Healthbeat

Medicaid provider lists promise pregnant women care that isn’t always there. A key reform is years away.

2026-09-15T17:31:06+00:00

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Medicaid is a critical healthcare safety net for millions of pregnant women: More than 40% of U.S. births are paid for by the program. Yet having Medicaid coverage is no guarantee it will be easy to find a doctor or midwife to provide care.

To find one, many women turn to their Medicaid plan’s provider directory. But getting an appointment can require navigating a gauntlet of obstacles: wrong phone numbers, and providers who aren’t actually in the network, providers who no longer practice at listed locations, and practices that aren’t accepting new patients.

Every call takes time when timely prenatal care matters.

As the country grapples with a maternal health crisis, federal investigators warn that problems with Medicaid managed care networks could be making it more difficult for pregnant women to get the care they need.

The issue has been known for more than a decade. Yet a key federal reform intended to expose “ghost providers” in Medicaid networks is still two years away.

Here’s what I found.

The Lead Signal

Medicaid’s maternal care networks may be bigger on paper than in reality.

A recent investigation by the U.S. Department of Health and Human Services Office of Inspector General warned that inaccurate Medicaid provider directories could put pregnant women at risk of delaying or missing important maternal care.

At issue: The provider list errors can make it frustratingly difficult to access care.

The OIG’s investigators examined online directories for a large sampling of OB/GYN physicians and certified nurse-midwives listed as participating in plans from the three largest insurance companies that offer Medicaid managed care plans: Centene, Elevance, and UnitedHealthcare.

These companies’ Medicaid plans covered more than 29 million people in 38 states during 2025, the investigators said.

Yet the OIG’s reviews of provider directories for the companies’ Medicaid managed care plans in Louisiana, Missouri, Nevada, New Jersey, and Washington found significant omissions and errors, including the listing of “ghost providers,” according to the OIG report released this summer.

Ghost providers is the term the OIG used to describe maternal care providers who shouldn’t have been listed in the plans’ directories because these providers weren’t participating in the networks that covered patients’ care.

“Some providers reported that they were never in-network with the plan or they practiced in a different State and did not accept out-of-State Medicaid plans,” the report said.

Investigators found that 22% of the maternal care providers Centene’s directories were not actually in-network for the Medicaid managed care plans reviewed. Listing providers who aren’t in-network also can mislead Medicaid enrollees when they are choosing between plans, the report said.

A screenshot from the HHS OIG’s report that found inaccurate Medicaid provider lists may limit patients’ access to maternal care.

Not only were the lists riddled with providers who weren’t in-network, they failed to include numerous maternal providers who were participating in the companies’ care networks, the investigators found.

And when participating providers were listed, their contact and office location information frequently was inaccurate, making it more difficult to search online for nearby providers.

“Enrollees may delay or forgo care if they experience challenges in finding an in-network provider, which can contribute to worse maternal health outcomes,” the report said.

The problem wasn’t limited to just the directories patients use.

In a companion investigation, the OIG examined the lists that plans operated by Centene, Elevance, and UnitedHealthcare submitted to state Medicaid officials to show their networks had enough providers to meet patients’ needs.

About one-quarter of the listed maternal health providers weren’t in network, despite being represented to the states that they were.

A screenshot from the OIG’s companion report that said inaccurate managed care plan lists submitted to state Medicaid officials may compromise oversight of patient access to maternal care.

None of the three companies cited in the OIG reports responded to interview and comment requests over several weeks. A spokesperson for Medicaid Health Plans of America, an industry organization whose members include the three companies, referred Healthbeat back to the companies.

Why It Matters

“Imagine sitting on the phone and trying to call to find out if they offer care in between your 15 minutes of time that you have on your lunch break,” said Tina Sherman, national director for maternal health at the advocacy group MomsRising. “It’s almost impossible. Which has been why some families end up entering prenatal care late, which also has ramifications of not getting the full scope of care that they need.”

States pay Medicaid managed care plans a set amount for each person enrolled in their coverage. The companies control costs through a variety of measures, including having a limited group of in-network health care providers who agree to accept the plan’s payment rates.

The plans are supposed to have enough providers to deliver care.

David Machledt, the director of the managed care portfolio at the National Health Law Program, said the OIG reports confirm long-standing concerns about Medicaid networks. He has worked on these issues since 2014 and said he was struck by the size of the provider discrepancies.

“It was actually bigger than what I would have expected,” said Machledt, whose nonprofit organization works to protect the rights of low income and underserved communities.

The Policy Response

Taxpayers pay Medicaid managed care plans hundreds of billions of dollars to provide care, according to the OIG.

For more than a decade, the OIG has called for greater scrutiny and oversight to ensure that Medicaid managed care plans have adequate provider networks. These federal watchdogs have pointed toward “secret shopper” surveys as a powerful oversight tool.

During secret shopper surveys, investigators pose as Medicaid enrollees or a family member and try to schedule appointments. Instead of relying on a plan’s paperwork, the surveys test how easy it is for patients to get care.

In 2024, a Medicaid managed care access rule required states to conduct annual secret shopper surveys to assess compliance with wait times and the accuracy of provider directories. Obstetrics and gynecology is one category of care that must be assessed.

But these assessments won’t start being required nationwide until 2028.

States don’t have to wait.

At least 28 states have used secret shopper surveys in recent years, according to a policy brief published last year.

But not all of them check on maternal care networks.

State Spotlight: Missouri

Missouri’s Medicaid program, MO HealthNet, already uses secret shoppers, but not for OB/GYN care.

The state’s recent secret shopper reports have focused on the accuracy of Medicaid provider directories for primary care providers and psychiatrists.

The state plans to add OB/GYN care to its annual reviews by 2028, said Baylee Watts, a spokesperson for the Missouri Department of Social Services.

Missouri was among the five states in the Health and Human Services OIG probe that found significant inaccuracies in maternal care provider lists.

“MO HealthNet has shared the findings from the HHS OIG reports with Missouri’s contracted managed care organizations,” Watts said by email, adding that maternal health care is a priority and the department provides help to Medicaid participants needing assistance.

A new vendor system for processing provider information should also improve the reliability of directories, Watts said.

What to Watch

Machledt said states have tools to hold managed care plans accountable. The question, is whether they’ll use them.

Every wrong number and unavailable provider shifts the burden of finding care onto patients, Machledt said.

“None of the beneficiaries who are making these phone calls are being paid for the time that they’re investing,” Machledt said. And the bureaucratic hurdles, he said, can lead people to give up on seeking care.

“That can have downstream effects that are really expensive for the system, and more importantly, are consequential to that person’s health.”

Tell us your Medicaid story: Healthbeat wants to hear what’s working and not working with Medicaid. Send your tips to ayoung@healthbeat.org.

Alison Young is Healthbeat’s senior national reporter. Sign up to receive her free national newsletter here. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

School vaccination rates reveal hidden measles outbreak risks. But access depends on where you live.

2026-09-08T17:26:28+00:00

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As Pennsylvania’s growing measles outbreak gets closer to her community on the west side of the state, Amanda Clear is taking actions to assess the risks to her son Dylan.

One of her first stops: A new state website that lets anyone look up the student vaccination rates at individual Pennsylvania schools. That’s how she learned that about 86% of the students at Dylan’s school are vaccinated against measles. That’s well below the 95% that’s considered necessary to prevent an outbreak of the highly contagious virus.

“Having that data point is very informative to help parents decide what they need to do,” Clear told me. Even though Dylan, 9, is vaccinated, he has an immune disorder that makes her worry he could be at increased risk for a breakthrough infection.

But across the country, not all parents can easily get access to this information. In some states, even public health officials don’t routinely know the vaccination rates at individual schools.

That’s despite research highlighting the importance of this data nationally in assessing the risks of outbreaks of measles and other vaccine-preventable diseases within local communities.

Here’s what I found.

What the research shows

Since measles was declared eliminated in the United States in 2000, CDC scientists have found that outbreaks involving more than 50 people have largely involved close-knit communities that for varying reasons have chosen not to get vaccinated. In the past few years, declining vaccination rates have contributed to these outbreaks spreading further within communities.

A prime example was the recent record-setting measles outbreak in South Carolina, which centered on a vaccine-hesitant Ukrainian- and Russian-speaking community in Spartanburg County and resulted in 997 documented infections by the time it ended in April. Most of those infected were school-age children and teens, and measles exposures that occurred at 33 schools resulted in 874 students being asked to quarantine at home for up to 21 days.

Yet across the country, data about childhood vaccination rates is often reported at a county or state level – averaging the vaccination status of kids over a broad geographic area.

It’s an approach that obscures localized pockets of unvaccinated people who live near each other, send their children to the same schools, and often share the same cultures, traditions, and beliefs, including about whether to vaccinate their children. In some cases these clusters may indicate shared barriers to accessing healthcare, such as transportation or language.

By analyzing South Carolina’s school-level immunization data, Clemson University researchers have identified clusters of undervaccinated students and their geographic relationship to measles exposures during the state’s recent outbreak.

As Clemson research associate Emily Serman mapped the data, it revealed that the risk from measles wasn’t spread evenly across Spartanburg County, which has one of the state’s lowest childhood vaccination rates.

Inside the largest U.S. measles outbreak in decades: Records reveal spread in vaccine-hesitant community

“It’s really concentrated in the northern half of Spartanburg County,” she told Healthbeat. The Clemson team’s findings suggest that the geographic clustering of undervaccinated students may pave the way for outbreaks.

At the national level, researchers from Cornell University warned in the journal Nature Medicine last month that county-level vaccination averages can appear high enough to protect against measles spreading, yet still hide dense clusters of unvaccinated children that can fuel outbreaks.

How states compare

Knowing how many children are — and are not — vaccinated at individual schools is a powerful indicator of local outbreak risks, these researchers say. Yet whether parents, researchers, or even health departments have routine access to that information varies significantly by state.

Some states post easily accessible, up-to-date maps and data. Others require a public records request or suggest the public seek the information from school districts, which might also require a public records request. Some don’t collect it until an outbreak strikes.

Texas: Neither the public nor the state’s health department have routine access to school-level vaccination data. State law only requires school districts to report student vaccination rates at an aggregated district-wide level, said Chris Van Deusen, spokesperson for the Texas Department of State Health Services, which posts an annual report of the information it receives. The report includes some information about individual private schools. Legislation to require reporting at the individual school level failed amid concerns from some legislators that it could result in students and families being harassed.

“In the event of an outbreak in a particular school or area, public health can get campus-level data from schools,” Van Deusen said.

Minnesota: The state’s health department has posted vaccination rates for individual schools and school districts since 2014, said Ben Christianson, senior epidemiologist in the department’s vaccine preventable disease section. The department uses the data to identify at-risk areas and its public availability has helped make school and childcare leaders better aware of immunization coverage in their local areas, Christianson said. It’s also reduced the department’s workload responding to data requests, he said.

Florida: Obtaining school-level data doesn’t appear to be easy. The Florida Department of Health — which last month announced a proposed rule that would reduce the number of required school vaccines — only posts aggregated county-level data for the state’s kindergartners and seventh graders on its website.

Isabella White, the department’s press secretary, said by email that “school-specific rates are not publicly available unless requested directly from the relevant health department or school district.” Does the state collect school-level data so it can prepare for and respond to outbreaks? White wouldn’t say. Two school districts — Broward County Public Schools and Miami-Dade County Public Schools — told Healthbeat they only submit aggregated district-wide data to the state health department. Neither district makes its school-level data public without a public records request.

South Carolina: During the state’s recent measles outbreak, the state health department began posting school-level data on its website that shows the percentage of children who were up-to-date on all of their required school shots, but not by individual vaccines. The department told Healthbeat that the data helps it prioritize outreach to schools with low vaccine coverage and that it plans to continue posting updated data online each winter. Previously the state had only published school vaccination data at the county and regional level.

During South Carolina’s recent measles outbreak, exposures occurred at 33 schools, including Boiling Springs Elementary School in Spartanburg County.

California: While the state health department posts school-level vaccination data on its website, it’s outdated — in some cases by several years, Healthbeat found. The most recent data displayed by the state’s interactive database and map is from the 2021-2022 school year. Elsewhere, the department posts some more recent, but still outdated, spreadsheets with school-level data for kindergarteners during the 2024-25 school year, plus some older data for seventh graders. Health officials have access to current data, the department told Healthbeat, and the 2025-26 school reports and data will be posted online over the next year.

“In the meantime, parents and members of the public may check with their school or local health department about coverage,” a department spokesperson said by email. School-level data can be found on at least some county health department websites, such as these for Los Angeles County and San Diego County.

Pennsylvania: This summer, the state’s health and education departments launched a new interactive website that details vaccination rates in key grades at individual schools. “Pennsylvania parents deserve clear, accessible data about the health of their children’s schools,” Dr. Debra Bogen, the state’s secretary of health, said in announcing the tool. The data will help families and local leaders work to reduce vaccine-preventable diseases, such as measles and whooping cough, she said.

Why it matters

Knowing the percentage of children immunized in individual schools can inform where and how health officials focus their resources, whether that’s for deploying staff to do contact tracing during an outbreak, assessing barriers to immunization, or conducting focused communication campaigns, the Clemson research team told Healthbeat.

“What the analysis did was it took a massive state-level problem and broke it down into several big, but more manageable, areas,” said Lior Rennert, a professor and director at the Clemson Center for Public Health Modeling and Response. “If you want to do an intervention, you now have targeted areas where you could do that.”

For the public, the data can provide a way to gauge outbreak risks in their immediate area. This can be especially useful for people at higher risk from certain diseases, such as pregnant women, infants, and young children who have not been vaccinated, and people with compromised immune systems, such as Dylan Clear.

After looking up Dylan’s school and learning not enough students were fully vaccinated against measles to prevent the virus spreading, his mother has begun working with school officials on a specialized plan in case he needs to miss school should Pennsylvania’s measles outbreak reach their area.

“If you have the knowledge,” Amanda Clear said, “you know how to respond appropriately rather than out of fear.”

What to watch

With the U.S. experiencing another record-breaking year for measles and outbreaks becoming a new norm, Pennsylvania and South Carolina this year made school-level vaccination data more transparent. We’re watching whether:

The resurgence in measles prompts other states to reconsider what information they make visible about vaccination coverage in local schools.
Parents and communities push for greater access to information about the outbreak risks at individual schools.

