The United States is facing its worst measles crisis in more than three decades, with South Carolina reporting 700 confirmed cases as of January 23, 2026, while the national total for January alone has reached 416 infections across 14 states. The outbreak, centered in Spartanburg County in the state's Upstate region, now accounts for 81 percent of all measles cases reported nationwide this year. Health officials have confirmed that 12 people, including both adults and children, have required hospitalization for complications since the outbreak began in October 2025.
The crisis comes on the heels of a devastating 2025, during which the Centers for Disease Control and Prevention confirmed 2,255 measles cases nationwide, the highest annual total since 1991 and a dramatic sevenfold increase from the 285 cases recorded in 2024. The overwhelming majority of those infected were unvaccinated, with 94 percent of 2026 cases occurring in individuals who were either unvaccinated or had unknown vaccination status. In South Carolina specifically, 483 of the first 558 cases investigated were confirmed as unvaccinated individuals.
The surge in measles infections is directly linked to declining childhood vaccination rates across the country. During the 2024-2025 school year, only 92.5 percent of kindergartners received the measles, mumps, and rubella vaccine, falling below the 95 percent threshold needed to maintain herd immunity. South Carolina's kindergarten vaccination rate stood at just 91 percent, with significantly lower rates in the Spartanburg County area where the outbreak is concentrated. Public health experts have warned that this downward trend in immunization was already underway before the recent federal policy changes to the childhood vaccine schedule.
The United States now faces the prospect of losing its measles elimination status, which it first achieved in 2000. Under the Pan American Health Organization framework, a country loses elimination status if continuous transmission of the same measles virus lineage persists for 12 months or more. Scientists have confirmed the same measles strain circulating in Texas, New Mexico, Utah, Arizona, South Carolina, Canada, Mexico, and several other North American countries. International health authorities are expected to meet in April to determine whether the United States has formally lost its measles-free designation, with many experts predicting that outcome is likely.
In a controversial statement on January 20, CDC Principal Deputy Director Ralph Abraham dismissed concerns about potentially losing elimination status, calling it simply the cost of doing business given porous borders and international travel. Abraham added that while the agency is helping states contain outbreaks, some transmission is occurring within communities where parents have chosen not to vaccinate their children, characterizing that as personal freedom. The American Academy of Pediatrics and other major medical organizations have strongly criticized this stance, calling for renewed efforts to boost vaccination rates.
South Carolina State Epidemiologist Dr. Linda Bell warned that the Spartanburg outbreak could persist for weeks or even months if protective behaviors do not change. As of the most recent update, 485 people remained in quarantine and 10 in isolation, with the latest quarantine period extending through February 14. The state health department has been issuing updates twice weekly as new cases continue to emerge from schools, churches, and other community gathering places in the affected region.
The broader implications of the crisis extend beyond the immediate outbreak. The Region of the Americas, including both the United States and Canada, already lost its measles elimination status in November 2025 after Canada recorded more than 5,000 cases over a 12-month period. Public health experts warn that without a significant reversal in vaccination trends and a stronger federal response, the United States risks returning to an era when measles was a common childhood illness, threatening the health of millions of unprotected individuals and potentially overwhelming local healthcare systems.
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