By Michelle Crouch
Co-published with The Charlotte Ledger
Measles, once considered eliminated in the U.S., is back in a big way.
Driven by declining vaccine rates and growing vaccine hesitancy, the United States experienced its largest number of measles cases in decades in 2025, with 2,242 cases reported across the country and outbreaks in Texas, New Mexico, Utah and South Carolina.
In North Carolina, seven cases have been confirmed since early December. Most are linked to a fast-spreading outbreak in Spartanburg, S.C., near the state border, where more than 430 cases have been reported.
Measles was also detected on Jan. 12 in Charlotte-area wastewater samples. It’s a sign the virus may be circulating in one of the state’s most populated metro areas, although no cases have been confirmed.
The North Carolina Department of Health and Human Services recently launched a dashboard that will be updated twice a week with new information about cases and sites where people could have been exposed. The state’s hospitals, clinicians and infectious disease experts are bracing for more infections, said David Wohl, a professor of medicine in the division of infectious disease at UNC Chapel Hill.
“It’s not a matter of if, it’s when,” he said. “This virus doesn’t care about state lines, and the outbreak in South Carolina is growing really at a rapid clip. We are going to get more cases and have to deal more and more with what to do about measles in North Carolina.”
Here are 10 things you need to know about measles as cases rise:
1. Measles spreads shockingly easily
Measles is one of the most contagious diseases in the world. Each infected person typically infects 12 to 18 unvaccinated others. It’s about 12 times more contagious than influenza, six times as contagious as Ebola, and three times as contagious as the original COVID-19 virus.
The disease is so highly infectious “that you can actually get it if the person with measles was in the room two hours before you entered,” said Amina Ahmed, chief medical director of pediatric infectious diseases at Atrium Health Levine Children’s Hospital in Charlotte. “Given how contagious it is, you need a very high percentage of the population to be immune for it not to spread like wildfire.” (That number — called herd immunity — is 95 percent. Read more about herd immunity below.)
2. The measles vaccine is by far the best way to protect yourself
The measles vaccine is safe, effective and usually protects for life, with few side effects, Ahmed said.
In the U.S., the measles vaccine is part of a combination shot: either the MMR (which covers measles, mumps and rubella) or the MMRV, which adds chickenpox to the mix. There is no standalone measles shot.
One dose of measles vaccine is 93% effective, and a two-dose regimen is 97% effective at preventing infection, according to the Centers for Disease Control and Prevention.
Unlike the COVID shot — which helps keep you from a serious case that can land you in the hospital but may not completely protect you from getting sick — the measles vaccine “is like a force field” that blocks you from getting infected in the first place, Wohl said.
Federal health officials recommend getting the first dose at between ages 12 months and 15 months and the second dose between ages 4 years and 6 years. If you’re unvaccinated, you can request the shot at any time.
You can get the vaccine from your health care provider or your local health department.
3. Yes, measles really is that dangerous
People who have never seen measles may think it’s a mild childhood disease, but it can have devastating consequences, Wohl and Ahmed said.
About 1 in 5 unvaccinated people in the U.S. who contract measles have to be hospitalized, with an even higher risk in children younger than age 5, according to the National Foundation of Infectious Diseases.
In addition, about one out of every 1,000 people with measles will develop brain swelling that can cause convulsions, deafness or permanent intellectual disability. One to three of every 1,000 will die, even with the best care.
And measles can delete your immune system’s memory of how to fight other types of germs, Ahmed said.
Doctors call it “immune amnesia,” and it leaves you more vulnerable to serious consequences other infections long after the measles rash fades. Recent research estimates that, historically, this immune deficiency contributed to increased childhood mortality from other diseases.
4. Measles may look like the flu or COVID at first
The rash that everyone associates with measles doesn’t appear right away, so it can be easy to mistake an early case of measles for the flu or another respiratory virus.
Symptoms typically appear 10 to 14 days after exposure and include a high fever, cough, runny nose and red, watery eyes. Some patients develop small white spots inside the mouth on day two or three, Wohl said, but they can be tough for non-medical providers to identify.
The characteristic measles rash usually emerges three to five days after the first symptoms, starting on the face or forehead and working its way down, Wohl said. “It’s not something you see and say ‘I noticed it on my leg,’” he said.
