US measles outbreak ‘remains hot’, former CDC official says
Measles cases in South Carolina jumped to 933 on Feb. 10, including 13 additional infections in the past week, according to state health data.
ASHEVILLE, N.C. — Around 2 a.m., 7-year-old twin brothers arrived at Mission Hospital in Asheville. Both had fever, cough, rash, red eyes and cold symptoms.
The boys sat in one waiting room, then another. Two hours and 20 minutes passed before the two were isolated, according to Centers for Medicare and Medicaid Services records obtained by KFF Health News. Then another two hours passed.
When the sun rose, the emergency room doctor called the state epidemiologist and explained the symptoms. Public health officials told him to lock the children in the hospital and isolate them. Shortly after that phone call, the patients received their diagnosis.
It was measles.
Hospital staff instructed the father on how to isolate his family and sent him home.
Federal investigators determined that at least 26 people contracted the virus at the hospital that January day. CMS health inspectors investigated the measles infection and other failures in care and concluded that the twins’ symptoms should have triggered isolation procedures that Mission Hospital staff had been trained on seven months earlier. CMS has designated the mission “imminent jeopardy” for the exposure and other unrelated issues, one of the toughest sanctions a hospital can face, and has threatened to withdraw federal funds if the problems are not remedied.
A Mission spokeswoman said its staff is trained to deal with airborne diseases and follows federal regulations.
As U.S. hospitals face an increased risk of measles encounters and pressure to detect measles quickly, health care workers face an unusual barrier: many people don’t know what measles looks like.
“There’s a term called ‘measles-like,’ meaning measles-like, and there are a lot of viruses that can cause a rash like childhood measles,” said Teresa Flynn, a pediatrician in Raleigh and president of the North Carolina Pediatric Society. In her 30 years in the medical field, she said she has never seen a case of measles.
More than 20 cases have been reported in North Carolina since mid-December, and more than 3,000 people have been infected nationwide since early 2025.
Children in areas with low immunization coverage are particularly vulnerable to outbreaks, prompting public health campaigns to promote measles vaccination. CMS Administrator Mehmet Oz encouraged vaccination in a Feb. 8 CNN interview.
If you receive two doses of the measles, mumps, and rubella vaccine, you have a 3% chance of contracting the virus after infection. According to the CDC, unvaccinated people have a 90% chance of getting infected. It may take one to two weeks for a person infected with measles to show symptoms.
But the Trump administration has spent the past year sowing doubts about the vaccine’s effectiveness. Health and Human Services Secretary Robert F. Kennedy Jr. was a longtime anti-vaccine activist even before he took office, and under his leadership the Centers for Disease Control and Prevention reduced the number of vaccinations it recommended for children.
After last year’s measles outbreak in West Texas, President Kennedy publicly recommended unconventional and unproven treatments for the virus, including steroids, antibiotics, and cod liver oil.
Infectious disease experts and doctors said federal policies are forcing health care workers to rely on their own experience and guidance from state public health systems to combat the disease, which many people may encounter for the first time and can initially have symptoms similar to the common cold.
“As measles spreads, all of us have increased our ability to recognize suspected measles and respond immediately,” Flynn said.
three C’s
Officially, the United States has maintained “measles-free status” since 2000, meaning the country has avoided significant spread of the virus. With outbreaks continuing in Texas, Arizona, Utah, and now South Carolina, the nation is on track to lose its designation by the end of the year. The independently adopted regulations tie eradication status to a lack of continued spread of the virus lasting 12 months.
One South Carolina county, an hour’s drive from Asheville, has seen more than 900 cases in the outbreak, more than Texas reported in all of 2025.
Symptoms of measles, a virus that attacks the lungs and respiratory tract, include fever, cough, patchy rash, and red, watery eyes. Researchers consider measles one of the most contagious diseases, and the virus can remain active for up to two hours after an infected person leaves the room.
It can be fatal, with 1 to 3 deaths per 1,000 cases in children.
In 2025, two children in Texas and one adult in New Mexico died from measles.
The CDC provides a detailed overview of measles diagnosis on its website, along with tracking data. State public health agencies and some counties have developed dashboards to track outbreaks of the disease in hospitals, schools, grocery stores, airports and more. The large hospital system developed a staff training protocol last year and shared it with local clinics.
