SPARTANBURG COUNTY, S.C. — In mid-January, Tim Smith addressed an almost empty room at a Spartanburg County school board meeting, recounting a harrowing experience: his fully vaccinated wife contracting measles after a case appeared in her classroom. “My wife was throwing up,” Smith said, describing her rapid decline. “She had diarrhea. She couldn’t breathe. All for what? This is — it’s absolute insanity.” His story, relayed on Facebook, reached Dr. Leigh Bragg, a pediatrician working in a neighboring county, but only after Smith took the unusual step of publicly sharing his ordeal.
Bragg hadn’t been aware of any measles hospitalizations in South Carolina. Part of the reason, she soon discovered, is that the state doesn’t require hospitals to report admissions for measles, leaving doctors to rely on fragmented information and professional networks to understand the true scope of the outbreak. With 973 confirmed cases as of February 22, 2026, South Carolina is experiencing its largest measles outbreak in decades, yet state data shows only 20 measles-related hospitalizations – roughly 2% of cases – since the outbreak was first confirmed on October 2, 2025.
That figure is dramatically lower than estimates from the Centers for Disease Control and Prevention, which suggests about 20% of measles cases typically require hospitalization. “A hospitalization rate at 2% is ludicrous,” said Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia, who previously served on the CDC’s immunization advisory committee. “It’s vast underreporting. Measles makes you sick.” ProPublica reported that the state’s low reporting rate raises concerns about the accuracy of the public health picture.
The lack of mandatory reporting isn’t unique to South Carolina. ProPublica’s investigation found that most states in the South do not require hospitals to report measles-related admissions. Alabama and Virginia are exceptions, though Virginia does not publicly release the data. North Carolina and Texas also rely on case investigations to identify hospitalizations, rather than requiring direct reporting. In contrast, Texas reported 99 hospitalizations out of 762 cases during its 2023 outbreak – a rate of approximately 13%.
The South Carolina Department of Public Health (DPH) is urging hospitals to voluntarily report admissions and seven have done so, according to Linda Bell, the state epidemiologist. However, the state lacks the authority to compel reporting. Bell explained that the agency hasn’t considered adding hospitalizations to the mandatory reporting list because its primary focus is tracking disease transmission, not complications. “We don’t suppose we are getting an accurate picture at all of how these illnesses are impacting our community,” Bell said at a recent briefing. The DPH has activated mobile health units to offer free MMR vaccines to unvaccinated individuals.
The absence of real-time hospitalization data hinders doctors’ ability to advise patients, particularly those hesitant about vaccination. Dr. Martha Edwards, president of the South Carolina chapter of the American Academy of Pediatrics, noted that the lack of information makes it difficult to communicate the severity of the illness. “It’s a very big disservice to the public not reporting complications we are seeing in hospitals or even ERs,” said Dr. Bragg. “Measles isn’t just a cold.” Complications can include pneumonia, dehydration, and encephalitis, a potentially life-threatening brain swelling.
The situation is further complicated by political pressures and a growing segment of vaccine-wary patients. A pending bill in the state legislature seeks to prevent hospitals and doctors from questioning a patient’s right to refuse treatment, a measure critics say could further discourage open communication about vaccine risks and benefits. The state’s Republican governor, Henry McMaster, has largely framed his response to the outbreak around the concept of medical freedom.
Dr. Danielle Scheurer, chief quality officer at the Medical University of South Carolina, suggested that hospitals likely wouldn’t object to mandatory reporting if the state changed its rules. “Transparency here is going to support other states,” Scheurer said. “The more transparent we are about all of our statistics, the better off any other state is going to be in preparing.”
As of mid-February, Spartanburg Regional Healthcare System reported four measles hospitalizations. Prisma Health, which owns eight acute-care hospitals in the Upstate, stated it is “reporting everything we are supposed to report” but declined to disclose the number of measles patients hospitalized at its facilities. The outbreak has also exposed individuals to the virus in unexpected locations, including the labor and delivery unit of a hospital, BMW and Michelin manufacturing plants, and a youth conference in Kentucky. Healthbeat reported on these exposure locations earlier this month.
Dr. Bragg continues to wear pro-vaccine T-shirts, despite the increasing polarization surrounding the issue. “Even a 10-year-old can advise you how polarizing vaccines have become,” she said. But she remains committed to educating patients, even as she navigates a system where critical data remains obscured, and the full impact of the outbreak remains unclear.
