This story was initially printed by ProPublica, a nonprofit newsroom that investigates abuses of energy. Sign up to obtain its biggest stories as quickly as they’re printed.
In mid-January, an unassuming man in khakis and a button-down shirt walked to a picket lectern at a college board assembly in Spartanburg County, South Carolina. Most chairs in the viewers had been empty. The man, Tim Smith, was the solely particular person signed up to converse throughout public feedback. He had 5 minutes.
“I trust that each one of you had a good Christmas and New Year’s,” he started. “Unfortunately, I can’t say the same thing.”
His spouse is an assistant instructor at a public elementary college in the county, epicenter of the state’s historic measles outbreak, and shortly earlier than winter break she’d obtained a discover {that a} youngster in her classroom had measles. Given his spouse is totally vaccinated, he wasn’t nervous.
Then, she started to get sick. And sicker. She acquired a measles take a look at and, to their shock, it got here again constructive. She was apparently amongst the very uncommon breakthrough infections.
Frightened, they took her to the hospital that night time. “My wife was throwing up,” Smith mentioned at the assembly. “She had diarrhea. She couldn’t breathe. All for what? This is — it’s absolute insanity.”
Dr. Leigh Bragg, a pediatrician working a county away, wasn’t even conscious that anybody in South Carolina had been hospitalized with measles-related diseases till a short while later when she logged on to Facebook and noticed somebody relay the distraught husband’s feedback.
Part of the cause Bragg didn’t know is that South Carolina doesn’t require hospitals to report admissions for measles, doubtlessly obscuring the illness’s severity. In the absence of necessary reporting guidelines, she and different doctors are sometimes left to depend on rumors, their grapevines of colleagues, and the fragments of data the state public well being company is ready to collect and keen to share.
With 973 reported cases, South Carolina’s measles outbreak has ballooned into the nation’s largest since the virus was declared eradicated in the U.S. 25 years in the past. Yet, since state well being officers first confirmed the outbreak on Oct. 2, the state’s hospitals have reported solely 20 measles-related admissions, or about 2% of instances. Some infectious illness specialists say that the true quantity is probably going a lot increased.
Hospitalization charges can range significantly by a measles outbreak’s location and who’s getting contaminated. But the Centers for Disease Control and Prevention estimates about 20% of measles cases will end result in admissions.
“A hospitalization rate at 2% is ludicrous,” mentioned Dr. Paul Offit, director of the Vaccine Education Center and an infectious illness doctor at Children’s Hospital of Philadelphia who served on the Centers for Disease Control and Prevention’s immunization advisory committee.
“It’s vast underreporting,” Offit mentioned. “Measles makes you sick.”
Measles is amongst the most contagious of viruses. In 2026 thus far, nearly half of states have reported instances. Yet it’s left largely to every state to determine how a lot infectious illness reporting to require about it.
“We don’t think we are getting an accurate picture at all of how these illnesses are impacting our community,” Linda Bell, the South Carolina state epidemiologist, mentioned at a briefing final month. “We’re just not getting a picture of that now with the small number of hospitalizations that are known to us.”
Bell mentioned the state Department of Public Health is urging hospitals to report their measles-related admissions, and 7 hospitals have performed so. (There are a minimum of a dozen acute care hospitals in the Upstate alone.) But the state can’t drive them to accomplish that. Bell additionally mentioned that the company, which units infectious illness reporting necessities, hasn’t thought-about including hospitalizations to the record as a result of the major goal of public well being surveillance is to perceive illness transmission, frequency and distribution — not to monitor issues.
That leaves doctors like Bragg advising sufferers, together with vaccine-resistant mother and father, with out the good thing about confirmed, real-time knowledge about what number of South Carolinians have been hospitalized with measles. Severe issues embody pneumonia, dehydration and a doubtlessly life-threatening mind swelling known as encephalitis.
“It’s a very big disservice to the public not reporting complications we are seeing in hospitals or even ERs,” Bragg mentioned. “Measles isn’t just a cold.”
ProfessionalPublica contacted state well being businesses throughout the South and located most don’t require hospitals to report measles-related admissions. Alabama does. So does Virginia, though it doesn’t launch that knowledge to the public. Like South Carolina, North Carolina and Texas don’t require reporting of hospitalizations, however epidemiologists can determine them throughout case investigations.
During the Texas measles outbreak final 12 months, 99 folks had been hospitalized out of 762 instances.
That’s a charge of about 13%. In South Carolina, the reported charge is 2%.
Real-time hospitalization knowledge can present the place to goal sources and assist hospitals put together for an inflow of sufferers. “As vaccine rates decrease, it could also really help us understand the changing epidemiology of measles in this current context,” mentioned Gabriel Benavidez, an epidemiology professor at Baylor University in Texas.
When ProfessionalPublica requested hospitals throughout the Upstate, the northwest quadrant of South Carolina the place the outbreak is concentrated, if they’re reporting their measles-related admissions to the state and what number of sufferers they’d handled, few responded. Only Spartanburg Regional Healthcare System shared its complete. (As of mid-February, the quantity was 4.)
A spokesperson for Prisma Health, a Greenville-based nonprofit that owns eight acute-care hospitals in the Upstate, mentioned its hospitals are “reporting everything we are supposed to report.” She wouldn’t say what number of measles sufferers have been hospitalized at Prisma hospitals or what number of the system has reported to the state.
Bragg, who’s board licensed in pediatrics and pediatric infectious illness, works in the area of South Carolina the place the outbreak is concentrated. It’s a extremely non secular expanse with the state’s lowest scholar vaccination charges. She just lately met with a mother or father questioning the beneficial vaccines for a 1-year-old youngster, which features a first dose of measles vaccine.
