COLUMBIA, S.C.— South Carolina is at the epicenter of the nation’s largest measles outbreak in more than a quarter-century.

As of Friday, 950 people across six counties — most of them unvaccinated children — had been infected with the highly contagious virus since October, and hundreds more have had to quarantine due to exposure.

No one in the state has died, to date, but 19 people — six adults and 13 children — have been hospitalized for measles, a respiratory virus that can lead to life-threatening complications and cause long-term damage to the immune system.

“This is not normal. This is unprecedented,” state epidemiologist Linda Bell said Wednesday during a media briefing on the outbreak. “We have not seen anything like this in decades.”

Just a couple years ago, a measles outbreak of this magnitude would have been inconceivable. The disease was declared eliminated from the United States in 2000, and while imported cases were still reported occasionally, high vaccination rates and swift public health responses thwarted community transmission.

Between 1991 and 2024, South Carolina reported just eight measles cases, six of which occurred within a single household in 2018, Bell said. The other two cases — one in 1997 and one in 2024 — were both imported.

In recent years, however, growing misinformation about the safety and effectiveness of vaccines has depressed confidence in public health measures and laid the groundwork for the current outbreak.

The shift in attitudes, which was supercharged by the COVID-19 pandemic, is apparent in the waning rates of measles, mumps and rubella, or MMR, vaccinations among kindergartners nationwide.

After 10 years of nearly 95% nationwide vaccination coverage, MMR rates began dropping during the 2020-2021 and 2021-2022 school years, and had sunk to 92.5% by 2024-2025, research shows.

Coverage of at least 95% with both doses of the measles vaccine is necessary to prevent outbreaks, according to the Centers for Disease Control and Prevention.

Low vaccination rates made SC susceptible to measles outbreak

While South Carolina reported 95.6% coverage for all required immunizations during the 2021-2022 school year, that rate had dropped to 93.7% by 2025-2026, according to S.C. Department of Public Health data.

The decline was especially pronounced in the Upstate, which saw its childhood immunization rate slip from 95.5% to 92.2% over the past four years, the largest dip in any of the state’s four regions.

Spartanburg County, where more than 95% of South Carolina’s recent measles cases have been reported, experienced an even greater drop. The fast-growing manufacturing hub has long had lower vaccination rates than most of the state, but has seen its population become especially vaccine hesitant since the pandemic, data shows.

Over the past four years, Spartanburg’s immunization rate has declined more than twice as fast as the state’s has, shrinking from 93.9% in 2021-2022 to 88.9% this school year. During the same period, the number of Spartanburg County children with religious exemptions from vaccine requirements has more than doubled to 5,490, or nearly 10% of all enrolled students.

Today, Spartanburg has the lowest childhood vaccination rate and the highest rate of vaccine exemptions of any county in the state. With that in mind, it’s not surprising that a measles outbreak in South Carolina would be centered there.

Of the 928 South Carolinians infected with measles during the current outbreak whose vaccination status is known, 883, or 95%, were unvaccinated, according to S.C. Department of Health data. Another 19 were partially vaccinated (2%) and 26 were fully vaccinated (2.8%).

According to the CDC, one dose of the MMR vaccine is 93% effective against measles and two doses are 97% effective. It’s recommended that children receive the first dose between 12 and 15 months of age and the second dose between ages 4 and 6.

“Decreasing vaccination coverage is the primary cause for the increased prevalence of measles in South Carolina,” said Bell, the Department of Public Health’s incident commander for the state’s measles outbreak.

Another factor, she said, is that some of Spartanburg County’s most highly-enrolled schools have lower vaccination rates, increasing the number of students at risk for exposure.

The initial source of South Carolina’s outbreak has never been identified, although health officials know the case was imported since there had not been ongoing measles transmission in the state at the time, Bell said.

On Oct. 2, when the department announced the outbreak — defined by the CDC as three or more related cases — officials said it involved two cases with no history of travel or identified source of exposure who subsequently spread the virus to close contacts.

A few days later, after the number of cases had grown to seven, state health officials announced that two Spartanburg schools — Global Academy of South Carolina and Fairforest Elementary — had confirmed measles cases.

With only 21% of its students vaccinated, Global Academy, a 600-student charter school that caters to the area’s Eastern European community, has the lowest immunization rate in Spartanburg County and one of the lowest in the state, according to DPH data.

“The earliest cases involved in the outbreak were unvaccinated individuals, and the primary challenge to our response is the initial low vaccination coverage and vaccine hesitancy in a pocket of our population,” Bell said in a statement.

How much longer will the measles outbreak last?

Measles cases climbed slowly throughout October, accelerated slightly in November and then, after a brief dip in early December, exploded after the holidays, peaking at 201 confirmed cases during the week of Jan. 11, data shows.

Since then, the outbreak has been on a strong downward trajectory, with cases declining week-over-week for the past month.

While that’s undoubtedly a good sign, state health officials aren’t yet ready to declare that the outbreak is dissipating.

Bell said at Wednesday’s media briefing that while the lower case counts are potentially an indication the outbreak could be slowing, it’s still too early to tell. Part of that is due to recent confirmed cases in Sumter and Lancaster counties, the first time the outbreak has touched the Midlands.

“We don’t know what the trajectory looks like in other counties in the Midlands,” she said Wednesday. “And because we don’t know, because we’re uncertain about potential unrecognized exposures, unexpected exposures, we continue to encourage people who are not vaccinated to seek the opportunity to get protected, regardless of where they live, because we don’t know where the virus will go.”

The state’s vaccination numbers still aren’t where they need to be, according to health officials, but efforts to encourage uptake appear to be paying off.

Nearly 17,000 doses of the measles vaccine were administered statewide in January, including more than 1,700 in Spartanburg County alone, according to DPH data.

That’s a 72% increase in inoculations statewide and a 162% increase in Spartanburg County compared to January 2025.

Bell said Wednesday that while January’s immunization numbers are a promising sign, South Carolina is “coming from behind” and still has work to do.

“That is increased uptake that was bringing us from a coverage level that was well below the percentage that we need for adequate population coverage, adequate herd immunity to prevent ongoing spread.” she explained. “So while those numbers are encouraging, we remind people that we had a significant gap to fill, and we are still working towards that.”

In furtherance of that goal, the Department of Public Health is deploying its mobile health unit to various locations to offer free measles shots to unvaccinated individuals.

The mobile unit’s next stop is Grace Community Church in Spartanburg on Tuesday, March 3, from 10 a.m. to 2 p.m.

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