South Carolina is battling the country’s largest measles outbreak since the disease was eliminated from the United States more than a quarter century ago, with more than 840 casesoverwhelmingly in unvaccinated children and adults.
The outbreak that started in October has taken hold in the Spartanburg area where vaccination coverage has fallen below levels needed to stop transmission. Vaccination rates for measles have slipped nationwide, as religious exemptions to school immunization mandates rise and clusters of susceptible people allow the highly contagious virus to spread.
In 16 weeks, South Carolina infections surpassed the case count over seven months in Texas, where an outbreak last year drove the country’s highest annual measles tally in 33 years.
“This is a milestone that we have reached in a relatively short period of time, very unfortunately,” South Carolina’s state epidemiologist, Linda Bell, recently told reporters in a briefing.
In South Carolina, 19 adults and children have been hospitalized for measles, which can cause fatal pneumonia, long-term complications and damage the immune system, leaving the person vulnerable to other diseases. More than 440 unvaccinated people in South Carolina, many of them schoolchildren, are being told to stay home in quarantine for up to 21 days after being exposed because they weren’t immunized and have been exposed to someone contagious.
Unlike the rural swath of West Texas struck by measles nearly a year ago, Bell said South Carolina is susceptible to sustained transmission because of a dense, relatively under-vaccinated population.
South Carolina has already seeded cases across the country, including some in neighboring North Carolina, which has reported 15 cases. In Washington state, three members of a South Carolina family visited King and Snohomish counties while infectious, leading to three cases there.
Across the United States, more than 500 measles cases have been reported in January, primarily driven by South Carolina’s outbreak, compared with more than 2,000 in all of 2025.As a result, experts fear the vaccine-preventable virus has regained a foothold and will result in the United States losing its measles-free designation.
Losing measles elimination status means the same strain of measles has been spreading within the country for at least 12 months, showing gaps in vaccination coverage and disease control. Several European countries and Canada have lost that status. In April, the Pan American Health Organization will review data to determine whether the United States will, too.
Ralph Abraham, the No. 2 official at the Centers for Disease Control and Prevention chosen by Health Secretary Robert F. Kennedy Jr., recently told reporters that losing the measles elimination status would be the “cost of doing business.”
“We have these communities that choose to be unvaccinated,” said Abraham, who until recently was Louisiana’s top health official known for unwinding vaccine promotion events.
Abraham said vaccination was the best way for people to prevent measles, but added: “That’s their personal freedom.”
Kennedy, who was an anti-vaccine activist before becoming health secretary, has espoused a similar message and promoted unproven alternative treatments.
Public health officials say measles spreads so efficiently that once vaccination coverage drops, individual choices can quickly have consequences far beyond any single household. Infants who are too young to be vaccinated and immunocompromised people are susceptible.
“We are losing decades of public health successes, and children will get very sick and die from preventable illnesses,” said Martha Edwards, a pediatrician who heads the South Carolina chapter of the American Academy of Pediatrics.
How an outbreak unfolds
The outbreak’s epicenter is in Spartanburg County, in South Carolina’s Upstate region at the foothills of the Blue Ridge Mountains. The area has long had lower childhood vaccination rates than much of the state, public health officials say.
Spartanburg is home to a mix of rural communities, conservative faith groups and immigrant families, including a sizable Slavic population — a cross-section of groups that are less likely to be vaccinated across the nation.
“Measles is no longer an abstract headline,” said Justin Moll, a pediatrician at Parkside Pediatrics, with 84 doctors across Upstate locations.
They have treated dozens of measles patients. They don full protective gear including gowns and masks to meet families outside. Most children recover after mild symptoms such as fever, cough, congestion and pink eye.
This is the first time the doctors, including Moll, have seen measles outside of textbooks.
“We thought it had been eliminated,” said Moll, 51.
In the current outbreak, officials say the airborne virus began spreading in elementary and middle schools in October. Holiday gatherings and travel accelerated transmission. The virus has moved quickly through more than 30 schools — sending some students into quarantine multiple times — and across the communities.
Measles is one of the most contagious diseases because it spreads through droplets that hang in the air for hours, and its carriers are contagious four days before and four days after the telltale rash appears.
Two doses of the childhood vaccine are 97 percent effective against infection and nearly wiped out a virus that once infected millions of children. But because the virus is so easily transmitted without immunization, 95 percent of a community needs to be vaccinated to prevent the disease from spreading once the virus is introduced.
The student vaccination rate for all required immunizations in Spartanburg County fell from 95 percent in the 2019-2020 school year to 89 percent this school year, according to a Washington Post examination of falling vaccination rates across the country.