The guidance said to look for the three C’s: cough, coryza (cold symptoms), and conjunctivitis (fluid eyes). HCA Healthcare, which owns Mission Hospital, trained Mission staff on the three Cs early last year, according to CMS inspection records. In addition to failing to quickly isolate the twin patients, mission staff did not have a designated area for patients with respiratory symptoms, federal inspectors found.
The CDC recommends that health care workers immediately place patients with measles or other suspicious symptoms in special isolation rooms with controlled air flow. CMS records show Mission patients were separated from other patients only by plastic partitions.
Mission spokeswoman Nancy Lindell said the hospital is equipped and staffed to manage airborne diseases such as measles.
“Our hospitals are working with state and federal health officials to be proactive and are following guidance provided by the CDC,” Dr. Lindell said.
(Dogwood Health Trust, a private foundation created as part of HCA’s acquisition of Mission Health, helps fund reporting for KFF Health News.)
Patsy Stinchfield, a nurse and former president of the National Foundation for Infectious Diseases, said most clinics and hospitals in the United States have never experienced a case of measles. He said CMS’ immediate danger penalty for the mission was “extreme” considering the virus is so difficult to identify.
“Right now, in the middle of winter, measles looks like any other viral respiratory infection that affects children,” Stinchfield said.
Health care workers and infectious disease experts say the CDC has had limited communication with clinics over the past year about responding to the outbreak. A KFF Health News investigation found that West Texas health officials failed to communicate with CDC scientists during a measles surge last February and March, a disconnect that began shortly after Trump took office.
“We’re certainly not feeling any support or guidance from the CDC at this point,” said Brigette Fogleman, a pediatrician at Asheville Children’s Medical Center. Staff at the center have come up with unique ways to prevent the virus. That means testing patients on the phone or in their cars before their visit.
In response to a question about how the CDC is supporting health care providers during a measles resurgence, Spokesman Andrew Nixon said that “state and local health officials are leading the investigation of measles cases and outbreaks” and that the CDC is providing assistance “as requested.” He pointed to a number of guides and simulation tools that authorities have developed as the virus spreads.
Jennifer Nuzzo, an epidemiologist and director of the Brown University Pandemic Center, acknowledged that diagnosing measles is a major challenge and emphasized the importance of collaboration among public health agencies to overcome this challenge.
Stinchfield blamed the measles outbreak on poor communication by CDC leaders to clinics and the general public: no advertising on buses, no social media campaigns, and a lack of urgency. “At a time when measles cases are at their highest level in 30 years, we should expect more measles cases from the federal government,” Stinchfield said. “And I think that’s harming children and causing an exorbitant amount of effort and expense that just doesn’t apply to health care right now.”
North Carolina braces for increase in measles cases
In Buncombe County, North Carolina, where Asheville and Mission Hospital is located, health officials had counted seven measles cases by mid-February and expected more, according to state epidemiologist Zach Moore. It’s unclear how many of those cases are related to the mission’s revelations.
“We’re preparing for a future where we follow a trajectory similar to South Carolina’s, where we see a gradual buildup of cases and then all of a sudden we reach some kind of tipping point and we see an explosion of cases and we see it spread across the state,” Moore said.
Fogleman, who is also a pediatrician, and Buncombe Health Department Director Jennifer Mullendore spoke during a recent Facebook livestream hosted by the county, urging families to get their children vaccinated, debunking vaccine misinformation and updating parents on local case numbers.
A few days ago, a local private school had quarantined about 100 students after being infected. Only 41% of students have been vaccinated, according to state data.
At Fogleman’s clinic, parents are asked to wait in the car with their child, and a staff member comes out and tests them there. Some parents are resistant to vaccination, she said, noting that federal recommendations for measles vaccines for children under 4 have recently weakened.
President Kennedy handpicked the commissioners who made these recommendations, some of whom had spread medical misinformation in the past.
One parent recently told a nurse, “It’s just measles. It’s not going to kill anyone,” Fogleman said.
That’s not true, her team needs an explanation.
While clinics are parking families in parking lots trying to determine whether symptoms indicate a dangerous virus, Fogleman said it’s difficult to get the message across, especially when national disease control officials have not conducted widespread information campaigns about the risks of measles or the vaccine’s ability to almost completely prevent it.
“You can’t change the past,” Fogleman said. “All we can do is educate and try to move forward.”
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