In mid-January, a man named Tim Smith approached the lectern at a Spartanburg County school board meeting, where most seats were vacant. He was the sole speaker for the public comments and had five minutes to express his thoughts.
“I hope you all had a good Christmas and New Year’s,” he started. “Unfortunately, I can’t say the same for my family.”
His wife, an assistant teacher at a local elementary school, had recently been notified that a student in her classroom had measles. Even though she was fully vaccinated, Smith felt reassured initially and didn’t think much of it.
Yet, shortly after, she started feeling unwell. Her condition worsened, and when they tested for measles, the result was shocking: she had contracted the virus in a breakthrough case.
Panicking, they took her to the hospital that night. “My wife was throwing up, had diarrhea, and struggled to breathe,” Smith recounted at the meeting. “All for what? This is — it’s absolute insanity.”
Dr. Leigh Bragg, a pediatrician from a nearby county, hadn’t realized that anyone in South Carolina had been hospitalized for measles until she logged onto Facebook and saw Smith’s comments.
The lack of information stemmed partly from the fact that South Carolina does not require hospitals to report measles admissions, which masks the true impact of the disease. Without mandatory reporting, doctors like Bragg often rely on rumors and limited information from the state’s public health agency.
With a staggering 973 reported cases, South Carolina is experiencing its largest measles outbreak in decades. Despite this, health officials reported only 20 hospitalizations related to measles, or a mere 2% of the cases. Experts suggest the actual number is likely much higher.
Hospitalization rates can differ based on the outbreak’s context. The Centers for Disease Control and Prevention estimates that around 20% of cases generally lead to admissions.
“A rate of 2% is ludicrous,” commented Dr. Paul Offit, an infectious disease physician in Philadelphia. “It’s a clear case of underreporting. Measles makes you sick.”
Measles is among the most contagious viruses, with nearly half of U.S. states reporting cases. However, states have their own criteria about reporting infectious diseases.
Linda Bell, the state epidemiologist, expressed concern, saying last month, “We don’t have an accurate picture of how these illnesses are affecting our community.”
The South Carolina Department of Public Health is now pressuring hospitals to report their measles admissions, and while seven hospitals have complied, they cannot enforce it. Moreover, the agency hasn’t pushed to include hospitalizations in obligatory reports, mainly focusing on disease transmission.
This lack of data leaves practitioners like Bragg trying to guide patients, especially hesitant parents, without real-time confirmation of measles hospitalizations. Severe complications include pneumonia, dehydration, and a serious brain condition called encephalitis.
Bragg noted, “It’s a disservice to the public to not report these complications. Measles isn’t just a cold.”
ProPublica reached out to health agencies across the South and found that many states do not require hospitals to report measles admissions. However, Alabama has such a requirement, while Virginia keeps that data private. North Carolina and Texas also don’t require reporting but can identify hospitalizations during investigations.
During last year’s Texas outbreak, 99 people were hospitalized out of 762 cases, translating to approximately 13%. In South Carolina, the reported rate stands at only 2%.
Having access to real-time hospitalization data can help target resources and prepare hospitals for patient surges. “As vaccination rates decline, it could really help us understand the evolving measles landscape,” said Gabriel Benavidez, an epidemiology professor at Baylor University.
ProPublica sought information from hospitals in Upstate South Carolina about their measles admissions, but few responded. Only Spartanburg Regional Healthcare revealed treating four patients as of mid-February.
A Prisma Health spokesperson claimed their hospitals are complying with reporting requirements but did not disclose how many measles patients were hospitalized.
Dr. Bragg, who works in the region most affected by the outbreak, noted that she recently spoke with a parent questioning vaccines recommended for their one-year-old, including the measles vaccine.
“We’re in the midst of a measles outbreak,” she thought to herself.
She then explained the vaccine’s proven safety and effectiveness, emphasizing that 95% of those infected in South Carolina were unvaccinated. She highlighted the historical risks associated with measles complications.
However, Bragg was unable to convey how serious the illnesses of other South Carolinians had become due to this outbreak.
