More measles in South Carolina imperils U.S. elimination status

Measles is considered eliminated in a country once it no longer spreads constantly for a full year. In the U.S., that deadline is fast approaching: Transmission of the highly contagious disease has been sustained since around Jan. 20. Unless that trend comes to an abrupt halt in the next three weeks — which is highly unlikely — the country could lose its elimination status, as Canada did in November.

Dr. Linda Bell, South Carolina’s state epidemiologist, said at a press briefing on Tuesday that measles transmission is ongoing in households, schools and churches there, and that 287 people are being quarantined to help limit the spread.

“We do anticipate more cases well into January,” she said.

All but three of South Carolina’s measles cases this year have been linked to an outbreak in Spartanburg County, in the northwestern part of the state.

The vast majority of cases have been in unvaccinated people, most of whom are children between 5 and 17 years old.

“We do believe that the holidays contributed to this,” Bell said, referring to measles transmission at family gatherings and during travel.

At least three people in South Carolina have been hospitalized with measles complications, according to the health department.

The surge in U.S. measles cases this year is mostly attributable to a decline in childhood vaccination rates and a rise in vaccine exemptions. Less than 93% of kindergartners received two doses of the combination measles, mumps and rubella (MMR) vaccine for the 2024-25 school year compared with 95% for the 2019-2020 school year. A vaccination rate of at least 95% is needed to curb the virus’ spread.

A large measles outbreak in West Texas this year accounted for a substantial share of the U.S. total — around 760 cases linked to the outbreak were recorded from January to August. It was centered in Gaines County, where kindergartners had a 77% measles vaccination rate as of the 2024-25 school year. Some affected families chose unproven remedies like vitamins and cod-liver oil instead of measles shots.

Two unvaccinated school-age children in Lubbock, Texas, died of measles, as did an unvaccinated adult across the border in New Mexico who did not seek medical care.

Before this year, the U.S. had not seen a measles death in roughly a decade.

In addition to the current outbreak in South Carolina, measles cases are simmering in Arizona and Utah as part of an outbreak that began in late summer. And in just the last week, Washoe County, Nevada, saw its first measles case since 2018. Health officials have also warned of possible exposures to measles at Newark Liberty International Airport, Boston Logan Airport and Denver International Airport.

Many public health experts have expressed concern about the federal messaging on vaccines since Health and Human Services Secretary Robert F. Kennedy Jr. took office in February. Though Kennedy has called for people to get the MMR shot, he has also framed vaccination as a personal choice, emphasized unproven treatments such as steroids and antibiotics, and falsely claimed that immunity from measles vaccines wanes quickly.

Common measles symptoms include a blotchy rash, high fever, cough, runny nose, pink or watery eyes and white spots on the insides of the cheeks. Severe cases can progress to pneumonia or swelling of the brain. The virus can linger in the air for up to two hours after an infected person has left. Without immunity from a vaccine or prior infection, about 9 in 10 people exposed to measles will get it.

State and county health departments continue to emphasize that vaccines are the best way to prevent the disease. Two shots are 97% effective and typically offer lifelong protection.