Feb 22, 2026
3 min read
In mid-January, at a school board meeting in Spartanburg County, South Carolina, a nondescript man in khakis and a button-down shirt approached a wooden lectern.Most of the audience seats were empty.That man, Tim Smith, was the only person signed up to speak during public comment.He had five minutes.
This story was originally published by ProPublica, a nonprofit news organization dedicated to investigating abuses of power.Sign up to get top stories as soon as they're published.
In mid-January, a gray-haired man in a button-down shirt walked up to a wooden chair at a school board meeting in Spartanburg County, South Carolina.Most of the seats in the audience were empty.That man, Tim Smith, was the only person who signed up to speak during public comment.He had five minutes.
"I'm sure you both have a great Christmas and New Year," he began."Sorry, I can't say that."
His wife is an assistant teacher at a public elementary school in the province, the epicenter of the state's historic measles outbreak, and just before winter break she received the announcement that a child in her class had measles.Since his wife was fully vaccinated, he wasn't worried.
Then he got sick.and sicker.He was tested for measles and tested positive for shock.Apparently it was one of those very rare sudden infections.
In fear, they took him to the hospital that night."My wife was throwing up," Smith said at the conference."He had diarrhea. He couldn't breathe. Why? This - it's absolutely crazy."
Dr.Leigh Bragg, a pediatrician who works in a remote county, didn't even know that someone in South Carolina had been hospitalized with measles until she logged onto Facebook a short time later and saw someone forwarding the distraught husband's comments.
Part of the reason Bragg didn't know is that South Carolina doesn't require hospitals to report measles admissions, potentially hiding the severity of the illness.In the absence of mandatory reporting rules, she and other doctors are often left to rely on hearsay, their guts from colleagues and the scraps of information the state public health agency can gather and is willing to share.
With 973 reported cases, the measles outbreak in South Carolina has become the nation's largest since the virus was eliminated in the US 25 years ago.Still, since state health officials first confirmed the outbreak on Oct. 2, state hospitals have reported only 20 measles-related admissions, or about 2% of cases.Some infectious disease experts say the real number is likely much higher.
Hospitalization rates can vary greatly depending on where the measles outbreak occurs and the person infected.However, the Centers for Disease Control and Prevention estimates that about 20 percent of measles cases result in hospitalization.
"The hospitalization rate of 2% is astonishing," said Dr. Paul Offit, director of the Center for Vaccine Education and an infectious disease physician at the Children's Hospital of Philadelphia who served on the Centers for Disease Control and Prevention's vaccination advisory committee.
"This is a huge misconception," Offit said, "Measles makes you sick."
Measles is one of the most contagious viruses.So far in 2026, its cases have been reported in almost half the states.However, it is largely left up to each state to decide how much infectious disease reporting is required.
"We don't think we're getting an accurate picture of how these diseases are affecting our community," South Carolina State Epidemiologist Linda Bell said at a briefing last month.
Bell said the state Department of Public Health encourages hospitals to report measles-related hospitalizations, and seven hospitals have done so.Rather than tracking problems, we understand disease prevalence, frequency, and distribution.
So without real-time data proving how many South Carolinians are hospitalized with measles, doctors like Bragg are counseling patients, including vaccine-resistant parents.Serious complications include pneumonia, dehydration and encephalitis, a life-threatening inflammation of the brain.
"It's a huge disservice to the public that we're not reporting the complications we're seeing in hospitals or emergency rooms," Bragg said."Measles is not just a cold."
ProPublica contacted state health agencies in the South and found that most do not require hospitals to report measles cases.Alabama does.So does Virginia, although it does not release that data publicly.South Carolina, North Carolina and Texas do not require hospital reporting, but epidemiologists can identify it during investigations.
During the measles outbreak in Texas last year, 99 people were hospitalized out of 762 cases.
That's about 13 percent, compared to the 2 percent reported in South Carolina.
Real-time hospital data can show where resources will be needed and help hospitals prepare for an influx of patients.
When ProPublica asked hospitals in the Upstate, the northwestern quadrant of South Carolina where the outbreak is concentrated, whether they had reported their measles-related hospitalizations to the state and how many patients they had treated, few responded.Only Spartanburg Regional Health System shared the total.(In mid-February the number was four.)
A spokeswoman for Prisma Health, a Greenville-based nonprofit with eight acute care hospitals upstate, said its hospitals are "reporting everything we think we need to report."He would not say how many measles patients Prisma admitted to the hospital or how many the system told the state.
Doctors in the Dark
Bragg, who is board certified in pediatrics and pediatric infectious diseases, works in the South Carolina area where the disease is concentrated.It has one of the lowest student vaccination rates in the state, with a high religious profile.Recently, she met with a parent who had questions about recommended vaccinations for a 1-year-old child, including the first dose of the measles vaccine.