One measles case could upend a campus for weeks. Colleges urge faculty to locate proof of immunity now.

2026-09-01T17:15:00+00:00

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While reporting a recent story on the surge in older adults seeking measles immunity tests, I kept coming across something I hadn’t expected. Colleges and universities were encouraging faculty and staff to gather proof of their immunity to measles before an exposure ever occurred on campus.

The more universities I spoke with, I realized there was another story unfolding. It wasn’t just that individuals were taking a personal interest in knowing their immunity. Some educational institutions also were preparing for the growing threat of measles, including looking for ways to prevent the disruption a single case could bring.

Here’s what I learned.

The lead signal

When a measles outbreak hit a suburban Denver school district earlier this year, it sent 80 exposed students and employees into home quarantine for weeks. It also spurred officials at the University of Northern Colorado to start preparing for the disease to arrive on their campus.

“This is going to be a problem that more and more educational entities are dealing with, both K-12 and higher ed, so we’re trying to be proactive about it,” Blaine Nickeson, the university’s associate vice president for administration, told Healthbeat.

The university has begun alerting students, faculty, and staff about the importance of having documentation of measles vaccination or immunity.

The push is not only to protect against the disease, but to help individuals avoid the significant disruptions that could result from just a single case of measles on campus — even for those who aren’t known to be infected.

“If even a single measles case is confirmed at UNC, state and county public health officials will collaborate with the university to orchestrate a significant public health response. This may include exclusion from campus for 21 days or more … Having a vaccine exemption on file will not prevent exclusion,” the university’s new measles awareness web page warns.

Students and their parents might not fully realize how a decision not to get vaccinated against measles could result in their exclusion from campus — including campus housing — during an extended quarantine period, Nickeson said.

Faculty and staff might not have thought about their measles immunization status in many years, but would face missing work if they are exposed to measles and lacked proof of vaccination or immunity, he said.

Unlike students, faculty and staff at colleges and universities generally don’t have campus vaccination requirements unless they work in certain hospital or health sciences settings.

The university highlights that measles shots and titer tests to check for immunity are available at the campus health center. The vaccine is typically covered by insurance, and the out-of-pocket cost of the titer test at the center is about $20 if insurance won’t cover it.

Where else we’re seeing this

University of Colorado Boulder: The university’s measles web page says: “To prevent unnecessary absences, faculty and staff are encouraged to have their immunization records or other evidence of immunity readily available for review if requested.” Faculty and staff can receive walk-up measles immunity testing on the Boulder campus for an out-of-pocket cost of $5.

University of Tennessee Chattanooga: The school’s measles preparedness efforts and recommendations for having proof of immunity were spurred in part by watching South Carolina’s Clemson University deal with measles earlier this year, said Jordan Jacobs, a UTC infectious disease nurse practitioner.

“For the majority of our faculty and staff, it is a new concept,” Jordan said. Their main question: How do they find their old immunization records? If their shots aren’t in state immunization registries, Jordan advises checking with past healthcare providers and schools. “Some staff do ask about titers and vaccinations,” she said.

University of Massachusetts Amherst: “Knowing and documenting your immunity status is critical as it determines whether you may continue working in the event of a confirmed exposure,” says the university’s measles web page, which was launched last year in response to the West Texas measles outbreak and continues to be updated. Dr. Khama Ennis, associate medical director for university health services, said there has been little feedback from faculty and staff, but the campus plans to do additional outreach this fall.

The national playbook

On the national level, the Centers for Disease Control and Prevention has created a checklist for higher education institutions to help prepare to respond to measles cases on campus.

The checklist notes the importance of maintaining records in accordance with legal requirements for privacy and confidentiality. Some university officials told Healthbeat that navigating privacy issues and the continued fallout from COVID vaccine mandates are among the reasons they are only advising faculty and staff to have their measles immunity documentation readily available, but not asking them to turn it in.

Some state health departments also are providing guidance: Among the proactive steps recommended by the North Carolina Department of Health and Human Services, colleges and universities should create a list of students who do not have appropriate documentation of immunity and recommend that faculty and staff have their evidence of immunity readily available.

“Obviously quarantining can have a significant impact,” said Dr. Emma Doran, medical director of the department’s Vaccine Preventable and Respiratory Diseases Medical Consultation Unit.

“Health systems and local health departments and the state health department have been preparing for this for a while, but I think we’re getting a little bit more traction in terms of preparing school systems and universities to think about it.”

How we got here

Historically, school vaccination laws and requirements were created as conditions of student enrollment as a way to combat childhood diseases — not usually as conditions for employment. So faculty and staff pose different challenges.

Many older faculty and staff don’t have easy access to records from shots given decades ago, before the creation of electronic medical records and state immunization registries. Unless they work in healthcare or laboratory settings, universities don’t generally require or track employee immunizations.

And in fact, the American College Health Association’s vaccination recommendations are specific to students and do not provide guidance related to faculty and staff.

JoLynn Montgomery, chair of the ACHA’s vaccine-preventable diseases committee, said the focus is on students because of their unique risk factors. “Many are navigating the healthcare system on their own for the first time,” she said.

But with measles cases at high levels, Montgomery said that generally it’s a good idea for all individuals, including faculty and staff, to be ready.

“Personally, I don’t have documentation for my doses, and I just went and got revaccinated,” said Montgomery, who is the senior manager for applied public health at the University of Michigan. She said her husband decided to get a measles titer test to check his immunity.

Why it matters

A single measles infection on campus can impact far more people than just the person who becomes sick.

As the infected person moves about campus, hundreds more can be exposed — and required to quarantine for up to 21 days — if they don’t have proof of vaccination or immunity.

“It’s not only disruptive to the patient, to the person who’s quarantined, but it’s disruptive to the school, the university. It’s very disruptive to have people out of work,” said Dr. Alan Melnick, the public health director in Clark County, Washington, and a board member of the National Association of County and City Health Officials.

The virus is highly contagious and spreads through the air. It can linger in a room for up to two hours. People can spread the disease in lecture halls, cafeterias, and communal housing beginning four days before the telltale measles rash appears.

What to watch

With U.S. measles cases so far this year already surpassing last year’s record number — the worst since 1991 — we’re watching whether:

More colleges and universities take measles preparedness actions.
Faculty and staff become a larger focus of campus communications, and how they respond.
More health departments and public health organizations issue guidance about having readily available documentation of measles immunity to avoid quarantine.

The bottom line

By urging faculty, staff, and students to gather proof of measles immunity before an exposure occurs, some colleges and universities hope to reduce weeks of disruption if measles reaches their campuses. It’s another example of how the return of measles across the United States is changing how we live.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

Michigan cyclospora outbreak reveals strains on U.S. public health system

2026-08-25T15:00:55+00:00

As the number of people stricken with cyclospora infections across the U.S. finally seems to be winding down, I recently spoke with Dr. Natasha Bagdasarian, the chief medical executive for the state of Michigan, about the challenges her state has faced investigating the outbreak.

Michigan — where the state health department has confirmed more than 14,000 cases of infected people across the state, including hundreds of hospitalizations and two rare deaths — seems to be the outbreak’s epicenter based on case counts.

At its height, Bagdasarian said:

About 400 cases a day were being reported.
Health systems couldn’t keep testing supplies stocked.
Labs were backlogged.
Some healthcare systems restricted testing to hospitalized and immunocompromised patients.

Yet those were only some of the challenges.

The cyclospora outbreak also revealed disconnects in how the U.S. public health system — operating with reduced funding, fewer people and strained federal-state coordination — currently responds when confronted with a massive outbreak, according to what Bagdasarian told Healthbeat.

Click here to continue reading.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

Exclusive data: More than 74,000 older adults seek measles immunity tests amid U.S. outbreaks

2026-07-29T20:40:13+00:00

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Measles was surging in West Texas as Nancy Churnin eagerly awaited the birth of two grandchildren. She was sure she had been vaccinated decades ago, but she wanted to confirm she was still protected.

She didn’t want to risk spreading the highly contagious disease to vulnerable newborns, so she got a simple blood test last year.

“I wanted to double-check my immunity,” said Churnin, a children’s book author who lives in Plano, Texas, near Dallas.

Churnin is among more than 74,000 U.S. adults over age 50 who have received blood tests checking their measles antibody status from January 2025 through March of this year, according to an exclusive analysis of medical records data conducted in response to questions from Healthbeat.

The rates of older adults seeking measles immunity tests spiked across the country during last year’s West Texas measles outbreak and again earlier this year as South Carolina’s measles outbreak became the nation’s largest in decades, according to the analysis by a research team at Truveta, a healthcare data and analytics company that receives patient care data from major health systems that serve about one in three U.S. residents.

Truveta’s research team said its analysis suggests that public awareness of high-profile local measles outbreaks might be influencing more people across the country to seek the immunity tests, which are called titer tests.

Nina Masters, the principal applied research scientist at Truveta who led the analysis, said she was struck by the spikes in titer testing during outbreaks because historically, the standard recommendation has been to just vaccinate people who don’t have proof of immunity.

“To me, that suggests outbreaks are influencing healthcare-seeking behavior and reflects growing concern among Americans who want to understand their immunity status and protect themselves and their loved ones amid rising measles activity,” said Masters, a former Centers for Disease Control and Prevention epidemiologist who has deployed to multiple measles outbreaks.

As the U.S. this month broke last year’s record number of measles cases, people who are infected are increasingly exposing others to the virus in a wide range of public settings from schools and churches to restaurants, stores, and airports. The virus spreads through the air and can linger in a room for two hours after the infectious person has left, putting anybody who goes through the area at risk if they lack immunity.

The result is large numbers of people need to quarantine at home for up to 21 days if they are not vaccinated against measles or cannot provide proof of their immunity through previous vaccination or illness.

“We think it’s important for people to know their immunity status,” said Dr. Emma Doran of the North Carolina Department of Health and Human Services, which recommends titer tests as one of the ways people can check their immunity before they are exposed.

Titer tests can be particularly helpful for older adults who were vaccinated against measles long before electronic medical records and state immunization registries and no longer have their paper vaccination records. The measles vaccine provides lifelong immunity for most people. Two doses of the combination measles-mumps-ruebella shot is 97% effective against measles, and one dose is 93% effective.

“There is a good chunk of the population there that, unfortunately, if somebody didn’t hold on to that paper, they don’t have it,” said Doran, who is the medical director of the department’s Vaccine Preventable and Respiratory Diseases Medical Consultation Unit.

Immunity tests spiked in U.S. during Texas, South Carolina outbreaks

The new data on titer testing provides a window into one of the many ways the return of measles in the United States is impacting people’s lives. The disease was declared eliminated from the country in 2000. In November, an international public health body will review whether the disease has once again become endemic to the United States.

During 2025 — as a major measles outbreak was underway in West Texas — more than 62,000 older adults across the country went to doctors’ offices to get measles titer tests, the Truveta analysis found.

The surge in testing was dramatic, and not just in Texas.

Nationwide, adults 50 and older received measles immunity testing last year at nearly seven times the rate they had in recent years. From 2021 through 2024, a typical month saw about 50 people get tested for measles immunity for every 100,000 adults who had an outpatient doctors’ visit. But in 2025, that figure reached nearly 341 tests per 100,000 adults.

The rate of titer testing within the state of Texas was particularly high, peaking at 627 tests per 100,000. But even when data from Texas was excluded, the data for the rest of the United States still showed a spike in testing at nearly 309 tests per 100,000.

A similar pattern played out during the first three months of this year, when more than 12,000 U.S. adults over 50 received titer tests as the South Carolina measles outbreak became the nation’s largest in 35 years. The analysis showed an even larger spike in testing rates in 2019, when measles outbreaks also fueled an earlier record number of cases.

The analysis involved an examination of electronic health record data from nearly 30 million patients over 50 who had outpatient visits from January 2018 through March. The data is provided to Truveta by the company’s health system members. The researchers looked at data for older adults to try to focus on those seeking the tests long after childhood vaccination or illness, as well as to reduce the inclusion of routine prenatal testing.

Truveta conducted the analysis after Healthbeat asked the company whether its data could provide any information about whether more people were seeking titer tests amid the recent measles outbreaks.

While the data does not say why the individuals received measles titer tests, Masters and her research team said the spikes in titer testing during outbreaks likely reflect a combination of patient concern, vigilance by healthcare providers, exposure-related evaluations, and adult uncertainty about immunization status. Media coverage might also play a role.

There could be many reasons why an adult might want to check their immunity amid increased spread of measles, the researchers said. They include grandparents seeking to confirm they are protected before visiting infant grandchildren, as well as adults who are worried about the risk of living in or traveling to an outbreak area.

Before her grandson, Ezra, was born last year, Nancy Churnin of Plano, Texas, had her blood tested to make sure she was immune to measles. She didn't want to put him at any risk. Churnin was surprised to discover she wasn't immune, prompting her to get an additional dose of MMR vaccine.

Protecting her newborn grandbabies was Nancy Churnin’s motivation in getting a measles titer test last year before they were born. The babies’ parents were also seeking to safeguard their infants against infectious diseases.

“Anybody who wanted to see the baby was on notice: Get all your shots or we can’t let you around the baby unless you’re fully, fully vaccinated,” recalled Churnin.

When Churnin’s titer test result came back, she was surprised to learn she was not immune to measles. She was certain she had been vaccinated as a child, but she was born in 1957 and she has no access to her records, and her parents aren’t around to ask. After the test, she got vaccinated.

“I was very, very glad I got the test. I’m very, very glad I got immunized,” Churnin said. “I don’t want to do anything to endanger those babies, anybody’s babies.”

Should you get a titer test? Cost, doctors’ views shape decisions.

Most older adults are likely to be protected against measles either because they were vaccinated as children or had the disease before vaccines became available.

Adults born before 1957 are officially presumed to be immune to measles because they were likely infected when they were children, according to the Centers for Disease Control and Prevention. Vaccines against measles have been available in the United States since the early 1960s, with an improved version of the vaccine distributed since 1968.

Should those who can’t find their vaccination records ask their doctors for titer tests?

The CDC recommends that adults born during or after 1957 who can’t find their immunization records get the MMR vaccine. But the CDC guidance also says they can get a measles titer test to determine if they need the vaccine. “There is no harm in getting another dose of MMR vaccine if an individual may already be immune,” the CDC says.

There are several factors to consider in whether to do a titer test or just get another MMR shot, experts said.