While she had heard of complications like pneumonia and ICU admissions, and even about cases of encephalitis, she struggled to confirm specifics or outcomes related to those cases. (Shortly after, it was reported that the state health agency had confirmed encephalitis cases in children, though patient numbers and outcomes were not disclosed.)
Dr. Martha Edwards, president of the South Carolina chapter of the American Academy of Pediatrics, noted that she was hearing about various “complications of measles,” which can mean a wide range of health issues.
Effectively communicating the risks associated with severe illness is crucial since many parents today haven’t witnessed measles first-hand, nor have most practicing physicians.
Dr. William Schaffner, a professor at Vanderbilt and an expert on infectious disease prevention, reflected on how medical students react upon learning that thousands died from measles each year before the vaccine became available. “They’re stunned,” he said.
“If we can’t determine the illness’s severity, that message can’t be conveyed accurately to the public,” Schaffner added. “The public might end up thinking measles is less serious than it really is.”
Dr. Robin LaCroix, a pediatric infectious disease physician at Prisma, shared that the organization’s physicians have encountered various acute and post-measles infections. “These children are sick,” she said, highlighting symptoms like fatigue, cough, rashes, and secondary infections such as pneumonia.
Measles poses particular dangers to infants who cannot yet be vaccinated and young kids who haven’t received their second dose. Furthermore, infections during pregnancy can lead to severe complications for mothers who aren’t vaccinated, including a tenfold increase in pneumonia-related fatalities. infected mothers can pass the virus to their babies, which can have devastating consequences, Dr. Kendreia Dickens-Carr highlighted.
In 2026, there have already been over 900 confirmed cases of measles nationwide, a significant rise from the total of 2,281 cases in 2025. Most cases this year have been in South Carolina, though Florida reported 63 cases and North Carolina 15.
Dr. Annie Andrews, a pediatrician and U.S. Senate candidate in South Carolina, stressed the importance of consistent reporting standards across state lines. “Public health officials should be comparing similar data,” she noted, emphasizing that diseases don’t recognize geographic boundaries.
The Medical University of South Carolina in Charleston, which offers the most advanced pediatric care in the state, has yet to admit any measles patients, according to physicians there.
Dr. Danielle Scheurer, the chief quality officer at MUSC, acknowledged South Carolina’s low hospitalization rate and expressed confidence that hospitals wouldn’t resist reporting requirements if the state mandated it.
“Increased transparency will aid other states,” Scheurer suggested, stressing that sharing comprehensive statistics benefits public health systems everywhere.
Many South Carolina healthcare systems have acquired local hospitals and practices, allowing them to control communications, especially on sensitive topics like vaccines. This centralization often leads to tightly controlled information sharing.
Edwards pointed out that there’s a hesitation among hospitals now that wasn’t there before, as they want to avoid offending vaccine-skeptical patients. Bragg echoed these sentiments but voiced concern that hospitals might be catering to a minority when 93% of the state’s students are vaccinated.
A pending bill seeks to prevent medical professionals from interfering with patients’ rights to decline vaccines or treatments. The bill claims federal agencies collaborated with medical groups to pressure individuals into accepting COVID-19 vaccinations, creating a conflict for doctors who seek to prioritize public health while respecting patient autonomy.
South Carolina’s Republican governor, Henry McMaster, along with GOP candidates to replace him, have framed their responses to the measles outbreak around the issue of medical freedom, especially regarding vaccine mandates.
Andrews shared her firsthand experience with how the GOP’s “anti-science movements” have affected healthcare systems and individual doctors. “Speaking out can lead to censorship or losing your job,” she stated, detailing a climate of caution where many prioritize simply doing their jobs over advocating for public health.
Bragg, who maintains an independent practice, enjoys the freedom to express her views on social media—she even wears pro-vaccine t-shirts that boldly state messages like, “Got polio? Me neither because I got the vaccine.”
Yet, her 10-year-old son has asked her why she chooses to wear those shirts. “Even kids understand how divisive the vaccine conversation has become,” she remarked. Still, she continues to wear her messages proudly.
