Why South Carolina Hospitals Have Reported Few Measles-Associated Admissions Regardless of Rising Outbreak — ProPublica

In mid-January, an unassuming man in khakis and a button-down shirt walked to a picket lectern at a faculty board assembly in Spartanburg County, South Carolina. Most chairs within the viewers have been empty. The person, Tim Smith, was the one individual signed as much as converse throughout public feedback. He had 5 minutes.

“I belief that every one in every of you had an excellent Christmas and New Yr’s,” he started. “Sadly, I can’t say the identical factor.”

His spouse is an assistant instructor at a public elementary college within 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 absolutely vaccinated, he wasn’t anxious. 

Then, she started to get sick. And sicker. She acquired a measles check and, to their shock, it got here again constructive. She was apparently among the many very uncommon breakthrough infections. 

Frightened, they took her to the hospital that night time. “My spouse was throwing up,” Smith stated on the assembly. “She had diarrhea. She couldn’t breathe. All for what? That is — it’s absolute madness.” 

Dr. Leigh Bragg, a pediatrician working a county away, wasn’t even conscious that anybody in South Carolina had been hospitalized with measles-related sicknesses till a short while later when she logged on to Fb and noticed somebody relay the distraught husband’s feedback. 

A part of the explanation Bragg didn’t know is that South Carolina doesn’t require hospitals to report admissions for measles, probably obscuring the illness’s severity. Within the absence of obligatory reporting guidelines, she and different docs 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 instances, South Carolina’s measles outbreak has ballooned into the nation’s largest for the reason that virus was declared eradicated within the U.S. 25 years in the past. But, 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 consultants say that the true quantity is probably going a lot greater. 

Hospitalization charges can range tremendously by a measles outbreak’s location and who’s getting contaminated. However the Facilities for Illness Management and Prevention estimates about 20% of measles instances will lead to admissions.  

“A hospitalization charge at 2% is ludicrous,” stated Dr. Paul Offit, director of the Vaccine Training Heart and an infectious illness doctor at Youngsters’s Hospital of Philadelphia who served on the Facilities for Illness Management and Prevention’s immunization advisory committee. 

“It’s huge underreporting,” Offit stated. “Measles makes you sick.”

Measles is among the many most contagious of viruses. In 2026 to this point, virtually half of states have reported instances. But it’s left largely to every state to resolve how a lot infectious illness reporting to require about it. 

“We don’t suppose we’re getting an correct image in any respect of how these sicknesses are impacting our group,” Linda Bell, the South Carolina state epidemiologist, stated at a briefing final month. “We’re simply not getting an image of that now with the small variety of hospitalizations which might be identified to us.” 

Bell stated the state Division of Public Well being is urging hospitals to report their measles-related admissions, and 7 hospitals have completed so. (There are at the least a dozen acute care hospitals within the Upstate alone.) However the state can not power them to take action. Bell additionally stated that the company, which units infectious illness reporting necessities, hasn’t thought-about including hospitalizations to the checklist as a result of the first function of public well being surveillance is to grasp illness transmission, frequency and distribution — to not monitor problems.

That leaves docs like Bragg advising sufferers, together with vaccine-resistant dad and mom, with out the advantage of confirmed, real-time knowledge about what number of South Carolinians have been hospitalized with measles. Extreme problems embrace pneumonia, dehydration and a probably life-threatening mind swelling known as encephalitis.

“It’s a really large disservice to the general public not reporting problems we’re seeing in hospitals and even ERs,” Bragg stated. “Measles isn’t only a chilly.”

ProPublica contacted state well being companies 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 general public. Like South Carolina, North Carolina and Texas don’t require reporting of hospitalizations, however epidemiologists can establish them throughout case investigations.

Throughout the Texas measles outbreak final 12 months, 99 folks have been hospitalized out of 762 instances. 

That’s a charge of about 13%. In South Carolina, the reported charge is 2%.

Actual-time hospitalization knowledge can present the place to focus on sources and assist hospitals put together for an inflow of sufferers. “As vaccine charges lower, it may additionally actually assist us perceive the altering epidemiology of measles on this present context,” stated Gabriel Benavidez, an epidemiology professor at Baylor College in Texas.

When ProPublica 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. Solely Spartanburg Regional Healthcare System shared its whole. (As of mid-February, the quantity was 4.) 

A spokesperson for Prisma Well being, a Greenville-based nonprofit that owns eight acute-care hospitals within the Upstate, stated its hospitals are “reporting the whole lot we’re imagined 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. 

Docs within the Darkish 

Bragg, who’s board licensed in pediatrics and pediatric infectious illness, works within the area of South Carolina the place the outbreak is concentrated. It’s a extremely spiritual expanse with the state’s lowest scholar vaccination charges. She lately met with a mother or father questioning the really helpful vaccines for a 1-year-old youngster, which features a first dose of measles vaccine.  