“We’re in the middle of a measles outbreak,” Bragg thought.
Then she started a 30-minute dialogue of the vaccine’s excessive security and 97% lifetime effectiveness when two doses are given. She defined that 95% of individuals in South Carolina who’ve gotten measles had been unvaccinated. She rattled off historic dangers of measles issues.
Yet Bragg couldn’t inform the mother or father simply how severely in poor health their fellow South Carolinians had been getting from the outbreak sickening folks round them.
She had heard about pneumonia, ICU admissions — and even a case of encephalitis. But she hadn’t been ready to affirm it, or discover out if it was a baby, a lot much less how the affected person fared. (Shortly after, Bell introduced that the state well being company had discovered of encephalitis instances in kids, however she didn’t present the numbers of sufferers or their outcomes.)
As president of the South Carolina chapter of the American Academy of Pediatrics, Dr. Martha Edwards is related to physicians throughout the state. “All I’m hearing about are ‘complications of measles,’” which might imply plenty of various things, she mentioned.
Communicating the dangers of extreme sickness is all the extra necessary as a result of few of at present’s mother and father have seen measles up shut. Neither have most practising doctors.
Early in his profession, Dr. William Schaffner, a professor at Vanderbilt University who focuses on the prevention of infectious ailments, labored with the CDC to implement the measles vaccine. When he tells medical college students at present that in the Nineteen Sixties, earlier than the measles vaccine, 400 to 500 children died of measles and its issues every year, “They’re stunned.”
“If the severity of the illness cannot be ascertained — if it can’t be determined — it can’t be appropriately communicated to the public,” Schaffner mentioned. “And the public might get the false impression that measles is milder than it really is.”
At a briefing, Dr. Robin LaCroix, a Prisma pediatric infectious illness doctor, mentioned the group’s physicians “have seen the whole gamut of acute and post-measles infections that have afflicted these children. They are sick.” Children have turn into listless and suffered blotchy rashes, coughing and coughing spasms, dehydration and secondary infections together with pneumonias.
Measles infections are significantly harmful for infants who can’t get vaccinated but and younger kids who haven’t gotten the second dose. Infections throughout being pregnant additionally pose extreme dangers for moms who are usually not vaccinated or immune, together with miscarriage and a tenfold improve in demise due to pneumonia. Mothers can cross on the virus to their infants, “which can be catastrophic,” mentioned Dr. Kendreia Dickens-Carr, a Prisma OB-GYN.
More than 900 confirmed measles instances have been reported throughout the nation already in 2026, in contrast with 2,281 in all of 2025. Most of this 12 months’s instances are in South Carolina, however Florida has reported 63 instances and neighboring North Carolina 15, together with one hospitalization.
“We really do need to think about the way in which we report these things, because viruses and bacteria don’t respect state lines,” mentioned Dr. Annie Andrews, a pediatrician operating as a Democrat for the U.S. Senate in South Carolina. “Public health professionals from one state to another should be comparing apples to apples and oranges to oranges.”
The most superior pediatric care in the state is offered at the Medical University of South Carolina’s campus in Charleston, a number of hours away from the Upstate on the coast. So far, its kids’s hospital hasn’t admitted any measles sufferers, doctors mentioned.
Dr. Danielle Scheurer, the chief high quality officer at MUSC, celebrated the state’s low hospitalization charge and mentioned she doubted hospitals would object to required reporting of measles-related admissions if the state well being company had been to change its guidelines.
“Transparency here is going to help other states,” Scheurer mentioned. “The more transparent we are about all of our statistics, the better off any other state is going to be in preparing.”
Across South Carolina, massive well being care methods have purchased up native hospitals and doctors’ practices. With that management, they will exert affect over what these doctors and hospital workers say publicly, particularly when it comes to doubtlessly controversial matters like vaccines. At the identical time, they face strain from Republican lawmakers and a rising phase of vaccine-wary sufferers.
The result’s usually extremely managed data sharing, or an absence thereof.
“There’s this level of caution that wasn’t there before,” Edwards mentioned. She understands that hospitals don’t need to offend sufferers who’re doubtful of vaccines. Bragg agreed however mentioned provided that 93% of the state’s college students are vaccinated, she worries the hospitals are “pandering to a small group.”
A pending bill, sponsored by a number of of Spartanburg County’s state representatives, seeks to stop hospitals and doctors from questioning or interfering “in any manner” with a affected person’s proper to refuse remedies or vaccines. During COVID-19, the invoice contends, federal businesses collaborated with medical organizations and others “to orchestrate a coordinated and coercive propaganda campaign” to disgrace individuals who declined COVID-19 vaccines. Doctors and hospitals argue they need to stability public well being dangers with people who decline to take vaccines.
The state’s Republican governor, Henry McMaster, and main GOP candidates to exchange him have largely framed their responses to the measles outbreak round the idea of medical freedom, significantly when discussing vaccine mandates.
Andrews, the pediatrician operating for the U.S. Senate, mentioned she’s skilled the “chilling effect” the GOP’s “anti-science movements” have had on well being care methods and particular person physicians. “If you speak up, you are at risk of being censored,” Andrews mentioned. “If you speak up, you are at risk of losing your job. So everyone is just trying to keep their head down and do what’s best for their patients.”
Bragg is amongst the declining ranks of doctors who run their very own unbiased practices. She has the freedom to submit what she needs to on social media and to put on pro-vaccine T-shirts that say issues like, “Got polio? Me neither because I got the vaccine.”
But one current day, her 10-year-old son requested why she insisted on sporting the T-shirts. “Even a 10-year-old can tell you how polarizing vaccines have become,” Bragg mentioned. Despite that, she has continued to put on them.