The surge in measles cases across the United States has reached alarming levels in early 2026, with the Centers for Disease Control and Prevention (CDC) reporting 416 confirmed cases in 14 states as of late January. This sharp increase follows a record-breaking 2025, when more than 2,200 cases were documented nationwide, marking the highest total since 1991.
The ongoing outbreaks, particularly a massive one in South Carolina that has climbed to 700 cases, highlight a troubling reversal of decades of progress in controlling this highly contagious virus. Once declared eliminated in the country in 2000, measles now threatens to return as a persistent public health challenge due to declining vaccination rates and shifting policy discussions.
The Current Surge: Numbers and Geographic Spread
The CDC’s latest data reveal that measles infections have spread rapidly in the opening weeks of 2026. South Carolina accounts for the largest share, with 338 cases reported to the CDC so far this year, representing about 81% of the national total.
The state’s Department of Public Health has tracked the outbreak to 700 cases overall, centered primarily in Spartanburg County in the Upstate region, where 95% of infections have occurred. This marks the largest measles outbreak in South Carolina in more than 30 years.
Other states reporting cases include Arizona, California, Florida, Georgia, Idaho, Kentucky, Minnesota, North Carolina, Ohio, Oregon, Utah, Virginia, and Washington. North Carolina has confirmed 12 cases in 2026, some linked to travel from South Carolina. Idaho reported two new cases this year after 14 in 2025. Utah ranks second nationally with 32 cases, tied to an outbreak along the Utah-Arizona border.
Nationwide, 86% of 2026 cases involve children and young adults under 19 years old, with 25% in children younger than 5. Hospitalization has occurred in about 2% of patients. Critically, 94% of cases are among individuals who are unvaccinated or whose vaccination status remains unknown. Only 3% involve those with one dose of the MMR vaccine, and another 3% involve those with the recommended two doses.
This pattern echoes 2025, when more than 95% of cases occurred in unvaccinated or undervaccinated people. The Texas outbreak that began in January 2025 and ended in August produced at least 762 cases, mostly in children, and resulted in two deaths, the first measles fatalities in the U.S. in a decade. Three deaths were reported nationwide last year.
Why Measles Is Surging: Declining Vaccination Coverage
The primary driver of this resurgence is clear: falling vaccination rates below the 95% threshold required for herd immunity. The CDC reports that during the 2024-2025 school year, 92.5% of kindergartners received the MMR vaccine, down from 92.7% the prior year and 95.2% in 2019-2020 before the COVID-19 pandemic disrupted routine immunizations.
Experts point to increasing vaccine hesitancy as a key factor. A CDC survey found that exemptions for school-required vaccines reached record levels last year, often due to philosophical or personal objections rather than medical reasons. Communities with lower coverage, often tight-knit groups influenced by misinformation, become vulnerable pockets where the virus spreads easily.
Measles ranks among the most contagious viruses known, capable of lingering in the air for up to two hours after an infected person leaves a space. One infected individual can spread it to 90% of unvaccinated close contacts. The MMR vaccine provides 93% effectiveness with one dose and 97% with two doses, given at 12-15 months and 4-6 years old, according to the CDC.
Infectious disease specialists express deep concern. Dr. Kristin Moffitt from Boston Children’s Hospital described the trend as alarming, attributing it directly to declining vaccination rates. Dr. Caitlin Rivers from Johns Hopkins emphasized that recent weekly case counts rival annual totals from years when measles was rare in the U.S.
Official Responses and Controversial Statements
Federal health officials have offered mixed messages amid the surge. CDC Principal Deputy Director Dr. Ralph Abraham described the potential loss of elimination status as the “cost of doing business,” linking it to international travel and porous borders, though data show imported cases remain minimal, fewer than 1% in 2026 and under 2% last year. He noted that unvaccinated communities reflect personal freedom.
Dr. Kirk Milhoan, chair of the CDC’s Advisory Committee on Immunization Practices (ACIP), suggested making vaccines for measles and polio optional, prioritizing individual autonomy and informed consent over mandates. He compared potential vaccine-preventable deaths to those from alcohol-related diseases, stating that freedom of choice must come first. These remarks drew sharp criticism from pediatricians and public health experts, who argue that such views undermine evidence-based prevention and endanger vulnerable populations, including infants too young to vaccinate and immunocompromised individuals.
The Wall Street Journal editorial board countered that unvaccinated children pose risks to others who cannot receive vaccines, stressing the need for better education rather than dismissal of serious illness. The Pan American Health Organization has scheduled a review in April 2026 to assess whether the U.S. maintains its measles elimination status, which depends on the absence of sustained local transmission for at least 12 months.
Risks and Complications of Measles
Measles begins with fever, cough, and runny nose before the characteristic rash appears. Complications include pneumonia, encephalitis (brain swelling), and subacute sclerosing panencephalitis, a rare but fatal neurological condition that can emerge years later. The virus poses the greatest danger to young children, with about 1 in 1,000 cases resulting in death and higher risks of hospitalization.
Outbreaks strain healthcare systems, as seen in South Carolina, where 485 people are in quarantine and 10 in isolation, with public exposures reported at schools, stores, fitness centers, and post offices. Mobile vaccination efforts in affected areas have seen disappointing uptake, underscoring challenges in reversing hesitancy.
Path Forward: Vaccination Remains Key
Public health authorities and experts unanimously stress that vaccination offers the most effective defense against measles. Strengthening school entry requirements, community outreach through trusted local partners, and clear messaging about the virus’s dangers could help restore coverage levels quickly, as demonstrated in past outbreaks.
The current trajectory raises questions about the resilience of the U.S. public health system. As Dr. Paul Offit from the Children’s Hospital of Philadelphia noted, vaccines have been victims of their own success; eliminating diseases like measles has reduced collective memory of their severity, allowing hesitancy to grow.
Without swift improvements in immunization rates, larger outbreaks and preventable tragedies remain likely. The resurgence serves as a stark reminder that gains in infectious disease control require sustained vigilance and broad acceptance of proven preventive measures.