Dr. Margot Savoy, chief medical officer of the American Academy of Family Physicians, told Healthbeat that it’s not common for patients to ask for a titer test unless they work in a healthcare field where the test is required.

“The question that they normally ask is: How do I know if I’m protected?” she said.

“For most family physicians, and most physicians in general, their answer would be, I don’t know that I would draw titers on most people. If we’re at all worried that you might not be protected, we would just give you another MMR” vaccine, she said.

Savoy said the time and cost of getting a titer test is not worth it for the average patient, because the test may show the person needs to get vaccinated anyway.

Unlike the MMR vaccine, which is routinely covered by insurance plans without patient cost-sharing, there are no requirements for insurance coverage of titer tests, although insurers can choose to cover them. In addition to getting the tests through a doctor’s office, many direct-to-consumer labs and walk-in clinics also will do the tests without a prescription, but the costs can range from $40 to $150 or more.

Individual patients may weigh the costs and benefits differently when deciding between just getting an MMR shot or getting tested, said Doran.

“I think there’s no one-size-fits-all approach for whether to do an MMR vaccine if you don’t have the records or whether to get a titer first,” she said.

Editor’s note: This story has been updated to reflect that, as of late July, there have been more measles cases in 2026 than in all of 2025.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

RFK Jr. orders hantavirus cruise passenger to remain in secure facility, overrules federal medical review

2026-06-16T23:36:02+00:00

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The order from Health and Human Services Secretary Robert F. Kennedy Jr. was slipped under Angela Perryman’s door Monday afternoon inside the secure National Quarantine Unit in Nebraska. This is where she and other former cruise ship passengers have been held since last month because of possible exposure to a dangerous type of hantavirus.

The order signed by Kennedy requires Perryman to stay inside the locked Nebraska facility through June 21, the end of the 42-day quarantine period — even though an HHS-appointed medical review determined last week that Perryman could safely finish her quarantine at home in Florida.

“It has nothing to do with public health at all,” Perryman told Healthbeat Monday evening. “They’re using administrative orders to detain American citizens with no judicial oversight.”

HHS officials did not answer Healthbeat’s questions about the reasons behind Kennedy’s order and why it appears to contradict the findings of the federal government’s own medical review of her detention.

A copy of the order, provided to Healthbeat by Perryman, only says generally that he finds that requirements for federal quarantine continue to be met.

The day after this article was published, HHS said in an emailed statement: “In the absence of proper home monitoring by state authorities, the Administration’s quarantine order is necessary to ensure both Ms. Perryman’s and her community’s wellbeing.”

HHS did not address the detailed findings in the medical review that said the monitoring would be appropriate and protective.

What began as a medical evacuation of Americans from a deadly outbreak aboard an international nature adventure cruise has raised increasing concerns from some public health and legal experts about whether the U.S. government has failed to properly balance protecting public health with ensuring people are quarantined in the least restrictive setting that is safe.

Neither Perryman nor any of the 17 other U.S. passengers who were sent to the Nebraska quarantine facility after leaving the M/V Hondius cruise ship have shown any signs of infection with Andes virus. This type of hantavirus typically spreads through contact with South American rodents, but also is the only hantavirus known to have the potential to spread from person to person.

Of the nearly 150 passengers and crew who were aboard the M/V Hondius, there have been 13 cases of Andes virus, including three deaths, according to the World Health Organization.

Person-to-person spread of Andes virus is “relatively rare and generally associated with prolonged close contact” with a person who is sick, the Centers for Disease Control and Prevention has said in its interim emergency guidance for the public health management of people who have been exposed.

Angela Perryman, pictured during the nature cruise that landed her in federal quarantine.

Recently, HHS has allowed some passengers to leave the facility and finish their quarantines at home – but often under requirements that state and local health departments ensure 24/7 monitoring.

But while Perryman’s home state of Florida is willing to supervise her quarantine at home, it won’t agree to 24/7 monitoring.

“At this time the assessment of the Florida Department of Health is that it is not necessary to implement the federal conditions of 24/7 continuous surveillance and twice daily in-person monitoring of the individual at their residence,” according to a May 28 letter Florida Surgeon General Joseph Ladopo sent to Dr. David Fitter, the hantavirus response incident manager at the Centers for Disease Control and Prevention.

Perryman provided a copy of the letter to Healthbeat.

As part of her quarantine appeals through a federal administrative process, Perryman requested a medical review of the necessity of the terms of her federal quarantine order.

According to the June 11 medical review report, an HHS-appointed official from the CDC recommended that Perryman be allowed to finish her quarantine at home in Florida.

“The disagreement between CDC and Florida over the appropriate monitoring conditions forms a central dispute in this medical review,” wrote Dr. Michael Bell, the appointed quarantine medical reviewer, who is the director of the CDC Division of Healthcare Quality and Promotion.

Bell noted in the report he was not previously involved with the quarantine orders in Perryman’s case.

After reviewing the evidence in the case, Bell said that it was his professional judgment that “less restrictive alternatives would adequately serve to protect public health.”

Bell noted that Florida health officials had proposed once-daily telehealth monitoring with remote temperature checks and symptom assessments. He said these conditions – along with a pre-arranged plan for an appropriate hospital to care for Perryman if she experienced symptoms – would be sufficient to protect public health.

“This is a reasonable and efficient approach that is consistent with the level of transmission risk associated with Andes virus infection,” wrote Bell.

Perryman, who has been appealing her continued detention in Nebraska for several weeks, had her hopes buoyed by Bell’s medical review. But then she received no information indicating anyone was arranging her transfer to Florida.

She said Kennedy’s order on Monday – essentially rejecting the medical review’s recommendations and upholding the current quarantine order – means she’s stuck at the Nebraska quarantine facility until the 42-day quarantine period ends on June 21.

Perryman said she thinks she’s being retaliated against for publicly criticizing how HHS has handled the quarantines.

“A non-physician just overrode the physician medical reviewer,” she said, emphasizing that Kennedy is not a doctor.

Lawrence Gostin, the founding O’Neill Chair in Global Health Law at Georgetown University, called Kennedy’s order “a shocking disregard for both science and personal freedom.”

“It’s a flagrant violation of due process and should be immediately challenged in the courts,” Gostin said on the social media platform X.

Appealing federal quarantine orders isn’t an easy process, Perryman said she and her attorneys have found. Numerous bureaucratic hurdles first have to be cleared within the federal government’s administrative process before you can seek a court’s review.

“They’ve managed to run the clock down and deny me my Fifth Amendment rights,” she said. “We followed the procedure set forth in the regulation, we complied with the law, and they did not.”

Editor’s note: This article has been updated to include a comment that the U.S. Department of Health and Human Services provided the day after publication.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

Second baby formula recall linked to botulism raises questions about safety, oversight

2026-06-15T20:57:35+00:00

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When ByHeart infant formula was linked to a nationwide outbreak of infant botulism last fall, the company encouraged its customers to switch to another premium whole milk formula made by Nara Organics.

Now Nara Organics, which has promoted the “thousands of tests” it runs on every formula batch, is recalling all of its whole milk organic powdered infant formula after the Centers for Disease Control and Prevention linked it to three babies being hospitalized with infant botulism.

The CDC and the U.S. Food and Drug Administration are urging parents and caregivers to immediately stop using Nara Organics Whole Milk Organic Infant formula, which is sold at Target and online. Parents should seek immediate care for their infant if they have symptoms such as poor feeding, loss of head control, difficult swallowing, or decreased facial expression.

Nara Organics organic infant formula. Lot code is found on the bottom of each can. Lot code is outlined in white in the above image

The Nara Organics recall, which follows ByHeart’s recall in November, marks the second time in seven months that a premium organic whole milk infant formula has been linked to an outbreak of infant botulism. The recalls have fueled concerns among parents about the safety of infant formula and the effectiveness of federal oversight.

“Two outbreaks in less than a year show that ByHeart was not a unique accident,” said Sarah Sorscher, director of regulatory affairs at the Center for Science in the Public Interest, a consumer advocacy group.

“Something is very wrong in the production of these formulas, and FDA is not moving fast enough to find the cause,” Sorscher said. “The agency is currently conducting testing of milk ingredients, but that process is creeping along at a snail’s pace and they still have no advice to offer on how to control these risks.”

Nara Organics says the recall, announced Saturday, is being done “out of an abundance of caution” because of the risk that its formula is contaminated with Clostridium botulinum bacteria spores, which cause infant botulism. It can take several weeks between when a child consumes the spores and when they start showing signs of illness. If not treated, infant botulism can lead to paralysis and death.

The company said its infant formula has not tested positive for C. botulinum. The CDC said testing is underway of opened cans of Nara Organics formula and unopened product samples from the company. Results are expected “in the coming weeks,” the CDC said.

Nara Organics did not answer Healthbeat’s questions about the decision last fall to promote Nara’s formula as the replacement for ByHeart’s recalled formula during its infant botulism outbreak. Nara also didn’t answer questions about whether the companies have any common suppliers or other relationships.

In an email Monday afternoon, a ByHeart spokesperson said: “ByHeart and Nara Organics are completely separate companies. There is no corporate, financial, contractual, manufacturing, operational, or ownership relationship between ByHeart and Nara.”

ByHeart said it shared a Nara discount code as a resource to help its customers find alternative options quickly.

A ByHeart post on Instagram from Nov. 11 that recommended Nara Organics products and offered a 20% off discount code was deleted Monday after Healthbeat shared the link with both companies. An archived image of the post is available here.

ByHeart told Healthbeat it removed the post “for safety considerations following the Nara news - while the offer is no longer valid, we did not want to take any chances.”

The source of the contamination of ByHeart’s formula is still under investigation. The FDA has focused on ingredients supplied to the company, including a powdered milk ingredient.

The agency said June 3 that while its inspections led to the identification of C. botulinum in a powdered milk ingredient, the agency “did not identify any additional factors within ByHeart’s facilities that could explain the cause of this outbreak. FDA’s root cause investigation is ongoing and will continue with a focus on ingredients.”

The FDA told Healthbeat it is working with experts around the world to understand the risks of C. botulinum in infant formula to inform future monitoring and control measures.

“Last year’s outbreak involving ByHeart powdered infant formula was the first botulism outbreak definitively tied to infant formula anywhere in the world since infant botulism was first described as a distinct clinical entity almost 50 years ago,” the FDA said in an email.

Health and Human Services Secretary Robert F. Kennedy Jr. last year launched an infant formula initiative called Operation Stork Speed, which initially focused on formula nutrients and testing for pesticides, heavy metals, and per- and polyfluoroalkyl substances, or PFAS. In February, in response to the ByHeart recall and infant botulism outbreak, the FDA said it was beginning a sampling project focused on dairy-based ingredients that includes looking for C. botulinum.

Nara Organics formula has been on the market less than a year

Nara Organics launched its infant formula last July, touting celebrity investors such as Serena Williams, Gina Rodriguez, and Nicky Hilton, and saying the company was “setting a new standard that exceeds both U.S. and European safety requirements.”

After initially being sold online, in January, the company announced its first retail launch, which put the product on the shelves of more than 1,800 Target stores nationwide, as well as on the retailer’s website.

The formula is manufactured in Germany from organic ingredients sourced from the United States and the European Union, according to the company.

“At Nara, we run testing three times. On raw ingredients, on our formula powder as it’s being made, and on our finished canned formula,” the company’s website says. “From our first batch, we’ve run voluntary screening for clostridia – a sign of bacteria that can cause botulism – and B. cereus, the organism that produces cereulide.” Cereulide is a toxin that can cause nausea, vomiting, and dehydration in infants.

Officials at Nara Organics did not answer questions from Healthbeat, including about its microbial safety testing and whether its testing methods and protocols are sufficient to ensure botulism bacteria spores are not present in formula sold to consumers. A Nara spokesperson told Healthbeat the company had no comment beyond what was in its recall announcement.

Over the years, some international food safety experts have expressed concerns about the difficulty of testing for and detecting botulism spores in infant formula.

Infants hospitalized in California, Pennsylvania, Washington

The FDA told Healthbeat that it first contacted Nara Organics on Wednesday, June 10, asking the company whether it had received any consumer complaints about infant botulism diagnoses.

Then on Friday, June 12, the FDA said it contacted Nara Organics and recommended the company conduct a recall “due to the severity of illness and the epidemiological signal.” The company, which said it was contacted “late Friday,” announced its recall on Saturday, June 13.

According to the FDA, the three infants – who all had been fed Nara Organics-brand powdered infant formula – fell ill between April and May. All required hospitalization. The last date of illness onset was May 31. The infants, who ranged in age from 2-months-old to 5-months-old, were in California, Pennsylvania, and Washington state.

Leftover formula has been collected for testing in two of the states, the FDA said.

The FDA told Healthbeat that before it was aware of the infant botulism cases, the agency inspected the two firms that manufacture Nara Organics Whole Milk Organic Infant Formula in Europe. “At the conclusion of both inspections, observations citing deficiencies were issued to both facilities. Both firms have submitted corrective action responses to FDA, which are currently under review,” the FDA said. No further details were provided.

The FDA is warning consumers to not use any Nara Organics Whole Milk Organic Powdered Infant Formula. But the agency is suggesting parents and caregivers consider holding onto any opened formula containers for a month – labeling them as “DO NOT USE” – so that they can be tested should their child become ill.

Because Nara Organics’ formula makes up less than 1% of the infant formula sold nationwide, there is not a risk of the recall and outbreak causing concerns about shortages.

Editor’s note: This story has been updated with responses from the FDA and ByHeart, which were sent after initial publication.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

Hantavirus cruise ship quarantine: 5 passengers sent to home quarantine, 13 remain in Nebraska facility

2026-06-01T23:21:17+00:00

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Five passengers from the hantavirus cruise ship have been allowed to leave a secure quarantine facility in Nebraska and continue being monitored at home, but 13 others remain at the secure facility, the U.S. Department of Health and Human Services told Healthbeat on Monday.

At least two of those released to home quarantine on Monday will be under around-the-clock monitoring and have been put under an official quarantine order, New York officials said.

Multiple media outlets have reported that federal officials had wanted to require that state health departments ensure a police officer or public health worker was stationed 24/7 outside each of the individuals’ homes. That is an unusual step that may stigmatize people who have shown no signs of infection.

