South Carolina Measles Outbreak: Underreporting and Concerns Over Public Health Data

South Carolina is grappling with the nation’s largest measles outbreak in over two decades, with 962 confirmed cases as of February 17, 2026, largely centered in Spartanburg County. However, a critical gap in public health data – the lack of mandatory reporting of measles-related hospitalizations – is raising concerns among physicians and infectious disease experts about the true severity of the outbreak and hindering effective response efforts.

The Problem of Underreporting

Unlike some states like Alabama and Virginia, South Carolina does not require hospitals to report admissions for measles-related illnesses. This lack of mandatory reporting has resulted in a significantly lower hospitalization rate – approximately 2% of cases – compared to the national average estimated by the Centers for Disease Control and Prevention (CDC), which suggests around 20% of measles cases require hospitalization.

Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia, described a 2% hospitalization rate as “ludicrous,” emphasizing that measles is a serious illness. The South Carolina Department of Public Health (DPH) acknowledges the issue, stating they are “not getting an accurate picture” of the illness’s impact on the community.

Impact on Medical Professionals and Public Awareness

The absence of real-time, comprehensive hospitalization data leaves doctors like Dr. Leigh Bragg, a pediatrician, relying on anecdotal information and “grapevines” of colleagues to understand the severity of the outbreak. This makes it tough to accurately advise patients, particularly vaccine-hesitant parents, about the potential risks of measles, including pneumonia, dehydration, and encephalitis (brain swelling).

The outbreak has also impacted healthcare facilities beyond hospitals, with exposure incidents reported in labor and delivery units, as well as workplaces like BMW and Michelin manufacturing plants. Infectious individuals have also carried the virus to other states, including Florida, Kentucky, Georgia, and Texas.

Political and Systemic Challenges

The lack of mandatory reporting is compounded by political pressures and concerns about influencing vaccine-wary patients. Some healthcare systems are hesitant to publicly share data that might be perceived as critical of vaccination efforts, whereas pending legislation seeks to limit the ability of healthcare providers to discuss vaccines with patients.

Current Situation and Ongoing Response

As of February 20, 2026, the DPH is reporting 962 cases of measles centered around Spartanburg County. The DPH has activated its Mobile Health Unit to offer free measles-mumps-rubella (MMR) vaccines to unvaccinated individuals. The agency will continue to post updates twice a week, on Tuesdays and Fridays.

Nationwide, over 900 confirmed measles cases have been reported in 2026, compared to 2,281 in all of 2025.

Key Takeaways

• South Carolina’s measles outbreak is the largest in the U.S. In over 25 years.
• The state does not require hospitals to report measles-related hospitalizations, leading to significant underreporting.
• Underreporting hinders public health officials’ ability to accurately assess the severity of the outbreak and allocate resources effectively.
• Political and systemic factors contribute to the challenges in collecting and sharing accurate data.