Researchers at a tertiary care center in South Carolina recently reported the details of an outbreak of measles that occurred between October 2025 and April 2026 (Richardson KM, Elkes J, Nieuwoudt C, et al. A Regional Measles Outbreak — South Carolina, 2025-2026. NEJM 2026 Aug 13;395(7):717-719). A total of 997 cases were reported statewide, with the highest concentration in Spartanburg County, where measles-mumps-rubella (MMR) vaccine coverage was 88.9%. Researchers reported several features of the outbreak:
- Twenty adults were affected.
- Most (> 73%) of the patients were unvaccinated. The most identified transmission location was the home.
- The most common symptoms were fever, cough or other respiratory symptoms, and a characteristic rash.
- Koplik spots were more frequent than has generally been reported in patients with measles, since Koplik spots are typically resolved by the time a patient develops fever and a rash.
- More than 25% of patients had gastrointestinal symptoms.
- Some patients had rash-associated itching, which is atypical for measles.
- Thirteen patients were hospitalized with dehydration and pneumonia; 10 were children and three were adults.
- Two patients had encephalitis, resulting in prolonged hospitalizations.
- Twenty-four patients were later determined to have immune amnesia caused by natural measles infection. The cases presented as otitis media, sinusitis and bacterial pneumonia.
Measles is a preventable illness.
Contributed by: Paul A. Offit, MD
Researchers at a tertiary care center in South Carolina recently reported the details of an outbreak of measles that occurred between October 2025 and April 2026 (Richardson KM, Elkes J, Nieuwoudt C, et al. A Regional Measles Outbreak — South Carolina, 2025-2026. NEJM 2026 Aug 13;395(7):717-719). A total of 997 cases were reported statewide, with the highest concentration in Spartanburg County, where measles-mumps-rubella (MMR) vaccine coverage was 88.9%. Researchers reported several features of the outbreak:
- Twenty adults were affected.
- Most (> 73%) of the patients were unvaccinated. The most identified transmission location was the home.
- The most common symptoms were fever, cough or other respiratory symptoms, and a characteristic rash.
- Koplik spots were more frequent than has generally been reported in patients with measles, since Koplik spots are typically resolved by the time a patient develops fever and a rash.
- More than 25% of patients had gastrointestinal symptoms.
- Some patients had rash-associated itching, which is atypical for measles.
- Thirteen patients were hospitalized with dehydration and pneumonia; 10 were children and three were adults.
- Two patients had encephalitis, resulting in prolonged hospitalizations.
- Twenty-four patients were later determined to have immune amnesia caused by natural measles infection. The cases presented as otitis media, sinusitis and bacterial pneumonia.
Measles is a preventable illness.
Contributed by: Paul A. Offit, MD