Officials at HHS and the Centers for Disease Control and Prevention did not answer questions about why some passengers are being allowed to leave the facility after 21 days of a 42-day quarantine or why others are remaining inside a secure, institutionalized setting. Nor have they provided any public health or scientific basis for how potential risks from former passengers of the M/V Hondius are being managed.

The lack of transparency and inconsistency in the federal government’s approach to managing potential public health risks in the wake of a deadly outbreak of Andes hantavirus is drawing concern from legal experts and public health officials.

Testing so far has not found any of the U.S. passengers being held in quarantine to be infected with the virus.

“The administration is being quite secretive and arbitrary in its use of quarantine powers,” said Lawrence Gostin, the founding O’Neill Chair in Global Health Law at Georgetown University.

“Quarantining a person is a massive infringement of civil liberties and must be done using a clear and science-based process,” Gostin said Monday. “I do not think the administration is acting in a transparent or rational fashion.”

The 18 U.S. passengers from the cruise ship were evacuated last month to the National Quarantine Unit at the University of Nebraska Medical Center in Omaha after three people who had been aboard an international nature cruise died from severe respiratory illness caused by an unusual type of hantavirus that has the potential for “limited” spread between people.

So far, health officials in multiple countries have identified 10 additional cases of Andes hantavirus among people who were among the nearly 150 passengers and crew aboard the ship, according to the World Health Organization’s latest update on May 28.

It’s unclear what the terms and conditions are for the five U.S. passengers who on Monday were allowed to leave the Nebraska facility, and whether federal health officials have issued any new or renewed federal quarantine orders to force any of the other passengers to remain in the facility.

Neither HHS nor the CDC would say. Officials at the University of Nebraska Medical Center also did not answer questions from Healthbeat.

“All five remain symptom-free and have met public health criteria to safely continue monitoring outside the NQU,” HHS said in an email to Healthbeat. The department did not respond to questions about what those criteria were.

Health workers in hazmat suits board the Dutch polar expedition cruise ship MV Hondius at a dock in Rotterdam. So far there have been 10 cases of the Andes hantavirus worldwide among about 150 passengers and crew. (Photo by Nicolas Economou/NurPhoto via Getty Images)

The five people being released to home quarantine will not travel on any commercial flights, HHS said. The department said “appropriate biocontainment measures are in place during transport,” but no details were released.

Once these five people are home, HHS said that state health departments will continue “daily symptom monitoring, maintain 24/7 oversight, and provide guidance throughout the remainder of the 42-day monitoring period.”

HHS officials did not answer questions about how the monitoring and oversight would be carried out.

“CDC encourages the public to support the people and families affected by this situation,” HHS said. “Public health monitoring is a precautionary measure that helps safeguard the health of potentially exposed individuals and protect communities.”

Two of the passengers beginning home quarantine have returned to their private residences in undisclosed locations outside of New York City, Dr. James McDonald, New York state health commissioner, said in a statement Monday afternoon. He said they will remain under “around-the-clock surveillance” and under a quarantine order.

A third New York passenger has chosen to complete the remaining 21 days of their quarantine in Nebraska, McDonald said.

Another Hondius passenger who has chosen to stay at the Nebraska facility is Jake Rosmarin, an Instagram content creator who switched from documenting sightseeing aboard the ship to documenting his time in quarantine.

“This whole experience has totally traumatized me,” Rosmarin said in a video posted Sunday to his Instagram account explaining why he’s choosing to stay at the National Quarantine Unit. “I’m afraid to leave this room until I know that I will not get sick. I do not want to leave here until I know that there is a 0% chance of me getting sick, a 0% chance of me risking my family and friends getting sick, or the general public getting sick.”

He said he also wants to be at a facility that can quickly treat him should he develop any symptoms of Andes virus before the quarantine period ends.

Rosmarin said the process that federal officials have set up to allow some Hondius passengers to leave the facility is complex and involves federal, state, and local authorities.

“The media is making it out to be much simpler than it actually is logistically to get people home to self isolate,” he said. “It is a really complicated process, and there’s a lot of factions that have to agree upon us going home to make that work.”

HHS noted that no cases of Andes virus have been confirmed in the United States. The risk to the public remains low, officials said.

The Andes virus is typically spread by rodents in South America, but has in some cases been able to spread from one infected person to another, according to the CDC. But this person-to-person spread usually requires close contact, such as having direct physical contact with the sick person, spending “prolonged” time in close or enclosed spaces, or being exposed to the infected person’s body fluids.

It can take between four and 42 days from when a person is exposed to the virus to when they start showing symptoms, such as fatigue, fever, achy muscles. People who are infected can become seriously ill with Hantavirus Pulmonary Syndrome. There is no specific treatment or vaccine. For those who are sickened, medical care focuses on managing symptoms.

Last month, the CDC issued federal quarantine orders to two of the 18 people being monitored at the Nebraska facility. Those orders were based on a disease list that does not include hantavirus.

The passengers had initially been “requested” to stay at the facility for testing and monitoring through May 31. When two of them began making arrangements to leave and quarantine at home, the CDC issued two federal quarantine orders against them, requiring that they stay in the facility.

CDC and HHS officials did not answer Healthbeat’s questions about the status of these quarantine orders.

Jennifer Nuzzo, an epidemiology professor and director of the Pandemic Center at Brown University School of Public Health, called the approach to managing the U.S. passengers’ risk unusual and concerning.

“Every American should be concerned about the somewhat quixotic and a bit arbitrary approach that they have taken in dealing with these passengers,” Nuzzo said.

Nuzzo noted that some passengers who disembarked the Hondius cruise ship after the first passengers died but before health officials were aware of an outbreak, have been allowed to quarantine at home since their return to the United States.

“To tell some passengers you can’t leave Nebraska, and to tell other passengers it’s okay to be home, that doesn’t make any sense. There’s no public health rationale for that,” she said.

She also questioned why the federal quarantine orders were issued last month to two of the patients who sought to quarantine at home.

“I have not heard a single assertion that these patients don’t want to quarantine,” Nuzzo said.

“The general public health practice, the ethical practice, the historical practice is we impose measures by the least restrictive means necessary,” Nuzzo said. “Quarantining in facilities is not typical, and only done under extreme cases, usually because someone has refused to comply with other measures.”

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

Hantavirus cruise ship quarantine orders are based on a disease list that doesn’t include hantavirus

2026-05-22T02:34:45+00:00

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The deadly hantavirus that has killed three passengers from a cruise ship does not appear on a key list that gives the Centers for Disease Control and Prevention its expansive detention powers, a public health law expert told Healthbeat. That means the federal quarantine orders the agency is using to detain two exposed passengers could face legal challenges.

At issue: Federal regulations only allow the CDC to quarantine people for specific “quarantinable communicable diseases” that are on a list created through presidential executive orders. The list includes a wide range of dangerous diseases: viral hemorrhagic fevers, infectious tuberculosis, measles, severe acute respiratory syndromes, and flu that can cause a pandemic.

However, no type of hantavirus is on this list.

The list can only be updated by presidential executive order, and President Donald Trump has not issued an order to add the deadly Andes hantavirus that has prompted worldwide concern.

Until this week, federal officials had requested, but not mandated, that 18 U.S. passengers from the M/V Hondius cruise ship undergo medical screening and observation at a Nebraska quarantine facility through May 31, which would be the 21st day of their monitoring period.

On Tuesday the CDC announced that it had issued federal quarantine orders to two of the passengers at the Nebraska facility, requiring that they stay until the monitoring period is over.

One of the passengers being held in Nebraska, Angela Perryman, has spoken publicly about receiving a quarantine order after making plans to leave the facility to continue voluntarily quarantining on her own. Perryman could not be reached.

James Hodge, Jr., director of the Center for Public Health Law & Policy at Arizona State University, told Healthbeat that he’s seen a copy of the CDC’s quarantine order. Federal health officials are using a broader category of disease placed on the list more than a decade ago to justify detaining the two passengers.

“Here’s what they’ve done: They are classifying hantavirus, the Andes strain, as a severe acute respiratory syndrome condition,” Hodge said. “That is a listed condition for which the CDC can actually quarantine.”

The Andes hantavirus, which is usually spread through contact with urine or droppings from rodents, can cause severe pulmonary symptoms. It is the only hantavirus that can also spread from person to person.

Hodge said he’s spoken to some medical experts who think it’s legitimate to classify the Andes hantavirus as a type of severe acute respiratory syndrome, but he noted that’s not typically how the term is applied.

“That’s going to be a real question,” Hodge said, “and it might be one for which we do see that quarantine order being significantly challenged.”

Officials at the CDC and the U.S. Department of Health and Human Services did not respond to questions from Healthbeat on Thursday.

Hodge said the CDC’s quarantine orders are relying on a July 2014 executive order issued by President Barack Obama that updated the list of quarantinable diseases to include a broadly defined category of “severe acute respiratory syndromes.”

The executive order defines these syndromes as “diseases that are associated with fever and signs and symptoms of pneumonia or other respiratory illness, are capable of being transmitted from person to person, and that either are causing, or have the potential to cause, a pandemic, or, upon infection, are highly likely to cause mortality or serious morbidity if not properly controlled.”

The order specifies that this definition does not apply to influenza.

It’s unclear whether the executive order was intended to apply to diseases such as those caused by the Andes strain of hantavirus, which has shown the ability to spread from person to person for many years.

The Obama executive order was issued amid heightened concerns about outbreaks of MERS – Middle East respiratory syndrome – coronavirus.

Obama’s order amended an April 2003 executive order issued by President George W. Bush that added “Severe Acute Respiratory Syndrome (SARS)” to the quarantinable list. The SARS coronavirus emerged in China in 2002 and spread to 28 countries before the outbreak ended in 2003.

Given the broadly written definition of severe acute respiratory syndromes in the Obama order, Hodge said the CDC is seeking to make the case that the Andes hantavirus qualifies as a quarantinable disease.

But he said the passengers subject to this week’s quarantine orders also have the potential to make several arguments if they choose to challenge the orders in court, including that the virus wasn’t specified as a quarantinable disease. “I would be saying, you’ve never previously called hantavirus Andes strain a severe acute respiratory condition,” he said.

Hodge added that any uncertainty could be ended with an executive order adding the Andes virus to the quarantinable list. “President Trump could issue that order in the next five minutes and we’d be done here,” he said.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

Inside the largest U.S. measles outbreak in decades: Records reveal spread in vaccine-hesitant community

2026-05-19T09:00:00+00:00

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Case #1 in what would become the largest U.S. measles outbreak in decades was a parent in South Carolina’s Upstate Region near Spartanburg.

The next seven people to fall ill were all children. Three of them were being cared for at home – limiting their ability to spread the highly contagious measles virus to others.

But the children who became Cases 5, 6, 7, and 8 were infectious while they mingled with other children at school and in daycare, according to internal records obtained by Healthbeat from the South Carolina Department of Public Health.

By the second week of the outbreak, the number of known infections had grown to 12. The internal records, obtained under the state’s public records law, reveal all of them lived in just four households.

At the center of the nearly seven-month South Carolina measles outbreak – from beginning to end – was a close-knit, vaccine-hesitant Ukrainian- and Russian-speaking community in and around Spartanburg County, according to South Carolina state health officials.

By the time the outbreak was declared over on April 27, the handful of cases that were first identified among a couple of families in October 2025 had resulted in 997 documented measles infections.

How the South Carolina measles outbreak began

A breakdown of the first eight cases:

South Carolina DPH estimates about 90% of these outbreak cases were among members of the area’s Ukrainian- and Russian-speaking community, which has around 15,000 people in Spartanburg County, the department said in emailed responses to Healthbeat’s questions.

“This community was at the center of the outbreak for its whole course,” said the department, which did not grant an interview.

The South Carolina outbreak is the latest example of a trend the Centers for Disease Control and Prevention has documented for decades: Nearly all large U.S. measles outbreaks since 2000 – when the country attained measles-free status – have involved various types of close-knit groups with low vaccination rates.

As measles makes a major comeback across the country, a Healthbeat examination of the challenges encountered controlling the South Carolina outbreak highlights the need for public health officials to understand the specific and sometimes differing reasons for vaccine hesitancy within individual groups.

It also illustrates the importance of identifying at-risk pockets of unvaccinated people and building trusted relationships before outbreaks happen. All are complex tasks made more difficult amid heightened public distrust in the wake of the Covid-19 pandemic and during a time of cuts to public health staffing and funding.

“Waiting for infectious disease to start spreading is too late. It is significantly more effective to prevent an outbreak than to contain it,” said Dr. Eliza Varadi, a Russian-speaking pediatrician in Charleston, S.C.

“Even in a state where most people are vaccinated, those small pockets, that’s where diseases will spread,” said Varadi, the immunization representative for the South Carolina chapter of the American Academy of Pediatrics, who worked with DPH officials during the outbreak and provided advice on culturally sensitive outreach and education.

Close-knit groups have fueled U.S. measles outbreaks since 2000

South Carolina’s outbreak is a case study in how years of declining immunization rates – especially among children obtaining religious and non-medical exemptions from school vaccination requirements – is making localized communities of various types across the country vulnerable to the spread of infectious diseases, according to Varadi and other health experts.

Dr. Satish Pillai, the CDC’s incident manager for the 2025-26 national measles response, noted the role of close-knit groups in “nearly all” measles outbreaks with more than 50 cases since 2000 during a presentation to local public health officials earlier this month.

Outbreak was concentrated in a close-knit community

From October 2025 through March 2026, the outbreak caused 997 known measles infections in and near Spartanburg County. State health officials estimate about 90% were members of the area’s Ukrainian- and Russian-speaking community.

These outbreaks include those that have occurred in New York during 2018-19 largely in an Orthodox Jewish community; in Washington state in 2019 among a Ukrainian- and Russian-speaking community; in central Ohio in 2022 primarily among children of Somali descent; in Chicago during 2024 within a shelter for migrants who were mostly from Venezuela; in Minnesota in 2024 where a Somali community was disproportionately impacted; and in West Texas in 2025 among a rural Mennonite community.

In recent months, Pillai noted, the types of close-knit groups driving measles outbreaks has been evolving. Large outbreaks this year have occurred on the campus of Ave Maria University in Florida and at a federal detention facility in Texas.

“Having large college outbreaks and large detention facility outbreaks at these levels are unprecedented since 2000,” Pillai said.

Meanwhile, lower vaccination rates throughout communities have begun allowing outbreaks that begin in close-knit communities to start spreading widely across populations, as has happened in the ongoing outbreak in Utah, he said.

