Measles Outbreak in South Carolina Signals Potential Loss of U.S. Elimination Status
The measles outbreak in South Carolina is demonstrating a concerning lack of deceleration, with the state now reporting 847 confirmed cases since the initial detection in October. This figure surpasses the measles case count experienced in Texas, where the outbreak commenced just over a year ago. The rapid progression in South Carolina, reaching the Texas total in a mere 16 weeks compared to seven months in Texas, underscores the severity of the current situation and raises serious questions about the nation’s capacity to control the virus.
Dr. Linda Bell, the state’s epidemiologist, expressed deep concern regarding the trajectory of the outbreak. Her remarks, delivered during a press briefing on Wednessaeday, highlighted the alarming speed at which measles is spreading within the state. The latest report on Friday revealed an additional 58 cases, further emphasizing the ongoing nature of the public health crisis. This surge in cases places the United States in a precarious position, threatening to reverse its status as a country free from continuous measles transmission. The U.S. has maintained this “elimination” status since January 2025, following the Texas outbreak.
The designation of measles elimination status is determined by a special verification commission established by the Pan American Health Organization (PAHO). This commission meticulously reviews extensive epidemiological data, genomic analyses, and surveillance reports to ascertain whether ongoing outbreaks represent a continuous chain of transmission originating from the Texas outbreak. However, even if PAHO concludes that the current outbreaks are isolated incidents, the U.S. risks losing its elimination status if it fails to demonstrate the ability to rapidly and consistently interrupt the spread of the disease. Experts suggest the U.S. is currently falling short of this crucial threshold.
Dr. Demetre Daskalakis, an infectious disease specialist and former senior official at the Centers for Disease Control and Prevention (CDC), stated that the U.S. currently lacks the capacity to effectively control measles, regardless of whether the outbreaks are determined to be part of a continuous transmission chain. He expressed a pessimistic outlook, suggesting that the elimination status may already be lost. PAHO is slated to review the U.S.'s measles elimination status this spring, a review that will carry significant weight for the nation’s public health standing.
The response from some within the federal health administration has been measured. Dr. Ralph Abraham, the principal deputy director of the CDC, downplayed the potential loss of elimination status, asserting that it would not alter the administration’s approach to combating measles. While acknowledging support for the measles vaccine, Dr. Abraham emphasized the importance of respecting individual freedoms related to religious and personal choices regarding vaccination. However, infectious disease experts and epidemiologists strongly disagree, emphasizing that the decision not to vaccinate is a primary driver of the current outbreak.
Caitlin Rivers, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health, views the potential loss of elimination status as a critical reflection of the current state of the public health system. She noted that the U.S. had maintained measles elimination for 25 years, and the current situation highlights a concerning cycle of neglect. The rising number of measles cases will inevitably lead to increased hospitalizations, more deaths, and a greater strain on public health resources. Furthermore, these resources will be diverted from other essential public health priorities.
The distinction between measles elimination and eradication is important to note. In 2000, PAHO declared measles eliminated from the U.S. because there had been no continuous domestic spread for over a year. However, the virus remains endemic in many parts of the world, leading to occasional importation cases. Eradication, as demonstrated with smallpox in 1980, signifies the complete global elimination of a disease, a goal that has not yet been achieved for measles.
The current outbreak in South Carolina is not confined to the state lines. Similar to the situation in Texas, the majority of cases in South Carolina have been among unvaccinated children and teenagers, resulting in school quarantines across approximately two dozen schools. Cases have also been reported in neighboring North Carolina, and as far away as Washington state, where unvaccination in a visiting family from South Carolina led to six confirmed cases in children.
Dr. Anna-Kathryn Burch, a pediatric infectious disease specialist with Prisma Health in Columbia, S.C., expressed deep concern over the outbreak in her home state, predicting that case numbers will likely continue to rise in the coming months. She emphasized the highly contagious nature of measles, stating that infected individuals can be contagious for up to four days before and four days after the rash appears, and can spread the virus through airborne particles that can linger for hours after the infected person has left a room. On average, one infected person can infect up to 18 unvaccinated individuals.
The most effective way to prevent measles is through vaccination. The measles, mumps, and rubella (MMR) vaccine is highly safe and effective, with two doses providing approximately 97% lifelong immunity. Maintaining high vaccination rates, ideally 95% or higher within communities, is crucial for preventing outbreaks by reducing the number of vulnerable individuals who can facilitate virus spread. While Spartanburg County, S.C., reports a school-wide vaccination rate of 90%, nationwide vaccination rates have been declining. In the 2024-2025 school year, only 92.5% of kindergartners in the U.S. received the measles vaccine, creating conditions ripe for outbreaks to occur.
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