to self-guided research for medical advice instead of licensed providers. 

“It's really easy to scare people and it's really hard to unscare them,” she said.

 believes the debunked claim that vaccines cause autism.

“So often what we see, and we're especially seeing it now, is overstating the risks of the vaccine and understating the risks of the disease,” she said. 

“Measles is not a mild illness,” she added. “Sure, many children, most children, will survive a measles infection, but that downplays how sick they are, the 20 percent of children that are hospitalized, the one in one thousand who will have encephalitis (and) the about one in one thousand that will die.”

Hall said some people got complacent and didn’t vaccinate because they haven’t seen the effects of the disease in a long time. She hopes a silver lining of the current outbreak is that people will take it seriously, bringing vaccination rates up. 

That’s especially important for people who can’t get the vaccine, like the Smiths.

It wouldn’t be their first time dealing with an outbreak. Randy Smith caught COVID four times. He eventually passed it on to his wife, who survived despite what he said was a 98 percent fatality rate.

“We've been there, done that,” Randy Smith said. “Even when COVID was happening (or) if there's a flu outbreak, it's all about me, because I'm the one that's going out of the house, and I'm the one that's going to bring something home. It's a stress that we deal with.”

“We're best friends to the end of this,” he added. “We're gonna do whatever we can to have the best life that we can to the end of this.”

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North Dakota has confirmed 24 cases of measles in 2026, and Minnesota has confirmed 14. People with weakened immune systems are most at risk.

Courtesy of Randy Smith

Two people hug together for a photograph.

Measles outbreak surges in North Dakota, putting immunocompromised in danger

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