Schools, families, churches contributed to virus spread in S.C.

South Carolina DPH officials told Healthbeat they do not know the infection source that led to the initial cases in the state’s measles outbreak. They said this indicates unrecognized spread of the virus was already occurring by the time cases started being reported to public health.

Measles poses a significant outbreak threat for unvaccinated, socially, and geographically connected people because it is so contagious and spreads through the air, where it can linger for up to two hours in enclosed spaces.

Families drive early infections

By Oct. 15, state investigators had identified 12 outbreak cases. All were members of just four households.

To prevent ongoing transmission of measles within communities, 95% of people need to be fully vaccinated against the disease, according to the CDC.

Some of the earliest cases in the South Carolina outbreak last October involved Global Academy of South Carolina. The Spartanburg County public charter school was founded by educators from Ukraine whose “passion to help families of immigrants” have prompted them to open tuition-free schools in California, Florida, and most recently South Carolina, according to the schools’ websites.

When the outbreak started, Global Academy’s student body had one of South Carolina’s lowest levels of vaccination coverage: Only 21% of its students were up-to-date on their school vaccinations during the 2025-26 school year, state data show. Even fewer of the school’s students – just 17% – were fully vaccinated during the previous school year.

Only 21% of the students at Global Academy in Spartanburg County were up-to-date on their school vaccinations during the 2025-26 school year, state data show.

Officials with Global Academy of South Carolina, its board of directors, and founders have either declined to be interviewed, did not respond to interview requests, or could not be reached during and after the outbreak.

As the measles cases continued to spread within households, some of those infected were unvaccinated children and teens who unknowingly brought measles into other schools – exposing scores more students who also weren’t vaccinated.

“We know that some schools with a high percentage of children from Ukrainian- or Russian-speaking families have been impacted and a number of public exposures have been reported in churches attended by these community members,” DPH said in response to Healthbeat’s questions.

In low-vaccination communities, one person can expose dozens

Because the initial symptoms of measles – such as a cough, runny nose, red eyes, and fever – can appear like those of a common cold or the flu, people can spread the disease before they know they have it. They are contagious beginning four days before the tell-tale measles rash appears on their face and body.

Further complicating public health efforts to control the virus’ spread is that there can be a significant lag time from when someone is exposed to the virus and when they start feeling ill. Symptoms often develop seven to 14 days after exposure, but it can sometimes take up to 21 days.

Internal South Carolina state health department records obtained by Healthbeat provide a window into how a single contagious person can expose dozens.

How measles can spread

How Case #44 in South Carolina’s outbreak exposed 66* close contacts to the virus who were unvaccinated or lacked immunity through previous infection.

*One individual was both a household member and Lyman Elementary School student.

Outbreak Case #44, identified by state health officials in mid November, exposed 66 close contacts to measles who were unvaccinated or lacked immunity to the virus through previous infection. They included three household members, four patients at a doctor’s office, 58 individuals at Lyman Elementary School (including one of the household members), and two school bus riders from D.R. Hill Middle School, according to an email update from DPH to the South Carolina governor’s office on Nov. 17.

As state public health officials investigated outbreak Case #45, they identified an initial 61 close contacts who had been exposed and weren’t protected against measles. They included four household members and 57 individuals from Boiling Springs Middle School. The person, while infectious, also attended a church with about 250 people in its congregation, according to DPH emails to the governor’s office on Nov. 19 and 20 that do not name the church, but say notification letters in multiple languages were provided for distribution.

As the outbreak continued, infected people participated in services and other activities at several Slavic churches, where services are held in the Russian or Ukrainian languages, including Slavic evangelical and Pentecostal churches.

At one of these churches, the Way of Truth Church in Inman, S.C., a person who was infectious attended on the evening of Nov. 7 and morning of Nov. 9, exposing others who weren’t vaccinated. Over the weeks that followed, at least 30 infections were linked to the church.

Of the 14 newly identified measles cases announced on Dec. 2 by state health officials, eight were people exposed at Way of Truth Church. Over the next week, 16 more people fell ill with measles from exposures at the church. Five more cases linked to the church were announced on Dec. 16, plus one more on Dec. 19.

During late December and into January, state health investigators tracing the movements of people recently diagnosed with measles identified additional exposures that had occurred at several other Slavic churches, including Tabernacle of Salvation Church, Ark of Salvation Church, and Slavic Pentecostal Church of Spartanburg. Church leaders could not be reached or did not respond to Healthbeat’s interview requests during and after the outbreak.

Slavic churches unwilling to host vaccination events during outbreak

Varadi, the state American Academy of Pediatrics representative who worked with South Carolina DPH during the outbreak, told Healthbeat that vaccine hesitancy within the membership of some Spartanburg-area churches was a key challenge in stopping the outbreak.

“The center of the outbreak was not the entire Russian-speaking or Ukrainian-speaking community. It was a small subset that may have been related to specific churches,” Varadi told Healthbeat.

“It’s not that the church leadership was discouraging vaccinations, they just were not encouraging,” Varadi said. “We wish that there would have been a better partnership to work together to encourage vaccination.”

DPH officials, who told Healthbeat that Varadi provided them with “valuable insights and assistance,” acknowledged that no church from within the area’s Ukrainian- or Russian-speaking community agreed to host a vaccination event during the outbreak.

“As is often the case, church leaders made decisions about whether to interact with DPH based largely on the wishes and feelings of their congregations,” the department said in its written responses to Healthbeat’s questions. “While some were willing to discuss outreach and education opportunities, others were not. Importantly, none were forced to meet with DPH to discuss any of these topics.”

Tabernacle of Salvation Church in Spartanburg, South Carolina, was among several Slavic churches that had measles exposure incidents during the outbreak.

One of the close-knit community’s “prominent churches” did voluntarily agree to meet with DPH leadership during the outbreak, the department said, “and that conversation was informative.” DPH declined to name the church.

From the beginning of the outbreak, DPH officials in press briefings emphasized the importance of vaccination in stopping the outbreak. They separately made information about measles available in the Ukrainian and Russian languages on the DPH website and to churches and other groups.

Two doses of the measles-mumps-rubella (MMR) vaccine are 97% effective in protecting against measles, and even one dose is 93% effective, according to the CDC.

While the Ukrainian- and Russian-speaking community remained a vaccination challenge, by January – as the outbreak spiked – the department started seeing wider increases in measles vaccination across Spartanburg County and the state. This increase, combined with the large number of people who became immune to measles through illness, helped end the outbreak, they said.

Dr. Brannon Traxler, the South Carolina DPH’s deputy director and chief medical officer, in response to Healthbeat’s questions during the department’s last media briefing on the outbreak on April 27, said it is important to understand the community’s history and reasons for being hesitant about vaccines.

“We recognize and appreciate there is history there that didn’t occur in South Carolina, often even before they came to the United States, that has led to very legitimate fears of government and of government health,” said Traxler, who last week was named the department’s acting director. “They have a reason to have the doubts that they do.”

How the South Carolina measles outbreak grew from 5 to 997 cases

Traxler did not elaborate. DPH, in response to Healthbeat’s questions, declined to discuss the reasons public health workers have been given by community members for not vaccinating their families against measles.

“Those reasons are theirs to communicate, not ours,” DPH said by email. “Our role in every communication was to provide the best factual information possible with which families could make informed decisions.”

Vaccination programs and government trust have a complicated history in Ukraine and Russia.

The more distant history includes the former Soviet Union’s mandatory and coercive national immunization programs and ongoing vaccine hesitancy and concerns about vaccine safety.

There also was a history in former Soviet republics of some measles vaccines having lower levels of effectiveness in preventing outbreaks that has been attributed to poor manufacturing quality control and improper vaccine storage and handling practices.

While the Russian Federation is estimated by the World Health Organization and UNICEF to have had high levels of measles vaccination coverage for many years, that has not been the case in Ukraine.

In Ukraine, the country’s vaccination coverage dropped dramatically after the high-profile death in 2008 of a Ukrainian teenager, an event later determined to be unrelated to being vaccinated against measles as part of a large immunization campaign.

According to the WHO, 95% of children in Ukraine in 2008 were fully vaccinated against measles. But by 2016, just 42% were protected with one dose of measles vaccine and 31% with two doses. And during 2017-19, the country experienced a measles epidemic that resulted in more than 115,000 reported cases.

Since then vaccination coverage has increased. As of 2024, about 91% of 1-year-old Ukrainian children and about 83% of 6-year-olds were vaccinated against measles, according to information released by UNICEF Ukraine last year.

In South Carolina, DPH officials said members of the Ukrainian- and Russian-speaking community cooperated with the department’s recommendations for isolating and quarantining at home to prevent spreading measles to others.

Quarantines, which could last up to 21 days, had a significant impact on these families’ daily lives, education, and finances, with children having to stay out of school and adults missing work.

DPH said its community health workers, when asked, helped these families identify social service resources, including for food and utility support

Community members are key to building trust in public health

Public health officials at the Washington State Department of Health found themselves facing similar challenges in 2019, following a measles outbreak among a Ukrainian- and Russian-speaking community.

“We didn’t have a lot of connection with that community or a lot of resources for them in their language,” said Danielle Koenig, the department’s health promotion supervisor.

In the wake of the outbreak, Koenig helped secure a CDC grant that for six years funded a project to better understand the needs of the community, build trust, and provide health resources. The grant ended last summer.

The South Carolina Department of Public Health had disappointing turnouts for its mobile vaccination clinics during the outbreak. Churches serving the Ukrainian- and Russian-speaking community at the center of the outbreak declined to host vaccination events, the department said.

The department found that a cornerstone of building trust is partnering with leaders and organizations from the impacted community, listening and responding to their needs – and also hiring members of the community – like Vadim Gaynaliy – to help lead the outreach.

Gaynaliy, a health educator at the department who speaks Ukrainian and Russian and is from a large Ukrainian community in northeast Portland, said his background and those of others involved in the project provided insights into the community’s values and how it functions.

“We’re not even talking about a single community here. There’s obvious political tensions between Russian and Ukrainian communities, there’s different religions and denominations. So we try to address them as different communities who will have different needs,” Gaynaliy told Healthbeat.

The project resulted in the creation of the Nashi Immigrants Health Board – now an independent nonprofit organization run by and for the Ukrainian- and Russian-speaking community that provides a range of resources and support programs beyond just information about vaccination.

“Trust is the biggest ingredient,” said Tamara Cyhan Cunitz, the board’s co-founder, executive director, and a registered nurse and educator whose relatives came to the United States after escaping the Soviet Union during World War II. “People who are from a cultural community will pay attention and connect better with someone who knows their culture and language.”

S.C. gets 5 months of funding to launch outreach project

The huge measles outbreak in the Spartanburg area is finally over, but the area remains at risk of future outbreaks because it continues to have large pockets of people who are not vaccinated against the disease – including in the Ukrainian- and Russian-speaking community.

To help address this, DPH told Healthbeat it is beginning a new partnership with two nonprofit public health organizations to hire community health workers to do education and outreach in two or three areas within Spartanburg County that face higher risks from measles and other vaccine-preventable diseases.

The CDC Foundation, a nonprofit organization that supports the CDC and public health, has agreed to provide five months of funding for the project, the groups said.

“The idea is to reach the specific Slavic community, that from a health department perspective, they have had struggles with reaching over the years and to really make inroads around vaccines and vaccine education,” said Scott Thorpe, executive director of the Southern Alliance for Public Health Leadership, which is one of the project’s partners. “Doing this work outside of a crisis is really, really important.”

Terri Jowers, executive director of the South Carolina Community Health Workers Association, the project’s other nonprofit partner, said the project plans to hire three community health workers, with two of them coming from within the Russian- and Ukrainian-speaking community.

Jowers said the project will develop training for this soon-to-be hired team on how to better engage with communities through conversations about why they are hesitant or concerned about vaccines, what they have heard, and ways to work together to find sources they trust to figure out the facts. The training will also be made available to other community health workers in Spartanburg County and across the state, she said.

“The goal is to really start training people by the end of June so that community health workers feel more comfortable having these conversations,” she said.

Five months is not a lot of time to build trust and Jowers said she is hoping that the project will be able to identify additional funding for a year beyond the initial grant. “You have to build those trusted relationships,” she said.

The CDC Foundation, which told Healthbeat it is providing more than $100,000 for the project, said that trusted messengers are critical. The foundation said the project’s limited timeframe is based on funding availability. “If additional funding becomes available, we would consider extending the timing,” it said.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

How the South Carolina measles outbreak grew from 5 to 997 cases

2026-04-27T23:55:10+00:00

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The South Carolina measles outbreak is one of the largest in the United States in decades.

It started with just five known cases in October, but by January exploded to 847 – becoming larger than last year’s deadly outbreak in Texas. By mid March, the outbreak had further grown to 997 known cases.

Along the way, hundreds of additional people in South Carolina – many of them children at schools with low vaccination rates – have had to stay in home quarantine for up to 21 days because they aren’t immunized and have been exposed to contagious people.

South Carolina’s state epidemiologist, Dr. Linda Bell, has said there also were likely many more people who weren’t in quarantine, but should have been. They were unaware they had been exposed during the normal course of their lives: Going to work, school, and church, shopping for groceries, dining in restaurants, and visiting museums.

Measles spreads through the air and can linger in a room for two hours after an infectious person has left. The people who are spreading the disease often don’t know they have it: They are contagious for four days before they develop the virus’ hallmark rash.

A Healthbeat review of the outbreak’s history provides a detailed timeline of how the South Carolina Department of Public Health worked to trace and contain new infections. For a while, the outbreak smoldered with few new cases. Then the holiday season supercharged the spread in January.

The South Carolina outbreak was declared over on April 27.

Here is how it happened.

October 2, 2025 - South Carolina announces measles outbreak

Total outbreak cases: 5.

The South Carolina Department of Public Health announces it has confirmed a measles outbreak in the Upstate region, the northwest part of the state that includes Spartanburg County. During 2025, the state had only identified three earlier measles cases: two in July and one in early September – and those were linked to exposures during international travel, plus one close contact of a traveler who became infected. “We now have identified five cases in a little more than a week,” Bell said. “This sharp uptick in cases and the unknown source of two of the recent cases indicates unrecognized community spread.”

October 7, 2025 - Two schools have early outbreak cases

Total outbreak cases: 7. New cases: 2.

