South Carolina is experiencing the largest measles outbreak in decades, with 789 confirmed cases as of late January 2026. This surge surpasses the 2025 Texas outbreak (762 cases), which tragically resulted in two child fatalities, though no deaths have been reported in South Carolina to date. The current crisis underscores a growing public health risk and raises concerns about the U.S.’s ability to maintain measles elimination status.
The Epicenter and Contributing Factors
The outbreak is concentrated in Spartanburg County, where vaccination rates among students are notably low. The South Carolina Department of Public Health (DPH) reports that 18 people have been hospitalized due to complications since October 2025, with additional cases requiring medical care but not hospitalization. The vast majority of infections occur in unvaccinated individuals: 695 out of the 789 cases are in people who have not been vaccinated, 14 have received only one dose, and 20 are fully vaccinated.
This pattern highlights the critical importance of full vaccination, although even the two-dose regimen (97% effective) isn’t foolproof. The slim chance of breakthrough infections emphasizes why herd immunity is essential – protecting the entire community by limiting viral spread. Unlike natural infections, vaccination minimizes the risk of severe illness or death.
U.S. Elimination Status at Risk
The U.S. may soon lose its measles elimination status, a designation earned when a country reports no sustained local transmission for at least one year. U.S. officials will meet with the Pan American Health Organization in April 2026 to determine if the country has indeed failed to meet this benchmark. If so, the U.S. will join nations like the U.K. and Canada, which have already lost their status due to declining vaccination rates.
CDC Response and Underlying Trends
Despite the alarming outbreak numbers, Dr. Ralph Abraham of the CDC expressed little concern in mid-January, suggesting that imported cases from travelers are driving the increase. However, this perspective overlooks the fact that sustained local transmission is what defines elimination status. A country can still experience imported cases, but consistent spread within its borders indicates a failure to control the disease.
The contrast between current numbers and the past is stark. In 2000, the year the U.S. was declared measles-free, there were only 85 cases nationwide. By 2025, that number had risen to 2,255. With South Carolina already reporting hundreds of cases in 2026, the U.S. is on track to surpass even those figures.
The resurgence of measles in the U.S. is a direct consequence of declining vaccination rates and underscores the vulnerability of public health when preventative measures are undermined.
The current situation demands a renewed focus on vaccination efforts and a reevaluation of public health strategies to prevent further outbreaks and protect the nation’s hard-won elimination status.