There’s no early test for measles, Ahmed said. The tests are designed to work after the rash appears.
5. Most vaccinated adults don’t need a measles booster
Because the MMR vaccine prevents measles for life, anyone who got two doses of the vaccine doesn’t need a booster,according to the CDC.
If you were vaccinated before 1989, when health officials recommended just one dose, you are still 93 percent protected. However, the agency recommends a booster if:
- You were vaccinated between 1963 and 1967 and received a “killed” version of the vaccine that proved to be ineffective.
- You are a health care worker, college student or an international traveler, or are otherwise at high risk of exposure.
- You are a close contact of someone immunocompromised or you have HIV.
- Measles is circulating in your community.
NCDHHS offers a measles immunity checker tool that can help you work through some of these factors. (Note: Adults born before 1957 are presumed to have natural immunity, because measles was so widespread before the vaccine was introduced, that they don’t need a booster, either.)
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6. Verifying your vaccination status might take some digging
If you were vaccinated before the late 2000s, when electronic medical records became common, finding your records may be a challenge. Here are some places to check:
- Check your state vaccination registry: If you grew up in North Carolina, you can ask your health care provider to check the state’s vaccination registry. You can also reach out to the health department in the county where you resided. However, you might not be in the registry even if you’re fully vaccinated, because the system didn’t launch until the 2005, and the state doesn’t require physicians to enter immunizations in the registry, NCDHHS said. Most other states maintain similar registries.
- Ask your parents: They may still have an old vaccination card. You can check baby books and camp records.
- Check with previous health care providers and schools: Many keep vaccination records indefinitely. You can also check military records.
7. If you’re unsure of your vaccination status, you may want to get a booster
Some people are asking their doctors for a blood test, known as a titer test, to measure antibodies.
However, health officials typically don’t recommend the tests for vaccinated adults, because a low antibody level doesn’t necessarily mean you’re not protected. The test doesn’t measure the other parts of your immune system (such as B cells and T cells) that respond if you’re exposed to measles, Wohl explained.
If you can’t determine your vaccination status, there is no harm in getting a booster, even if you already had two doses, Wohl and Ahmed said.
“If you have any question about it, get the vaccine. Then you don’t have to worry,” Wohl said.
8. You can look up the vaccination rates in your community
Because measles is so contagious, about 95 percent of people in an area need to be immunized to keep it from spreading. That’s what’s known as “herd immunity” — when enough people are protected that the virus runs out of targets.
While North Carolina is close to that threshold with a 94.2 percent overall statewide vaccination rate, the problem is that many smaller areas within the state have much lower rates, Wohl said.
To see what’s happening in your neck of the woods, you can look up the estimated measles vaccination rates for the schools in your area. North Carolina has published the rate for every elementary school in the state, broken down by grade level.
9. There is no cure for measles
There are no antivirals or other drugs for measles. Treatment focuses on managing the symptoms with fever reducers, plenty of fluids and rest.
While vitamin A supplements are sometimes recommended to reduce the severity of the illness, the CDC emphasizes that they do not prevent infection and are not a substitute for vaccination.
If you’ve been recently exposed to the measles and aren’t immune, getting the vaccine within 72 hours of exposure or receiving a dose of immunoglobulin can sometimes help prevent the virus from taking hold.
Parents should be on alert for a worsening cough (pneumonia is the most common complication from measles) and/or severe headache and sensitivity to light, which could indicate development of a type of brain inflammation called encephalitis.
10. The U.S. is in danger of losing its measles elimination status
With so many outbreaks, health experts believe the United States could soon lose its measles elimination status. That status, which the U.S. received in 2000, confirms that a country no longer has continuous transmission of measles.
Losing it isn’t just a blow to American pride; it could mean travel bans or other countries requiring proof of vaccination from American visitors, Wohl said. More importantly, it represents a major setback in the collective effort to keep preventable diseases at bay.
“The reason we are seeing measles right now is not because of a mutation of the virus. The measles vaccine is still safe and effective. Nothing is broken,” Wohl said. “The only reason we are having this problem right now is that fewer people are getting vaccinated.”
This article is part of a partnership between The Charlotte Ledger and North Carolina Health News to produce original health care reporting. You can support this effort with a tax-deductible donation.
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