As a measles outbreak burns through South Carolina, not enough people are getting vaccinated

By Deidre McPhillips, CNN

(CNN) — As measles outbreaks flared up across the US last year, causing a record number of cases, Scott Thorpe kept a wary eye on Spartanburg County, South Carolina.

Nestled in the foothills of the Appalachian Mountains in South Carolina’s upstate region, it’s a community with pockets of residents who have particularly low vaccination rates.

It’s not much different than many other parts of the US, especially as vaccination rates have been falling nationwide, said Thorpe, who ​​is the executive director of the Southern Alliance for Public Health Leadership, a nonprofit focused on improving health outcomes across the South. But Spartanburg County had already been through a measles outbreak about a decade earlier, and it’s now significantly more vulnerable: The share of schoolchildren in the county who have gotten the required immunizations has fallen from 95% to 90% over the past five school years.

Then it happened: The first measles cases hit the region last fall, and the South Carolina health department declared an outbreak at the start of October. Now, more than 200 cases have been reported over the past few months, and there are no signs of slowing.

“As community exposures increase, it’s becoming more and more difficult to actually pinpoint where all cases were exposed,” Dr. Linda Bell, state epidemiologist with the South Carolina Department of Public Health, said Wednesday.

“When we’re seeing more and more transmission in the community, it’s important to recognize that we will reach a point when we won’t know about all cases,” she said – a worry that has been heightened after the holidays, when schools were closed and public health lost key connection points to the community.

Coverage with the measles-mumps-rubella (MMR) vaccine is lower than the national average in South Carolina, and vaccination rates in Spartanburg County are among the lowest in the state. Local health care providers say that the more imminent threat of measles has changed the calculus for some parents who had been hesitant but now want protection for their child.

Others, however, remain staunchly against vaccination — even when measles has reached their doorstep. And while the public health department is enacting measures to contain spread as much as possible, a growing list of exposures is making it increasingly difficult to keep the dam from breaking.

The South Carolina measles outbreak probably started in a Ukrainian immigrant community in the Spartanburg area, among whom vaccination rates tend to be particularly low, Thorpe said, but it has taken hold in a much broader population in the region.

“Antivax attitudes are firmly embedded in Ukrainian society,” says an analysis published in 2021 by the Wilson Center, a nonpartisan foreign policy think tank. It cites many possible factors for the sentiment, but much can be traced back to the early 2010s, when the Ukrainian government mishandled the storage and administration of routine vaccinations, resulting in many cases of complications among children that were initially covered up.

Many measles cases in the current South Carolina outbreak have resulted from exposures at local churches. But the outbreak has also continued to grow in the broader community, to the point where some people have had multiple exposure points and it’s unclear which one may have led to a case, Bell said. Public schools have been major sources of spread, and exposures have also been reported at restaurants and shops.

The vast majority of measles cases in South Carolina have been among children, nearly all of whom were unvaccinated.

The state health department consistently promotes vaccination as the best defense. It has held pop-up vaccination clinics and continues to offer the mobile health unit to community partners interested in scheduling a vaccination event, but health officials have said that progress has been slow.

“At this time, we need to increase MMR vaccination coverage to stop this outbreak,” Bell said.

When measles cases were growing in New Mexico last year in connection with an outbreak in West Texas, health officials there had much more success. Thorpe said it probably comes down to a difference in resources and deeper investment from the state government.

“The folks who do outreach at the state health department in South Carolina are doing God’s work. They do amazing things with very little, but they’re still doing amazing things with very little,” he said. “If you want to see turnout and engagement from the community, you can’t wait until there’s something really bad happening.”

With low rates of vaccination among the local population, the health department is relying on other efforts to contain the spread as much as possible. Contact tracing helps the agency notify people who may have been exposed, and unvaccinated people are encouraged to quarantine if they are exposed to a known case. But it’s a time-consuming and resource-intensive process; hundreds of people have been in quarantine over the past few weeks, just a subset of the hundreds more who had to be contacted.

“Our strategy is primarily focusing on rapidly identifying people who are infectious so that we can contain spread around them,” Bell said.

That involves reaching people who had direct, close contact and making public notifications of exposure settings, she said – a prospect that gets harder as the number of exposures increases and more and more people are out and about in the community without knowing that they may be infectious.

