North Carolina has reported more measles cases since December than it did between 2014 and 2025, with patients largely testing positive in parts of the state where vaccination rates are slumping.
Speaking to reporters on a webinar Wednesday, Zack Moore, the N.C. Department of Health and Human Service's chief epidemiologist, linked many of the cases with an ongoing outbreak around Spartanburg, South Carolina. That outbreak has resulted in more than 500 people testing positive for the highly infectious disease.
"Embers from that fire in the South Carolina outbreak have started landing here in North Carolina, and unfortunately we have a lot of dry tinder, meaning that we have communities with low vaccination coverage rates," Moore said on a webinar hosted by the Better Cities Health Coalition.
Of the 11 people who have tested positive for measles so far in North Carolina, nine are located in western North Carolina. This week, a pair of people tested positive in Cabarrus County, easily the furthest east.
Now, Moore and other epidemiologists are warning that the disease is likely being transmitted among community members, particularly because the western North Carolina counties where cases have been found are estimated to have vaccination rates among children below the 95% threshold that experts say is necessary to halt the spread of measles.
In Buncombe County, which has six cases, DHHS estimates about 90% of people are vaccinated against measles. Polk County, which has two cases, is estimated to have an 89% vaccination rate. DHHS estimates that both Cabarrus County (two cases) and Rutherford County (one case) have 94% vaccination rates.
"We have a lot of communities that are very susceptible, if a measles case lands there, to spread. And that is unfortunately what we're starting to see now in North Carolina," Moore said.
In Polk and neighboring Henderson counties, for instance, DHHS estimates that every child attends elementary school goes to class in a building where the vaccination rate is below the 95% threshold.
In Buncombe County, which has the most cases so far, 87% of elementary school kids are students in a building below that rate that offers protection to the whole community.
The United States reported more than 2,200 measles cases in 2025, its most in decades. Many of those cases — 762 — were linked to an outbreak in West Texas that resulted in 99 hospitalizations and three deaths, including two school-aged children.
Katherine Wells, the city of Lubbock's director of public health, said she hadn't responded to measles until that outbreak, which she said found a foothold in pockets of the community where vaccination rates had fallen significantly.
"We need to recognize that outbreaks like this are not inevitable, but unfortunately now I think they are predictable. When vaccination rates fall, measles will find those gaps," Wells said.
Vaccinating against measles
Measles is highly contagious, the Centers for Disease Control and Prevention says, with people able to contract the airborne virus that causes the illness even two hours after someone carrying it has coughed or sneezed in a room.
"Measles is basically the most infectious disease that we know of, so it can really be hard to control," Moore said.
To that end, public health officials have been conducting contact tracing to figure out who may have been exposed to measles and urge them to quarantine to stop the disease from spreading. DHHS and local health agencies are also working, Moore said, to address vaccine hesitancy.
It takes two doses of the measles, mumps and rubella (MMR) vaccine to be considered completely vaccinated against measles, with the first administered when a child is between 12 and 15 months old.
The second is typically administered when a child is between four and six years old. When someone has received both shots, it is considered 97% effective against measles.
"It doesn't get a whole lot better than that," Moore said.
Measles is a highly contagious disease that the CDC says is particularly dangerous for children younger than five years old. The agency says that symptoms typically appear between seven and 14 days after someone is exposed to the virus.
Those symptoms include a rash, a fever that can spike to more than 104 degrees Fahrenheit, coughing and red, watery eyes.
In serious cases, measles can lead to pneumonia and brain inflammation. The disease has been considered eliminated in the United States since 2000, with rare outbreaks.
Chrissie Juliano, the executive director of the Big Cities Health Coalition, warned Wednesday that increased vaccine skepticism from leaders at the U.S. Department of Health and Human Services could cause the nation to lose that elimination status, bringing a host of risks to public health.
"What took decades to build and maintain has been torn down in just a year. While the status in and of itself may or may not actually be important, it highlights a dangerous trend for the health of our children. In its place, we will continue to see more illness, more hospitalizations, more missed school and work days and less time for kids to just be kids," Juliano said.
Moore, who is a pediatric infectious disease specialist by training, said he'd never seen a case until he entered public health and investigated an outbreak. That's common, he said, for doctors who started practicing after the early 1990s, when the second dose of the MMR vaccine increased the effectiveness against stopping measles.
"Unfortunately," Moore said, "I think a lot of our providers are going to start becoming familiar with measles if the trajectory continues that we're seeing now."