Like elsewhere in the United States, more families in South Carolina are seeking exemptions from routine childhood vaccinations for religious reasons. In Spartanburg County, 3 percent of students, or 1,608, received religious exemptions during the 2018-2019 school year. By the 2025-2026 school year, that had more than tripled to 9.6 percent,or about 5,490 students.
At one charter elementary school in Spartanburg where exposure took place early in the outbreak, only 21 percent of students had the required immunizations.
The soaring case count has sparked at least one local lawmaker to urge reconsideration of how broadly religious exemptions are granted. While he supports allowing religious exemptions, state Sen. Josh Kimbrell (R-Spartanburg) said officials need to take public health considerations into account.
“It’s crazy,” he said in an interview. “The number just keeps climbing. I’m deeply concerned about an eventual death.”
Lt. Gov. Pamela Evette (R), who is running for governor, said this week that vaccination to prevent measles is a parental choice.
The stakes of vaccination
As in Texas, South Carolina’s outbreak is expected to eventually reduce to a simmer as the virus runs out of unvaccinated people to infect. New cases seem to be declining.
But other parts of the country with vaccination rates below 95 percent — including metropolitan areas around Atlanta, Memphis and Nashville — are also at risk, said Scott Thorpe, a former South Carolina health department epidemiologist. Outbreaks in those comparable southern regions would be “terrifying,” he said.
“We will continue to see measles cases all over the country as vaccination rates continue to fall,” said Thorpe, who runs the nonprofit Southern Alliance for Public Health Leadership. “I don’t see a clear end to this.”
Public health officials say the success of vaccination in nearly eliminating illness can backfire. Parents don’t see the urgency to protect their children — until outbreaks arrive.
In Spartanburg County, Holly Springs-Motlow Elementary school in Campobello had 59 students in quarantine as of Friday, the highest of any school in the state. Just under 80 percent of the school’s 482 students were up-to-date on their vaccinations in the current school year, health department data shows.
Hope Gray, who heads the school’s PTO, said some parents on social media say they focus on “natural” approaches, such as avoiding medications like Tylenol, she said. Gray said some bristle at being told what they must put into their children’s bodies.
Gray’s family has never received covid vaccines and does not get flu shots. Her two older children are fully immunized for measles and have gotten all vaccines required for school. But Gray said she postponed getting the measles shot for her 4-year-old daughter, Raimy, who has anemia and often had fevers when she was due for vaccines.
But the growing numbers in the outbreak changed her mind. Gray took her daughter to a pediatrician on Friday for her first MMR dose.
“I do feel more relieved that if she is exposed she won’t get sick or as sick from it,” Gray said in a text message Friday.
Vaccine resistance in communities
Health officials emphasize that measles outbreaks follow immunity gaps, not specific communities — and that once the virus begins spreading, it rarely stays confined to any single group. Still, the South Carolina outbreak highlighted the need for public health officials to build trust in some close-knit immigrant communities more resistant to vaccination.
Physicians and public health advocates say the outbreak has been affecting the region’s Slavic communities. Public health officials have not shared demographic data beyond age.
Doctors in South Carolina said attitudes toward vaccination in the Slavic community are shaped less by opposition to vaccines themselves and more by experiences many immigrants carry with them from Ukraine and Russia — including deep mistrust of government-run institutions.
That history includes a widely publicized incident in 2008, when a teenager in Ukraine died of bacterial meningitis shortly after receiving a measles vaccine during a mass immunization campaign. Although investigators found no evidence that the vaccine caused the death, public confidence in vaccination dropped sharply.
Eliza Varadi, a pediatrician in private practice in Charleston who is originally from Russia, said the health department has reached out to leaders in the Slavic community. Varadi has also volunteered her own services as public health officials develop a more formal vaccine outreach plan.
“It’s important that you don’t go storming in with needles,” Varadi said, who is also the immunization chair for the American Academy of Pediatrics’ state chapter. “You have to tread very gently to gain the trust.”
Public health officials say they are trying to tailor messages to counter myths and misinformation with science-based information “about how vaccines work, what they do and do not do,” Bell, the state epidemiologist, said. But vaccine uptake is not as rapid as they would like, she said.
At the Tabernacle of Salvation Church, a man who answered the phone and identified himself as the church’s secretary said leaders have urged Slavic congregants to stay home if they are sick. Some of the church’s roughly 800 members have fallen ill, he said.
But the man, who spoke on the condition of anonymity, rejected the idea of hosting a vaccine clinic in partnership with the state health department.
“We wouldn’t do anything like that,” he said. “We’re a religious organization. We don’t push big pharma products.”
Caitlin Gilbert contributed to this report. Graphics by Adrián Blanco Ramos.
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