Two additional cases of measles are identified in Spartanburg County, raising to seven outbreak cases that had been reported since Sept. 25. None have an identified source, state health officials said, “suggesting that measles is circulating in the community.” Two schools – Global Academy of South Carolina, a public charter school where state data show only 21% of students had all their school vaccinations, and Fairforest Elementary, a public school where 82% of students were up-to-date on their school shots – are locations with confirmed measles cases. Health officials identified 153 unvaccinated students at the two schools who were exposed and at risk of measles infection, resulting in their required exclusion from classes until the 21-day period of potential disease transmission was over. The school exclusion periods were over on Oct. 21 for the Global Academy students, and on Oct. 22 for the Fairforest students.

Vaccination coverage of 95% is needed in local communities to stop the spread of measles. Across Spartanburg County, the state health department estimates that just 90% of school-age children are fully vaccinated. Rates at some schools are even lower, state data show.

Global Academy of South Carolina, a public charter school in Spartanburg, S.C., was one of two schools that had some of the earliest confirmed cases of measles linked to the outbreak.

October 9, 2025 - A child in Greenville County has measles

Total outbreak cases: 8*. New cases: 1.

State health officials announce another case of measles, a child in Greenville County, which borders the west side of Spartanburg County. While it was not immediately clear whether the child’s illness was related to the Spartanburg County outbreak, health officials eventually included the case in the outbreak count. “What this case tells us is that there is active, unrecognized community transmission of measles occurring in the Upstate, which makes it vital to ensure that the public have received their measles vaccinations,” the state health department said. The department would later identify the Crunch Fitness gym at 1332 S. Pleasantburg Dr. in Greenville as the source of the child’s exposure on Sept. 30.

(*) Total case count includes this Greenville County child, whose measles case was later determined to be an outbreak case on Oct. 21.

October 13, 2025 – Quarantines appear to be working

Outbreak investigators from the state health department are optimistic about their efforts to control the spread of measles at Global Academy of South Carolina and Fairforest Elementary, according to internal health department records obtained by Healthbeat. “The quarantine of students from Global Academy and Fairforest Elementary appears to be working. The recent confirmed cases in those exposure groups did not lead to additional case investigations because they were already in quarantine,” according to an Oct. 13 email obtained by Healthbeat that the state health department sent to staff in the governor’s office.

October 14, 2025 - School exposures result in more cases

Total outbreak cases: 13*. New cases: 5.

Five new measles infections are confirmed among unvaccinated students who were already in quarantine at home because of previously reported school exposures. The department previously identified exposures at Global Academy of South Carolina and Fairforest Elementary. “Because they were quarantining before they became infectious, no additional exposures occurred with these new cases,” state health officials said. The state health department announces the next day that it will be sending its mobile measles vaccination unit to hold five events at four locations in Spartanburg County – including churches, a community center, and a library.

(*) Total case count includes a Greenville County child whose measles infection was announced on Oct. 9 as being under investigation, and was later determined to be an outbreak case on Oct. 21.

October 17, 2025 - Three cases among contacts in quarantine

Total outbreak cases: 16*. New cases: 3.

Three new cases are identified among close contacts of people with measles who were already in quarantine at home. State health officials said the new cases show how early quarantine after an identified exposure “is highly effective in preventing community spread.”

(*) Total case count includes a Greenville County child whose measles infection was announced on Oct. 9 as being under investigation, and was later determined to be an outbreak case on Oct. 21.

October 21, 2025 - Four new cases in Spartanburg County

Total outbreak cases: 20. New cases 4.

Two new cases are confirmed among close contacts of people already in home quarantine. And two additional measles cases are identified in association with a business in Spartanburg that had “no public exposures,” health officials said. They also announce that the Greenville County child exposed at a gym whose case was announced on Oct. 9 is now being considered an outbreak case “due to ongoing unrecognized community transmission.”

October 24, 2025 - Two more sickened with measles

Total outbreak cases: 22. New cases 2.

Two new measles cases are confirmed in Spartanburg County; both are linked to close contacts of people with measles who had been in quarantine at home, state health officials announced.

October 28, 2025 - Mobile clinics give 24 shots as more fall ill

Total outbreak cases: 30. New cases: 8.

As state health officials announce eight new measles cases in Spartanburg County among close contacts of people already in home quarantine, they continue to send their mobile vaccination clinic to offer free measles shots at more locations. Multiple vaccination events have been offered in the community since Oct. 16, but only 24 vaccines have been administered: 19 to adults and five to children, state health officials said.

October 31, 2025 - State emphasizes isolation, quarantine

Total outbreak cases: 34. New cases: 4.

Four new measles infections were confirmed in Spartanburg County. All were linked to close contacts of previously known cases. “No public exposures have been identified from these cases,” state health officials said. “We continue to rely on isolation and quarantine measures for those who have been exposed and are unvaccinated to prevent the spread of measles in the community to contain this outbreak.” The state health department added that its “additional response” to the outbreak “is to encourage protection with the measles-mumps-rubella (MMR) vaccine for those who are not immune.” With free mobile vaccination clinics ongoing, just 28 doses of MMR vaccine – 23 to adults and five to children – have been administered since the outreach events began on Oct. 16.

November 4, 2025 – No new cases as holiday season looms

Total outbreak cases: 34. New cases: 0.

No new measles cases were identified by health officials since the previous Friday. Yet they cautioned that 34 people were still in quarantine because they were unvaccinated and had been exposed to someone who was contagious. The latest end date for those in quarantine to no longer be at risk of developing measles is Nov. 24. “We are reminding people that travel for the upcoming holidays increases the risk of exposures greatly for those traveling and for those accepting visitors,” the state health department said. “Consider getting vaccinated now to prevent measles from disrupting your holiday plans.”

November 7, 2025 – Another case confirmed, more expected

Total outbreak cases: 35. New cases: 1.

State health officials announce they have identified one new measles case and are still investigating how many people may have been exposed to the virus by this person. “We also expect more cases to come in the days ahead from exposed family members of known previous cases,” the state health department said, noting that there are 31 people in quarantine.

November 10, 2025 – Restaurant mistakenly flagged for exposure

While investigating the ongoing outbreak, state health officials put out a press release saying a person who was infectious with measles was at the Kanpai of Tokyo restaurant at 2300 Winchester Pl. in Spartanburg on Nov. 2 from 3 to 6 p.m.; they urged anyone who believes they were exposed – particularly those without immunity – to contact their health care providers. But a mistake was made, and the health department said it had been given the wrong date: The person actually dined at the restaurant in late October – at a time when they weren’t infectious.

“Our business went down for a good two months. We lost sales, we lost wages,” general manager Nick Nakincheng told Healthbeat. “People thought we closed, and then people were just scared to even come at all.” Business is finally returning, he said in January. But the state health department, while acknowledging the error to the Post and Courier in December, still had not corrected its press release as of Jan. 26. The department declined to answer Healthbeat’s questions about the error or explain why the press release remained posted on its website without correction – even though it had corrected at least one other outbreak press release. After Healthbeat published this timeline, the department added a correction to its Kanpai of Tokyo press release.

The general manager of Kanpai of Tokyo said the Spartanburg restaurant lost business after the state health department publicly warned in November 2025 that an infectious person had dined there. It later turned out that outbreak investigators were given a wrong date – and the person wasn’t contagious when they were at the restaurant.

November 12, 2025 – Eight new measles cases identified

Total outbreak cases: 43. New cases: 8.

Of the eight new measles cases announced by state officials, six were household members of known cases who were in quarantine. But the source of the infection for the other two cases, who were people from the same household, is unclear. “The unidentified source of the two new cases reinforces our concern about potential ongoing community transmission,” the state health department said.

November 14, 2025 – One new measles case

Total outbreak cases: 44. New cases 1.

Just one new measles case has been identified since the state’s last update and the extent of others exposed to the person is still under investigation, state health officials said; 18 people are currently in quarantine because of outbreak exposures.

November 18, 2025 – More cases, more public exposures

Total outbreak cases: 49. New cases: 5.

While two of the five new cases are household members of known measles cases in quarantine, the source of the infection of the other three people is unknown, state health officials said. “The initial investigation of contacts of the new cases has determined potential exposures in public settings. Additional information will be provided once more details are obtained,” the department said, noting that 84 people are in quarantine and that direct contacts and facilities that have been impacted are being notified about the potential exposures.

November 21, 2025 – School, church, airport exposures

Total outbreak cases: 52. New cases: 3.

State health officials announce the confirmation of three new measles cases – and that as a result of contact tracing by health workers, there are now 137 people in quarantine because they are unvaccinated and have been exposed, plus one person in isolation because of infection. Many of these people are from schools in Spartanburg County: 57 are from Lyman Elementary School (where 89% of students were up-to-date on school vaccines); 55 are from Boiling Springs Middle School; and one attends D.R. Hill Middle School (where 88% of students were up-to-date on vaccines). Health officials also warned that an employee at the Greenville-Spartanburg International Airport who was infected with measles may have exposed airport visitors between 9 a.m. and 7 p.m. on Nov. 10 and 11. They also said an infectious person attended the Way of Truth Church in Inman, S.C., which is in Spartanburg County, from 7 to 11 p.m. on Nov. 7 and from 10 a.m. to 2 p.m. on Nov. 9.

State health officials linked multiple outbreak cases to exposures that occurred at the Way of Truth Church in Inman, S.C., which is in Spartanburg County.

November 25, 2025 – Public exposure at county treasurer’s office

Total outbreak cases 55. New cases: 3.

On the Tuesday before Thanksgiving, the state health department announces they have identified three additional measles cases. Two of the people are household members of known cases. The source of the third person’s infection is still being investigated. Meanwhile, the department warns of another public exposure location: An infectious person was at the Spartanburg County Treasurer’s Office on Nov. 17 and 18 during the hours the office was open.

November 28, 2025 – Public exposure event at Costco

Total outbreak cases: 62. New cases: 7.

Of the seven new measles cases announced, six were household members of known cases who were in quarantine, and one was a person exposed in a school setting who also was in quarantine. Total people currently in quarantine: 144; six in isolation. State health officials also warn there was a potential measles exposure event at a Costco store and tire center at 211 W. Blackstock Rd. in Spartanburg on Nov. 18 between 9:30 a.m. and 1 p.m.

As the outbreak grew, state health officials warned of infectious people potentially exposing others while shopping at a range of retail stores. One incident occurred at the Costco store and tire center at 211 W. Blackstock Rd. in Spartanburg on Nov. 18, 2025.

December 2, 2025 - More school exposures, 14 new cases

Total outbreak cases: 76. New cases: 14.

Eight of the 14 new measles cases announced by state health officials were the result of the previously reported exposure at the Way of Truth Church in Inman. Three of the new cases were exposed in a school setting, and the other three are still under investigation. Based on public health investigations of the new cases, the public was alerted that four Spartanburg County schools were the sites of additional measles exposures, requiring dozens of unvaccinated students to be excluded from school and quarantined. The schools involved: Hendrix Elementary School, where state data show 87% of students are up-to-date on school vaccines (40 students in quarantine); Mabry Middle School, where 81% of students are up-to-date on vaccines (13 students in quarantine); Chapman High School, where 87% of students are up-to-date on vaccines (5 students in quarantine); and Tyger River Elementary School, where 89% of students are up-to-date on vaccines (17 students in quarantine).

December 5, 2025 – Measles quarantines hit more schools

Total outbreak cases: 84. New cases: 8.

Eight new measles cases are announced by state health officials, but the number of people in quarantine and at risk of developing measles has jumped to 281. Based on public health investigations of the new cases, the public was alerted to new measles exposures at four additional Spartanburg County schools: Fairforest Elementary School, where 82% of students were up-to-date on their school vaccines (44 students in quarantine); Rainbow Lake Middle School, where 82% of students were up-to-date on vaccines (61 students in quarantine); Fairforest Middle School, where 90% of students are up-to-date on vaccines (fewer than 5 students in quarantine); Dorman Freshman Campus, where 93% of students are up-to-date on vaccines (15 students in quarantine). This is the second round of quarantines at Fairforest Elementary, which was one of the earliest sites of known measles cases in early October.

December 9, 2025 – Earlier church exposure fuels new infections

Total outbreak cases: 111. New cases: 27.

Of the 27 new measles cases announced, 16 resulted from previously reported exposure incidents in November at Way of Truth Church in Inman. Eight of the new infections were among household members of known cases. One infection was from a school exposure, one had an unknown source, and one was from an exposure in a health care setting. State health officials said the new cases have resulted in additional public exposures at Inman Intermediate School, where state data show 83% of students were up-to-date on vaccines (43 students in quarantine). Officials continue to encourage those who may have been exposed to measles to alert their health care provider in advance of going to their office, so that measures can be taken to protect against additional exposures.

December 12, 2025 – More than 300 in quarantine, 15 new cases

Total outbreak cases: 126. New cases: 15.

As state health officials investigate the contacts of 15 new measles cases, they identified two more Spartanburg County schools where public exposures have occurred: Campobello Gramling School, where state data show 80% of students are up-to-date on school vaccines (67 students in quarantine), and Boiling Springs Elementary School, where 80% of students are up-to-date on vaccines (16 students in quarantine). Overall, 303 people are in quarantine, many of them students at 11 schools. The large number in quarantine is a potential warning sign of the magnitude of future measles cases because there is a lag time between when people are exposed and when they start feeling sick – typically seven to 10 days, but sometimes as long as 21 days.

Of the 15 new cases, 13 involved exposures within households with known measles cases; one infection involved a neighborhood contact; and the source of one is unknown and under investigation.

Boiling Springs Elementary, a public school operated by Spartanburg County School District Two, is among several schools in South Carolina’s Upstate region that have had multiple rounds of quarantines.

December 16, 2025 - Nine new cases, another school exposure

Total outbreak cases: 135. New cases: 9.

Of the nine new measles cases announced, five were the result of a previously reported exposure at Way of Truth Church in Inman. Three cases involved known household exposures and one involved a neighborhood contact. Investigations of the new cases identified an additional Spartanburg County school with public exposures: Berry Shoals Elementary School, where 93% of students are up-to-date on school vaccines (44 students in quarantine).

December 19, 2025 – Another school with measles exposures

Total outbreak cases: 144. New cases: 9.

