By DEVI SHASTRI

The U.S. is having its worst year for measles spread in more than three decades, with a total of 1,288 cases nationally and another six months to go in 2025.

The U.S. Centers for Disease Control and Prevention said Wednesday that the national case count surpassed 2019, when there were 1,274 cases for the year and the country almost lost its status of having eliminated the vaccine-preventable illness. That could happen this year if the virus has nonstop spread for 12 months.

This year’s outbreaks, some of them interconnected, started five months ago in undervaccinated communities in West Texas. Three people have died — two children in Texas and an adult in New Mexico — and dozens of people have been hospitalized. Public health experts maintain the true case count may be higher than state health departments have confirmed.

North America has three other major measles outbreaks, with 2,966 cases in Chihuahua state, Mexico, 2,223 cases in Ontario, Canada and 1,230 in Alberta, Canada. Twelve other states have current confirmed outbreaks of three or more people — Arizona, Colorado, Georgia, Illinois, Iowa, Kansas, Michigan, Montana, New Mexico, North Dakota, Oklahoma and Utah — and four other states saw their outbreaks end.

The measles, mumps and rubella vaccine is 97% effective at preventing measles after two doses.

The World Health Organization said in 2000 that measles had been eliminated from the U.S.

The CDC identified 22 outbreaks in 2019, the largest being two separate clusters in New York — 412 in New York state and 702 in New York City. These were linked because as measles was spreading through close-knit Orthodox Jewish communities, the CDC said.

It’s a similar situation in North America this year, where the Canada, Mexico and Texas outbreaks stem from large Mennonite communities in the regions. Mennonite churches do not formally discourage vaccination, though more conservative Mennonite communities historically have low vaccination rates and a distrust of government.

A recent study found childhood vaccination rates against measles fell after the COVID-19 pandemic in nearly 80% of the more than 2,000 U.S. counties with available data, including in states that are battling outbreaks this year.

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Only 92.7% of kindergarteners in the U.S. had the measles, mumps and rubella vaccine in the 2023-2024 school year, below the 95% needed to prevent outbreaks. In Gaines County, Texas, the epicenter of the Texas outbreak, only 82% of kindergarteners were up-to-date with MMR vaccines.

State and federal leaders have for years kept funding stagnant for local public health departments’ vaccination programs that are tasked with reversing the trend.

“What we’re seeing with measles is a little bit of a ‘canary in a coal mine,’” said Lauren Gardner, leader of Johns Hopkins University’s independent measles and COVID tracking databases. “It’s indicative of a problem that we know exists with vaccination attitudes in this county and just, I think, likely to get worse.”

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

By MATT BROWN and MICHELLE L. PRICE, Associated Press

WASHINGTON (AP) — President Joe Biden’s former White House physician is refusing to answer questions as part of the House Republican investigation into Biden’s health in office.

Dr. Kevin O’Connor invoked doctor-client privilege and his rights under the Fifth Amendment during an appearance Wednesday before the House Oversight Committee, his attorneys said.

Republicans are conducting a sweeping investigation into Biden’s actions in office and questioning whether the Democrat’s use of an autopen in office may have been invalid. They have also claimed that some policies carried out by the White House autopen may be invalid if it is proven that Biden was mentally incapacitated for some part of his term.

Biden has strongly denied that he was not in a right state of mind at any point while in office, calling the claims “ridiculous and false.”

David Schertler, one of O’Connor’s lawyers, said in a written statement he prepared for the committee that the doctor would not violate his oath of confidentiality with his patients. He also said the House Oversight committee should hold off on its investigation until Attorney General Pam Bondi concludes an investigation that the Oversight Committee’s chair, Rep. James Comer of Kentucky, said she has launched into the use of the autopen.

“The pending Department of Justice criminal investigation leaves Dr. O’Connor no choice but to invoke his constitutional rights under the Fifth Amendment of the Constitution to any questions posed by the Committee,” Schertler said in the statement.

Comer, in a statement, said O’Connor’s decision not to testify made it “clear there was a conspiracy.”