For unvaccinated children, quarantine means missing three weeks of school — a consequence that the state health department warns parents and guardians about as they’re applying for an exemption from vaccinations that are required to attend school. It’s also a talking point that Dr. Stuart Simko, a pediatrician who practices in a town on the edge of Spartanburg County, raises to parents who are hesitant about vaccines.

“It’s just one more layer that we can talk about,” he said, also noting the significant economic impact it can have on families if a parent has to miss work to take care of a child who is out of school in quarantine.

Some families have chosen vaccination after going through one round of quarantine, but others have continued to not vaccinate – even after two rounds of quarantine, the state health department said.

Local pediatricians in the upstate region of South Carolina have also seen parents refuse vaccination for their children, even after direct experience with illness from measles.

Like many health care providers in the US, Simko had studied measles but had never seen a case. Now his practice has treated five patients, and he says they were some of the sickest he’s ever seen.

Watching the progression of disease was “shocking,” he said. Through one child’s regular telehealth visits, he watched the rash develop in the hairline and make its way down the child’s body, working with the parents to help manage the high fever and keep the child hydrated.

“He looked really sick. You could tell he did not feel well at all,” Simko said. “Definitely one of the sicker kids that I’ve seen.”

When parents have specific concerns about vaccinating their children, it’s usually possible to talk with them and find agreement on the importance of vaccination, says Dr. Leigh Bragg, a pediatrician who practices about two counties over from the epicenter of South Carolina’s measles outbreak.

But more and more often, parents can’t pinpoint why they’re hesitant, she said — which limits possibility of change.

“It’s just kind of a feeling that they have or something that they have seen on social media,” Bragg said. “That has been a challenge as a pediatrician. It’s kind of hard to explain why [vaccines are] important and ease their mind if you don’t really know what their reservations are.”

Vaccine exemptions for nonmedical reasons have become increasingly common in the US in recent years. In South Carolina specifically, religious exemptions have nearly doubled since the start of the Covid-19 pandemic, according to data from the US Centers for Disease Control and Prevention.

But not all are for staunchly anti-vaccine reasons or even because of vaccine hesitancy, Thorpe said. In some cases, broader issues around health care access come into play.

“When we look across a lot of the communities with lower vaccination rates, we know a good chunk of those folks who are not up to date on their vaccines are in that situation because they’re struggling with getting access,” Thorpe said. “There’s a lot of great data out there that talks about how important the relationship is between a physician and a family. But if folks are struggling to access those kind of services, that doesn’t really get us so far.”

Since the height of Covid, schools across South Carolina have also been very focused on getting kids back into the classroom to avoid potential scenarios where they fall out of the education system completely, Thorpe said. It puts schools in an “unenviable position” of having to choose between pushing to get the child vaccinated or letting them slide so they can continue to receive education and other services that the school can provide.

“In many cases, that religious exemption is a lot easier [for parents] than the multiple visits it would take to go see their provider to get their kids vaccinated,” he said. “Until now, the consequences for that were fairly low.”

Overall, the US ended 2025 with 2,144 confirmed measles cases, according to the CDC — significantly more than at any point since the early 1990s — and 2026 is on track to be just as bad, if not worse.

In November, the Pan American Health Organization, part of the World Health Organization, determined that Canada had lost its measles elimination status amid a large ongoing outbreak there.

Elimination status in the US – a standing the country has held since 2000 – is now on the line.

Multiple large outbreaks in the US that started last year may be connected, particularly the West Texas outbreak and the ongoing outbreak in South Carolina. Questions remain about exactly how much evidence PAHO will need to determine whether the two outbreaks are linked, but continued spread through the end of January would mark one year since the start – a time frame that Bell considers all but inevitable, especially with more than 100 people currently in quarantine and little change in local vaccination rates.

At least four major international airports in the US reported measles cases or potential exposures during peak holiday travel last month, and the New Mexico health department warned of possible measles exposure in Albuquerque from someone visiting from South Carolina.

Days into the new year, the nation has already seen three measles cases: two in South Carolina and one in North Carolina — the result of a family visit to Spartanburg County.

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