State health officials announce nine new measles cases: Four were infections of household members of known cases; one was from a previously identified school exposure; one was from a previously identified exposure at Way of Truth Church in Inman; and the source of three infections is unknown. Contact investigations for the new cases identified an additional school where measles exposures have occurred: New Prospect Elementary School in Inman, where 82% of students are up-to-date on school vaccines (56 students in quarantine).

December 23, 2025 – Nine new measles cases identified

Total outbreak cases: 153. New cases: 9.

Of the nine new cases announced, five resulted from household exposures to known cases; two involved a previously known school exposure; the source of one is unknown; and another is still being investigated.

December 26, 2025 – Three new measles cases identified

Total outbreak cases: 156. New cases: 3.

Amid the holiday season, three new measles cases were reported between Tuesday and Friday. All were the result of a previously reported school exposure, state officials said. There are 252 people in quarantine and three in isolation. The latest end date for those in quarantine is Jan. 15.

December 29, 2025 – School contact tracing delayed by holidays, resistance

Although it was not made public at the time, internal health department records later obtained by Healthbeat under South Carolina’s public records law show how efforts to quickly quarantine schoolchildren exposed to measles before winter break were hampered by school closures, as well as resistance from one school. With students continuing to fall ill with measles in late December, outbreak investigators couldn’t reach anyone at multiple Spartanburg schools to get contact information for classmates, staff and others who had been exposed before the two-week break. The schools where state records show contact-tracing delays occurred included: Global Academy of South Carolina, Sugar Ridge Elementary, Boiling Springs Elementary, and Jesse S. Bobo Elementary. The result: During this critical period in the outbreak, as cases were rising and more people were socializing and traveling, public health officials were not able to warn potentially infected people they needed to quarantine at home.

“Our inability to get contact information for potentially exposed students and notify those families resulted in some people being out and about in the community without knowing that they were infectious,” Bell would later tell Healthbeat. “The consequences being new cases due to additional exposures from people who would have otherwise been in quarantine had we been able to make contact.” At one school that health officials were able to reach by email on Dec. 29 – Westgate Christian School in Spartanburg – the principal refused to provide required information about students who had been exposed to measles. “We will not provide personal details and immunization status information for the students in our school,” the principal replied the next day. After state health officials sent Westgate a “final notice” letter in early January that threatened enforcement actions and potential fines, the school provided the information.

December 30, 2025 – As cases rise, 3 hospitalized from measles

Total outbreak cases: 176. New cases: 20.

Since Friday, state health officials identified 20 new measles cases and learned of three people – including adults and children – who required hospitalization because of complications from the disease. Citing patient privacy, health officials would not provide additional details about the hospitalized cases. The measles virus can cause serious complications such as pneumonia, brain inflammation, risks of premature births for pregnant mothers and it also can weaken a person’s immune system. Of the new cases, seven involved household exposures, five involved a previously known school exposure, two involved a church exposure, and one resulted from an exposure at either school or church, the state health department said.

January 2, 2026 – Nine more measles cases identified

Total outbreak cases: 185. New cases: 9.

Of the nine new cases detected, four were household exposures of known measles cases; one involved a previously reported school exposure; one case is still being investigated; and the source of three cases is unknown. The number of people in quarantine because they lack immunity and have been exposed: 223; three are in isolation for infections.

January 3, 2026 – Exposures at Best Buy, restaurant, library

The state health department announces that a person who did not know they were infectious with measles visited multiple public locations during the previous week. On Dec. 24, they visited the Nose Dive Restaurant, a gastropub at 116 S. Main St. in Greenville, then went to a Best Buy store at 1125 Woodruff Rd. in Greenville. A few days later, on Dec. 27, they attended an afternoon planetarium show about solar superstorms at the Spartanburg County Public Libraries headquarters library in downtown Spartanburg, which in October opened a new planetarium learning center with a 135-seat domed theater. Todd Stephens, the county’s librarian, said a public health official called him the day before the state’s press release went out and let him know someone with measles had been in the library’s theater a week earlier. “We have a response plan on Covid. We don’t have a document like that for this,” Stephens told Healthbeat. “But I can say we applied some of those principles that we’ve learned.” He said he’s not received any calls or concerns from library patrons about the potential exposure and he is not aware of anyone becoming infected.

A person who didn’t know they were infectious with measles attended an afternoon show in the Spartanburg County Libraries 135-seat domed planetarium theater on Dec. 27, 2025 in downtown Spartanburg, according to state health officials.

January 5, 2026 – S.C. outbreak exposes other states

People infected in South Carolina’s outbreak have exposed others while traveling, including at sites in Kentucky, North Carolina, Texas, Georgia, and New Mexico, according to a Jan. 5 memo the South Carolina Department of Public Health sent to staff at the South Carolina governor’s office. “The three latter sites are all associated with one case,” said the memo, which Healthbeat obtained with a public records request. “We sent an exposure notifications [sic] to all U.S. jurisdictions regarding the potential for exposure at the out-of-state-sites.”

January 6, 2026 – Public exposures at more schools, churches

Total outbreak cases: 211. New cases: 26.

Among the 26 new cases identified by state health officials, 19 involved exposures in households with known cases and at schools with previously announced exposures. Four of the new infections resulted from an exposure at church. One case has an unknown source, and two are still being investigated. Another 144 people without immunity are in quarantine because of exposures. Investigations of recent cases identified multiple locations of public exposures. Nine students are in quarantine at two Spartanburg County schools where these exposures occurred: Sugar Ridge Elementary, where 78% of students are up-to-date on vaccines, and Boiling Springs Elementary, where 80% of students are up-to-date on vaccines. It was the second time during the outbreak that students at Boiling Springs Elementary had to be quarantined; the previous quarantines were in December. Churches where public exposures occurred, health officials said, included: Tabernacle of Salvation Church, Slavic Pentecostal Church of Spartanburg, Ark of Salvation Church, and the Unitarian Universalist Church of Spartanburg.

January 7, 2026 - Health alert sent to providers, facilities

The state department of public health sent out a statewide alert to all health care providers and facilities about the importance of having “heightened awareness” for measles and providing advice on the recommended measures for the use of masks and rapid isolation of people suspected of having measles infections to protect others in health care settings from being exposed.

January 9, 2026 – Measles cases spike with 99 new infections

Total outbreak cases: 310. New cases: 99.

Between Tuesday and Friday this week, state health officials identified 99 new cases of measles. They said another 200 people were in quarantine because of exposures. Dr. Linda Bell, the state epidemiologist, warned it was becoming increasingly difficult to identify likely sources of infection because of the increasing number of public exposure sites. “The number of those in quarantine does not reflect the number actually exposed,” Bell said. “An increasing number of public exposure sites are being identified with likely hundreds more people exposed who are not aware they should be in quarantine if they are not immune to measles.” The department flags one new public exposure site: Jesse S. Bobo Elementary School, where state data show 94% of students are up-to-date on school vaccines.

Jesse S. Bobo Elementary School, a public school in Spartanburg County School District Six, had a measles exposure incident that state health officials announced on Jan. 9, 2026.

January 12, 2026 – Measles exposures at BMW, Michelin plants

Although not publicly known at the time, internal South Carolina Department of Public Health records obtained by Healthbeat show that large manufacturing plants for BMW and Michelin in Spartanburg were the sites of measles exposure incidents in January. While the health department alerted staff at the South Carolina governor’s office about the plant exposures in a Jan. 12 email, these exposures at large, prominent manufacturing plants weren’t publicly announced. When Healthbeat later revealed the exposures, BMW said it kept its workforce informed about measles cases at the plant and that the company was providing on-site access to vaccinations. Michelin declined to answer questions about what actions it took.

January 13, 2026 - Surge continues with 124 new measles cases

Total outbreak cases: 434. New cases: 124.

Health officials announce another surge in cases, with 124 new infections identified in recent days. They said another 409 people are in isolation because they were exposed and lacked vaccination or immunity from previous infection; 17 were in isolation. Investigators have learned of more than 30 public locations where infectious people have potentially exposed others to measles in recent days, Bell said. Besides schools, these locations have included churches, restaurants, and many health care settings, she said. But the department is only naming locations where details about exposure dates and times are available to allow the public to take informed actions, she said.

Adding to concerns: Health officials learned that a person who didn’t know they were infectious had visited the South Carolina State Museum in Columbia – the state’s capital city, which is about 95 miles southeast of the outbreak area in Spartanburg County. No measles cases have been identified outside the Upstate region, officials said. “Circulation of the measles virus is increasing in numerous community settings in the Upstate, and the risk of infection to those who are not immune to measles by vaccination or previous disease is increasing,” Bell said. “This includes people who may be traveling to the upstate region. So [the Department of Public Health] strongly encourages those who are not protected to consider getting vaccinated now to protect against unexpected exposures, against illness, and possible complications.”

January 15, 2026 – S.C. residents spark Washington, N.C. cases

The Snohomish County Health Department in Washington state announces that an infectious family from South Carolina who was visiting the area two weeks ago is now connected to three new measles cases among local children. The three cases are considered an outbreak and a sign the virus is spreading in the community, the department said. The South Carolina family members, one adult and two children, were infectious while visiting multiple locations in Everett, Marysville, and Mukilteo – including schools – from Dec. 27, 2025 through Jan. 1, 2026. They also flew through Seattle-Tacoma International Airport. “We are hoping to contain it, but unfortunately there have been a number of exposure sites already and there are likely more cases in the community that we do not know about yet,” said Dr. James Lewis, the Snohomish County health officer.

In North Carolina, state health officials announce that the South Carolina outbreak is connected to two cases of measles in unvaccinated siblings Buncombe County, N.C.

January 16, 2026 – Schools hit with repeated quarantines

Total outbreak cases: 558. New cases: 124.

Another 124 new measles cases are announced by state health officials; 531 people are in quarantine; and 85 are in isolation. The outbreak continues to be centered around Spartanburg County, they said.

Based on investigations of the newest cases, health officials said public exposures have occurred at nine schools: Holly Springs-Motlow Elementary, where state data show 80% of students are up-to-date on school vaccines (53 students in quarantine); Campobello Gramling School, where 80% of students are up-to-date on vaccines (46 students in quarantine – and the school’s second round of quarantines); Crestview Elementary, where 90% of students are up-to-date on vaccines (22 students in quarantine); Libertas Academy, where 74% of students are up-to-date on their vaccines (15 students in quarantine); Fairforest Elementary, where 82% of students were up-to-date on their school vaccines (14 students in quarantine – and the third round of quarantines at this school); Berry Shoals Elementary, where 93% of students are up-to-date on school vaccines (14 students in quarantine – and the school’s second round of quarantines); Oakland Elementary, where 83% of students are up-to-date on vaccines (6 students in quarantine); Mabry Middle School, where 81% of students are up-to-date on vaccines (6 students in quarantine – and the school’s second round of quarantines); and Landrum High School, where 94% of students are up-to-date on vaccines (5 students in quarantine).

Additional public exposures occurred during certain hours at: Walmart at 203 Cedar Springs Rd. in Spartanburg on Jan. 3; Wash Depot at 2177 S. Pine St. in Spartanburg on Jan. 3 and 4; and at Bintime Spartanburg at 445 S. Blackstock Rd. in Spartanburg on Jan. 7.

Fairforest Elementary, a public school in Spartanburg, S.C., was one of two schools that had some of the earliest confirmed cases of measles linked to the outbreak.

January 20, 2026 – Exposures at schools, Clemson University

Total outbreak cases: 646. New cases: 88.

“As we continue to watch this daily surge in cases, DPH strongly encourages those who are not protected to take advantage of the opportunity to get protected,” Dr. Linda Bell, the state epidemiologist, says at a press briefing about the outbreak numbers released on Jan. 20.

In recent days, state health officials identified 88 new measles cases. They said 538 people are in quarantine and 33 in isolation. Bell said that since the outbreak began,10 people, including adults and children, have required hospitalization for measles complications.

Through investigations of the latest cases, health officials have identified six additional schools where public exposures have recently occurred: Starr Elementary, where 96% of students are up-to-date on school vaccines (17 students in quarantine); Global Academy of South Carolina, where 21% of students are up-to-date on vaccines (13 students in quarantine – and this school’s second round of quarantines); Boiling Springs High School, where 92% of students are up-to-date on vaccines (11 students in quarantine); Chapman High School, where 87% of students are up-to-date on vaccines (fewer than 5 students in quarantine – this is the school’s second round of quarantines); Boiling Springs Elementary (students in quarantine to be determined – this is the school’s third round of quarantines); Rainbow Lake Middle School, where 82% of students were up-to-date on vaccines (quarantine numbers still being determined – this is the school’s second round of quarantines).

Public exposures have also been identified at Clemson University (where 34 students were in quarantine) and Anderson University (where 50 students were in quarantine). While both universities are in South Carolina’s Upstate region, they are in counties west and southwest of the Spartanburg County area where the outbreak has been centered.

Additional public measles exposures were announced as occurring during certain hours at two grocery stores: a Publix at 2153 E. Main St. in Duncan on Jan. 16; and a Food Lion at 11153 Asheville Hwy. in Inman on Jan. 11 and 12.

January 23, 2026 – Cases reach 700, plus 485 in quarantine

Total outbreak cases: 700. New cases: 54.

The number of known cases in South Carolina’s measles outbreak is approaching the total cases in the huge Texas outbreak last year. When the Texas outbreak was declared over in August 2025, the state health department had confirmed 762 measles cases since late January 2025. Two school-age children died and 99 people required hospitalization. The South Carolina Department of Public Health announces it has identified 54 new measles cases in the Upstate region – raising the total outbreak cases to 700. There are an additional 485 people in quarantine and 10 people are in isolation, the department said. Since the outbreak began, 12 people have required hospitalization.

Case investigations have identified additional public exposures at multiple schools: Cooley Springs-Fingerville Elementary, where 77% of students are up-to-date on their school vaccines (22 students in quarantine); Cannons Elementary, where 95% of students are up-to-date on vaccines (8 students in quarantine); Abner Creek Middle School, where 89% of students are up-to-date on vaccines (the number of students being quarantined is still being determined); Mayo Elementary, where 89% of students are up-to-date on vaccines (student quarantines still being determined); and Sugar Ridge Elementary, where 78% of students are up-to-date on vaccines (student quarantines still being determined, this is the second round of quarantines at this school).