“The American people demand transparency, but Dr. O’Connor would rather conceal the truth,” Comer said.

In a June subpoena of O’Connor, Comer said that claims of physician-patient privilege under the American Medical Association’s code of ethics “lack merit” because that code is not part of federal law. He said the committee’s subpoena meets the AMA’s own requirement that physicians must share a patient’s medical information if “legally compelled to disclose the information” or “ordered to do so by legally constituted authority.”

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Comer has said his committee will release a report of all its findings after the probe is complete. He has issued subpoenas for O’Connor and Anthony Bernal, former chief of staff to former first lady Jill Biden. Last month, Neera Tanden, former director of Biden’s domestic policy counsel, gave voluntary testimony.

Comer has requested testimony from nearly a dozen former senior Biden aides, including former White House chiefs of staff Ron Klain and Jeff Zients; former senior advisers Mike Donilon and Anita Dunn; former deputy chief of staff Bruce Reed, former counselor to the president Steve Ricchetti, former deputy chief of staff Annie Tomasini and a former assistant to the president, Ashley Williams.

President Donald Trump’s White House has waived executive privilege, a right that protects many communications between the president and staff from Congress and the courts, for almost all of those senior staffers. That clears the way for those staffers to discuss their conversations with Biden while he was president.

NEW YORK (AP) — Chipmaker Nvidia became the first public company to top $4 trillion in value Wednesday after a two-year investor frenzy driven by the artificial intelligence boom.

Nvidia shares rose 2.5%, in early trading Wednesday, topping $164 each. At the beginning of 2023, Nvidia shares were around $14 each. The company’s rise has been meteoric.

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The Santa Clara, California, company, was founded in 1993. In just over a decade, it was worth $2 trillion. In June 2024, it reached $3 trillion.

Nvidia quickly surpassed Microsoft, Apple, Amazon and Google parent Alphabet. The stock’s movement carries more weight on the S&P 500 than any other company.

In its most recent quarter, Nvidia overcame tariff-driven turbulence to deliver another quarter of robust growth amid feverish demand for its high-powered AI chips. Nvidia notched a profit of $18.8 billion as its revenue surged 69% to $44.1 billion.

Nvidia reports its second-quarter results next month. Wall Street is expecting another quarter of record sales and profit for the company.

Nvidia and other companies benefiting from the AI boom have been a major reason the S&P 500 has climbed to record after record recently. Their explosion of profits has helped to propel the market despite worries about stubbornly high inflation and possible pain coming for the U.S. economy from tariffs and other policies of President Donald Trump.

By NADIA LATHAN and JOHN SEEWER, Associated Press

HUNT, Texas (AP) — Crews used backhoes and their bare hands Wednesday to dig through piles of debris that stretched for miles in the search for more than 160 people believed to be missing in the flash floods that laid waste to state’s Hill Country.

Over 100 bodies have been recovered, but the large number of missing suggested that the full extent of the catastrophe was still unclear five days after the disaster.

“We will not stop until every missing person is accounted for,” Gov. Greg Abbott told a news conference Tuesday. “Know this also: There very likely could be more added to that list.”

Texas Gov. Greg Abbott speaks during a press conference on Tuesday, July 8, 2025, after touring damage from flash flooding in Hunt, Texas. (AP Photo/Eli Hartman)

Officials have been seeking more information about those who were in the popular tourist destination during the Fourth of July holiday weekend but did not register at a camp or a hotel and may have been in the area without many people knowing, the governor said.

The riverbanks and hills of Kerr County along the Guadalupe River, where most of the flood victims have been recovered so far, are filled with vacation cabins, youth camps and campgrounds, including Camp Mystic, the century-old all-girls Christian summer camp where at least 27 campers and counselors died. Officials said five campers and one counselor have still not been found.

Crews in air boats and helicopters and on horseback combed the terrain. They also used excavators and their hands, going through the earth layer by layer, with search dogs sniffing for any sign of buried bodies.