"We're in a 'measles house,'" Berg thought.
He then launched into a 30-minute discussion about the vaccine's extreme safety and 97% lifetime effectiveness with two doses.He explained that 95% of people in South Carolina who have measles attacks are not vaccinated.It eliminates the historical risks of measles complications.
However, Bragg could not tell his parents how badly their friends from South Carolina were suffering from an epidemic that sickened those around them.
He heard about pneumonia, ICU admissions - including a case of encephalitis.But he could not confirm or find the child, much less the patient.(Bell later said that the federal Department of Health was aware of cases of encephalitis in children, but he did not release the number of patients and their outcomes.)
As president of the South Carolina chapter of the American Academy of Pediatrics, Dr. Martha Edwards has been communicating with doctors in the state.
Explaining the risk of serious illness is even more important because few parents today have seen measles up close.So are many doctors.
At the beginning of his career, Dr.William Schaffner, a professor at Vanderbilt University who specializes in infectious disease prevention, worked with the CDC to implement the measles vaccine.When he tells medical students today that in the 1960s, before the measles vaccine was available, 400 to 500 children died each year from measles and its complications, "they are amazed."
"If the severity of the disease can't be determined -- if it can't be detected -- then it can't be properly communicated to the public," Schaffner said."And the public can get the false impression that measles is milder than it really is."
At the briefing, Dr. Robin Lacroix, an infectious disease physician at Prism, said the organization's doctors "saw the full spectrum of acute and post-measles infections that afflicted these children. They are sick." The children became listless, suffering from blotchy rashes, convulsions and coughing fits, dehydration and secondary infections, including pneumonia.
Measles infections are especially dangerous for babies who cannot yet be vaccinated and young children who have not received a second dose.Infections during pregnancy also pose serious risks to mothers who are not vaccinated or immune, including miscarriage and a tenfold increase in pneumonia deaths.Mothers can pass the virus to their babies, "which can be catastrophic," said Dr.Kendreia Dickens-Carr, Prisma gynecologist.
More than 900 confirmed cases of measles will be reported nationwide in 2026, compared to 2,281 in all of 2025.Most cases this year have been in South Carolina, but Florida has reported 63 cases and neighboring North Carolina 15, including one hospitalization.
"We really have to figure out how to report this because viruses and bacteria don't respect national lines," said Dr. Annie Andrews, a pediatrician who is running for the U.S. Senate.as a Democrat from South Carolina.
The most advanced pediatric care in the state is provided at the Charleston campus of the Medical University of South Carolina, a few hours upstate.So far, doctors say, the local children's hospital has not seen a measles patient.
Dr. Danielle Scheurer, MUSC's director of quality, praised the state's low hospitalization rates and said she doubted hospitals would object to mandatory reporting of measles-related hospitalizations if state health agencies change their regulations.
"The transparency here will help other states," Scheuer said."The more transparent we are about all of our statistics, the better prepared every other state will be."
Across South Carolina, large health systems have bought up local hospitals and doctor's offices.With that control, they can influence what doctors and hospital staff say publicly, especially when it comes to potentially controversial topics like vaccines.At the same time, they face pressure from Republican lawmakers and a growing number of vaccine-fearing patients.
The result is often very limited information sharing or lack thereof.
"There's an unprecedented level of caution," Edwards said.He knows that hospitals don't want to hurt patients who are skeptical about vaccinations.Bragg agreed, but said that since 93% of the state's students have been vaccinated, he is concerned that clinics are "giving it to a minority."
The pending legislative draft It is supported by several state representatives of Spartanburg County. It seeks to prevent hospitals and doctors from questioning or interfering "in any way" with the right of patients to refuse treatment or vaccines during the 2019 coronavirus disease. The bill confirms that the federal agency has cooperated with medical organizations and others.willing to be vaccinated.
Republican Governor Henry McMaster and the leading GOP candidates to replace him have largely framed their responses to the measles outbreak around the idea of medical freedom, particularly when discussing vaccination mandates.
Andrews, a pediatrician running for the U.S. Senate, said she has experienced the "disturbing effect" the GOP's "anti-science movements" have had on health systems and individual doctors."If you speak out, you risk being censored," Andrews said. "If you speak out, you risk losing your job. So everyone's just trying to keep their heads down and do what's best for their patients."
Bragg is among the dwindling ranks of doctors who run their own practices.He's free to post whatever he wants on social media and wear a pro-vaccination T-shirt that reads, "Do I get it? Neither can I because I got the shot."
But one day recently, his 10-year-old son asked why he insisted on wearing the shirt."Even a 10-year-old can tell you how destructive vaccines are," Bragg said.Despite that, he continued to wear them.