“We’re in the course 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 have been unvaccinated. She rattled off historic dangers of measles problems. 

But Bragg couldn’t inform the mother or father simply how severely unwell their fellow South Carolinians have been getting from the outbreak sickening folks round them. 

She had heard about pneumonia, ICU admissions — and even a case of encephalitis. However she hadn’t been in a position to affirm it, or discover out if it was a toddler, 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 linked to physicians throughout the state. “All I’m listening to about are ‘problems of measles,’” which might imply a whole lot of various things, she stated.

Speaking the dangers of extreme sickness is all of the extra necessary as a result of few of at present’s dad and mom have seen measles up shut. Neither have most working towards docs. 

Early in his profession, Dr. William Schaffner, a professor at Vanderbilt College who focuses on the prevention of infectious illnesses, labored with the CDC to implement the measles vaccine. When he tells medical college students at present that within the Nineteen Sixties, earlier than the measles vaccine, 400 to 500 children died of measles and its problems annually, “They’re surprised.” 

“If the severity of the sickness can’t be ascertained — if it will possibly’t be decided — it will possibly’t be appropriately communicated to the general public,” Schaffner stated. “And the general public may get the misunderstanding that measles is milder than it truly is.”

At a briefing, Dr. Robin LaCroix, a Prisma pediatric infectious illness doctor, stated the group’s physicians “have seen the entire gamut of acute and post-measles infections which have stricken these kids. They’re sick.” Youngsters have turn out to be 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 not get vaccinated but and younger kids who haven’t gotten the second dose. Infections throughout being pregnant additionally pose extreme dangers for moms who should not vaccinated or immune, together with miscarriage and a tenfold improve in loss of life as a consequence of pneumonia. Moms can go on the virus to their infants, “which might be catastrophic,” stated Dr. Kendreia Dickens-Carr, a Prisma OB-GYN.

Greater 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 actually do want to consider the best way during which we report these items, as a result of viruses and micro organism don’t respect state strains,” stated Dr. Annie Andrews, a pediatrician working as a Democrat for the U.S. Senate in South Carolina. “Public well being professionals from one state to a different ought to be evaluating apples to apples and oranges to oranges.” 

Essentially the most superior pediatric care within the state is supplied on the Medical College of South Carolina’s campus in Charleston, a number of hours away from the Upstate on the coast. Thus far, its kids’s hospital hasn’t admitted any measles sufferers, docs stated. 

Dr. Danielle Scheurer, the chief high quality officer at MUSC, celebrated the state’s low hospitalization charge and stated she doubted hospitals would object to required reporting of measles-related admissions if the state well being company have been to alter its guidelines. 

“Transparency right here goes to assist different states,” Scheurer stated. “The extra clear we’re about all of our statistics, the higher off another state goes to be in making ready.” 

Political Pressures

Throughout South Carolina, massive well being care programs have purchased up native hospitals and docs’ practices. With that management, they will exert affect over what these docs and hospital staff say publicly, particularly in terms of probably controversial matters like vaccines. On the similar time, they face stress from Republican lawmakers and a rising section of vaccine-wary sufferers. 

The result’s typically extremely managed info sharing, or an absence thereof.

“There’s this degree of warning that wasn’t there earlier than,” Edwards stated. She understands that hospitals don’t wish to offend sufferers who’re doubtful of vaccines. Bragg agreed however stated provided that 93% of the state’s college students are vaccinated, she worries the hospitals are “pandering to a small group.”

A pending invoice, sponsored by a number of of Spartanburg County’s state representatives, seeks to stop hospitals and docs from questioning or interfering “in any method” with a affected person’s proper to refuse remedies or vaccines. Throughout COVID-19, the invoice contends, federal companies collaborated with medical organizations and others “to orchestrate a coordinated and coercive propaganda marketing campaign” to disgrace individuals who declined COVID-19 vaccines. Docs and hospitals argue they have 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 across the idea of medical freedom, significantly when discussing vaccine mandates. 

Andrews, the pediatrician working for the U.S. Senate, stated she’s skilled the “chilling impact” the GOP’s “anti-science actions” have had on well being care programs and particular person physicians. “If you happen to converse up, you’re liable to being censored,” Andrews stated. “If you happen to converse up, you’re liable to dropping your job. So everyone seems to be simply making an attempt to maintain their head down and do what’s finest for his or her sufferers.”

Bragg is among the many declining ranks of docs who run their very own impartial practices. She has the liberty to submit what she desires to on social media and to put on pro-vaccine T-shirts that say issues like, “Acquired polio? Me neither as a result of I acquired the vaccine.” 

However one latest day, her 10-year-old son requested why she insisted on carrying the T-shirts. “Even a 10-year-old can inform you how polarizing vaccines have turn out to be,” Bragg stated. Regardless of that, she has continued to put on them.