They were joined by hundreds of volunteers in one of the largest search operations in Texas history. The search has been slow, made more difficult by ongoing storms and dense layers of tangled trees and rubble.

The flash flood was the deadliest from inland flooding in the U.S. since Colorado’s Big Thompson Canyon flood on July 31, 1976, killed 144 people, said Bob Henson, a meteorologist with Yale Climate Connections. That flood surged through a narrow canyon packed with people on a holiday weekend marking Colorado’s centennial.

Public officials in charge of locating victims in Texas faced intensifying questions Tuesday about who was in charge of monitoring the weather and warning that floodwaters were barreling toward camps and homes.

Abbott said President Donald Trump has pledged to provide whatever relief Texas needs to recover. Trump plans to visit the state Friday.

Polls taken before the Texas floods show Americans largely believe the federal government should play a major role in preparing for and responding to natural disasters.

Elsewhere, a deluge in New Mexico triggered flash floods that killed three people Tuesday.

Scenes of devastation at Camp Mystic

Outside the cabins at Camp Mystic where the girls had slept, mud-splattered blankets and pillows were scattered on a grassy hill that slopes toward the river. Also in the debris were pink, purple and blue luggage decorated with stickers.

Camper’s belongings sit outside one of Camp Mystic’s cabins near the Guadalupe River, Monday, July 7, 2025, in Hunt, Texas, after a flash flood swept through the area. (AP Photo/Eli Hartman)

Among those who died at the camp were a second grader who loved pink sparkles and bows, a 19-year-old counselor who enjoyed mentoring young girls and the camp’s 75-year-old director.

The flash floods erupted before daybreak Friday after massive rains sent water speeding down hills into the Guadalupe River, causing it to rise 26 feet (8 meters) in less than an hour. Some campers had to swim out of cabin windows to safety while others held onto a rope as they made their way to higher ground.

Just two days before the flooding, Texas inspectors signed off on the camp’s emergency planning. But five years of inspection reports released to The Associated Press did not provide any details about how campers would be evacuated or the specific duties assigned to each staff member and counselor.

Although it’s difficult to attribute a single weather event to climate change, experts say a warming atmosphere and oceans make catastrophic storms more likely.

Where were the warnings?

Questions mounted about what, if any, actions local officials took to warn campers and residents who were in the scenic area long known to locals as “flash flood alley.”

Lost items sit at a bridge as a volunteer cleans up debris on Tuesday, July 8, 2025, after a flash flood swept through the area in Kerrville, Texas. (AP Photo/Ashley Landis)

Leaders in Kerr county, where searchers have found about 90 bodies, said their first priority is recovering victims, not reviewing what happened in the moments before the flash floods.

Kerr County Judge Rob Kelly, the county’s chief elected official, said the county does not have a warning system.

Generations of families in the Hill Country have known the dangers. A 1987 flood forced the evacuation of a youth camp in the town of Comfort and swamped buses and vans. Ten teenagers were killed.

Local leaders have talked for years about the need for a warning system. Kerr County sought a nearly $1 million grant eight years ago for such a system, but the request was turned down by the Federal Emergency Management Agency. Local residents balked at footing the bill themselves, Kelly said.

Recovery and cleanup efforts go on

The bodies of 30 children were among those that have been recovered in the county, which is home to Camp Mystic and several other summer camps, the sheriff said.

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The devastation spread across several hundred miles in central Texas all the way to just outside the capital of Austin.

Aidan Duncan escaped just in time after hearing the muffled blare of a megaphone urging residents to evacuate Riverside RV Park in the Hill Country town of Ingram.

All his belongings — a mattress, sports cards, his pet parakeet’s bird cage — now sit caked in mud in front of his home.

“What’s going on right now, it hurts,” the 17-year-old said. “I literally cried so hard.”

Seewer reported from Toledo, Ohio. Associated Press writers Joshua A. Bickel in Kerrville, Texas, Jim Vertuno in Austin, Texas, and John Hanna in Topeka, Kansas, contributed to this report.