Additional public exposure locations occurred during certain hours at: Anytime Fitness at 3621 Boiling Springs Rd. in Boiling Springs on Jan. 13; the U.S. Post Office at 504 Pennsylvania Ave. in Greer on Jan. 13; Goodwill at 1333 W. Wade Hampton Blvd. in Greer on Jan. 13; and Aldi at 1560 W. Floyd Baker Blvd. in Gaffney on Jan. 17.

January 27, 2026 – S.C. outbreak exceeds Texas outbreak

Total outbreak cases: 789. New cases: 89.

State health officials announce they have confirmed 89 new measles cases, and that there are 557 people in quarantine and 20 in isolation. Outbreak investigators also have identified more public measles exposures that have occurred at several schools: Dorman High, where 96% of students are up-to-date on school vaccines; Inman Intermediate, where students have previously been quarantined and 83% of students are up-to-date on vaccines; and New Prospect Elementary in Inman, where students have previously been quarantined and where 82% of students are up-to-date. The state health department said the number of students that need to quarantine at each of these schools is still being determined. The newly identified cases raise the South Carolina outbreak’s total to 789 – surpassing the number sickened in the deadly Texas outbreak last year. In Texas, 762 cases of measles were confirmed in an outbreak that began in late January 2025 and was declared over in August 2025.

January 30, 2026 – Surge puts 443 in quarantine

Total outbreak cases: 847. New cases: 58.

Numbers released by the state health department show 58 new measles cases have been identified. There are 443 people in quarantine who have been exposed, who lack immunity, and who are at risk of developing the disease in the coming days and weeks. Twenty people are in isolation because of illness. Public health investigators have identified a school and a fast food restaurant with recent public exposures because of the presence of an infectious person. Health officials are still determining how many students need to be quarantined and excluded from class at the school, Lyman Elementary, where state records show 89% of students are up-to-date on school vaccines. The school was involved in a previous exposure situation announced on Nov. 21. The other public exposure event involves a Burger King restaurant at 6196 US-221 in Roebuck, S.C., that occurred on Jan. 28 between 11:30 a.m. and 2:30 p.m.

February 3, 2026 – Fewer infections – but one in Sumter County

Total outbreak cases: 876. New cases: 29.

The state health department announces 29 new cases of measles in the ongoing outbreak in South Carolina’s Upstate region, in and near Spartanburg County. They also said a measles case has been confirmed in a resident of Sumter County – which is located in South Carolina’s Pee Dee Region, southeast from where the outbreak has been occurring. “At this point in the investigation, it is not yet clear whether this new case is linked to the Upstate outbreak centered around Spartanburg County or if the case may have been exposed where measles is occurring in other locations,” the department said. The department said public exposures to measles have occurred during certain specific hours at three locations in Sumter, S.C.: Mariachis Mexican Restaurant at 1072 Broad St. on Jan. 23; Food Lion at 5700 Broad Street Ext. on Jan. 24; and the Walmart Neighborhood Market at 343 Pinewood Rd. on Jan. 25. The health department said there are currently 354 people in quarantine who have been exposed to measles and lack vaccination or immunity; 22 people are ill and in isolation.

February 6, 2026 – Vaccination is up significantly

Total outbreak cases: 920. New cases: 44

State health officials announce 44 new measles cases, plus another 277 people who are in quarantine because they were exposed and are unvaccinated or lack immunity from prior infection; eight people are in isolation because of illness. They also announce new locations of public exposure incidents during certain specific time periods at a Social Security Administration office at 145 N. Church St. in Spartanburg on Jan. 29; Boost Mobile at 1515 Asheville Hwy. in Spartanburg on Jan. 29; Rick Erwin’s Level 10 Restaurant at 225 W. Main St. in Spartanburg on Jan. 29; and the Target store at 6025 Wade Hampton Blvd. in Taylors on Jan. 30.

During a media call earlier in the week, Bell said state health officials are encouraged by increases in measles vaccination during January. In Spartanburg County, the number of measles vaccines given last month was up 162% over January 2025, an increase of more than 1,000 doses, she said. Statewide, measles vaccination was up 72%, with about 7,000 more doses given across South Carolina last month than were administered in January 2025. “So far, this is the best month for measles vaccination during this outbreak,” Bell said.

While complications from measles aren’t reportable to state health officials, Bell said the department has learned of some serious complications among 19 people – children and adults – who have been hospitalized since the outbreak began in October. “Some of these complications include measles encephalitis, or inflammation of the brain in children, and pneumonia.”

In addition, Bell said, several pregnant women were exposed to measles and required administration of immune globulin to protect against the high risk of complications measles poses to pregnant women and their newborns. Bell declined to provide additional details about the exposures of the pregnant women. Earlier in the week, Healthbeat revealed a measles exposure incident had occurred on a labor and delivery unit at Prisma Health Greer Memorial Hospital.

February 10, 2026 – Fewer new cases, but one in Lancaster County

Total outbreak cases: 933. New cases: 13

Just 13 new measles cases are announced in the state health department’s update; 235 people are in quarantine because of exposures, and six are in isolation because of illness. The department noted that a measles infection has been confirmed in a resident of Lancaster County; the source of the person’s exposure is still under investigation. The outbreak has not previously had any cases in Lancaster County, which is in north-central South Carolina. Two schools in Spartanburg County have been the sites of recent public exposures: Libertas Academy, where 74% of students are up-to-date on their school vaccines (nine individuals in quarantine); and Inman Intermediate, 83% of students are up-to-date on vaccines (fewer than five individuals in quarantine). People also remain in quarantine from an earlier public exposure at Lyman Elementary School, where 89% of students are up-to-date on vaccines (23 individuals remain in quarantine).

February 13, 2026 – Concerns linger about undetected cases

Total outbreak cases: 950. New cases: 17

The number of new measles cases announced today continues to be well below the numbers during the January surge. The state health department said 17 new cases of measles have been identified and there are another 186 people in quarantine because of exposures; nine people are in isolation because of illness. The recent identification of measles cases in Lancaster and Sumter counties – with no identified source of exposure – indicate that unrecognized transmission of measles is occurring in the community, Bell told reporters this week. “That can result in more and more transmission if we don’t stay on top of those cases, find out where that transmission is occurring, and implement our disease control measures,” Bell said. The outbreak continues to be centered in Spartanburg County, she said, and about 95% of those who have been infected are unvaccinated. The department announced three locations where public exposures have occurred recently during defined time periods: Children’s Medical Center, 841 S. Buncombe Rd. in Greer, all day on Feb. 4 and 6; Itto Ramen Bar, 1807 Poinsett Hwy. in Greenville, on Feb. 5 from 12:30 p.m. to 3:30 p.m.; and HomeGoods, 1125 Woodruff Rd. in Greenville, on Feb. 5 from 10 a.m. to 12:45 p.m.

February 17, 2026 – Most new infections involve known cases

Total outbreak cases: 962. New cases: 12.

State health officials announce 12 new cases and said there are an additional 127 people in quarantine because of exposures; eight people are in isolation because of symptoms. “The majority of cases are close contacts of known cases,” the state health department said. “However, the number of public exposure sites indicates that measles is circulating in the community, increasing the risk of exposure and the risk of infection for those who are not immune due to vaccination or natural infection.” The department said it is aware of 20 hospitalizations, involving children and adults, since the start of the outbreak. Libertas Academy has been the site of a recent public exposure event (17 individuals in quarantine). This school, where 74% of students are up-to-date on their school vaccines, has had previous exposure events, state records show. The department also announced a public exposure event occurred at Walmart – Powdersville, 11410 Anderson Rd. in Greenville on Feb. 8 from 4 to 8 p.m.

February 20, 2026 – Church, school, community college exposures

Total outbreak cases: 973. New cases: 11.

Health officials announce the identification of 11 new measles cases, and say there are 105 people in quarantine because of exposure and seven in isolation because of illness. “We are seeing a slowing, but it is too soon for us to say when this will end,” Bell said this week. “The concern is that we can see ongoing, smoldering transmission that can be introduced into other communities. The measles virus can find susceptible people wherever.”

While the number of new cases announced continues to be low, state health officials warn that public exposures have occurred recently at multiple locations in Spartanburg County. The exposure locations include Mabry Middle School in Inman, where 81% of students are up-to-date on vaccines and exposures have occurred previously. Other sites: Tabernacle of Salvation Slavic Church, 150 Outlet Rd. in Spartanburg, on Feb. 15 from 10 a.m. to 1 p.m.; Westgate Baptist Church, 1990 Old Reidville Rd. in Spartanburg, on Feb. 11 from 6:30 to 10 p.m .; Spartanburg Community College - Giles Campus, 107 Community College Dr. in Spartanburg, on Feb. 17 from 9:30 a.m. to 7:30 p.m.; Costco, 211 W. Blackstock Rd., Spartanburg, on Feb. 17 from 12 to 3 p.m.

February 24, 2026 – Just 6 new cases

Total outbreak cases: 979. New cases: 6.

Just six new cases of measles are announced by state health officials, plus 91 others who are in quarantine for exposures; one person is in isolation because of illness. The latest end date for those in quarantine is March 15. The newest cases have resulted in outbreak investigators identifying public exposures at Willow Creek Gathers Homeschool Co-op, where 17 individuals are in quarantine, the state health department said. Although South Carolina requires immediate reporting of cases of measles or suspected measles to the health department, the state doesn’t specifically require reporting about whether these cases were hospitalized or had complications. Over the course of the outbreak, the health department says it has learned about 21 people, children and adults, who have been hospitalized.

Since the outbreak began, the South Carolina Department of Public Health has used its mobile clinic to offer free measles-mumps-rubella vaccines in the Spartanburg County area.

February 27, 2026 – Hopes for earlier end to outbreak

Total outbreak cases: 985. New cases: 6.

Since Tuesday, state health officials say they have identified six new measles cases. There are 61 people in quarantine because of exposures; two people are in isolation for illness. The latest end date for people currently in quarantine and who may develop the disease is March 20. “We’re encouraged with the downward trend, particularly in the last two weeks,” Bell, the state epidemiologist, said this week. It’s possible that the outbreak may even end earlier than projected, she said. But the risk of another surge remains because of low vaccination coverage. The department said that based on the recent cases, investigators have identified public exposures that have recently occurred at Sugar Ridge Elementary, where 78% of students are up-to-date on vaccines. Fewer than five individuals from the school are in quarantine, officials said. This is the third round of quarantines for the school, health department records show. Another public exposure incident occurred at Costco - Spartanburg at 211 W. Blackstock Rd. on Feb. 22 from 2 to 6 p.m. It’s the third known measles exposure incident at the store, with the others occurring on Feb. 17 and Nov. 18, according to health department reports. State health officials said their mobile health unit will hold another measles vaccination clinic next week.

March 3, 2026 - Increased vaccination is helping slow outbreak, state says

Total outbreak cases: 990. New cases: 5.

The number of new cases reported to the state health department remains low: Just five new cases since Friday, health officials announced. There are 52 people in quarantine because of exposures and four in isolation because of illness. The latest end date for those in quarantine is March 27. The state health department also said there was a public measles exposure incident at Westgate Baptist Church, 1990 Old Reidville Rd. in Spartanburg, on Feb. 22 from 10:45 a.m. to 4 p.m. This church also had a measles exposure incident on Feb. 11. “We saw another strong increase in measles vaccination uptake during the month of February, which is encouraging,” Bell said at a media briefing this week. “Compared to February of 2025, there was a 133% increase in measles vaccination in Spartanburg County, with around 900 additional doses given,” she said. Statewide, there was a 70% increase in measles vaccination, with an additional 7,000 doses given. “This increase in vaccination is one of the reasons why this outbreak is slowing,” Bell said. “But given the surge in cases we saw following the Christmas holidays, we remain concerned that another surge could occur following spring break, when many people can be traveling and participating in more social activities.”

March 6, 2026 – Just one new case as outbreak cost reaches $1.6 million

Total outbreak cases: 991. New cases: 1.

Just one new measles case is announced by state health officials in their Friday update. There are 52 people in quarantine because of exposures and three in isolation because of illness. The latest end date for those in quarantine is March 27. Meanwhile, state health officials told Healthbeat this week that the public health response to the outbreak has cost taxpayers $1.6 million so far. Most of that has been personnel costs, including for contact tracing and other activities to combat the outbreak, the department said.

Of the 991 outbreak cases, most have been children and teens: 260 are younger than 5; 637 are ages 5-17; 86 are age 18 or older; and the age is unknown for eight cases. Almost all who have been infected have been unvaccinated or only partially vaccinated: 925 were unvaccinated; 19 had only one one dose of the recommended two-dose MMR vaccine; 26 were fully vaccinated with two doses of MMR; and the vaccination status was unknown for 21 cases.

March 10, 2026 – Slow trickle of cases continues

Total outbreak cases: 993. New cases: 2.

State health officials announce just two new measles cases have been identified since Friday; 42 people are in quarantine because of exposures; 2 are in isolation because of illness. The latest end date for those keeping watch for signs of illness while in quarantine is April 2. “We’re very encouraged by the decline in cases, but we won’t be able to declare this outbreak over until we’re certain that measles transmission has ended,” Bell said this week. The department doesn’t want to have measles cases surge during the upcoming spring break period. Bell said the department has asked all schools in the Upstate region to identify a point of contact who will be available when schools are closed over spring break to provide student contact information if it’s needed for measles exposure investigations. Healthbeat previously revealed how outbreak investigations were hampered and quarantines were delayed during school winter break because health officials couldn’t quickly get contact information from several schools.

March 13, 2026 – Three new cases

Total outbreak cases: 996. New cases: 3.

State officials announce three new measles cases, and that the number of people in quarantine because of exposures is down to 30. Four people are in isolation because of illness. The latest quarantine end date is April 2. Of the outbreak’s 996 cases, 993 have been in Spartanburg County and 36 have been in neighboring Greenville County. A handful of additional cases have been in three other nearby counties in South Carolina’s Upstate region: eight in Anderson County, six in Pickens County, and fewer than five in Cherokee County. Two additional counties in other parts of the state also have a small number of cases: Lancaster County, in the state’s Midlands region, and Sumter County in the Pee Dee region each have fewer than five cases, according to state data.

March 17, 2026 – ‘We are not letting our guard down’

Total outbreak cases: 997. New cases: 1.

State officials announce one new measles case and say there are only eight people in quarantine for exposures and none in isolation because of illness. The latest end date for those in quarantine is April 2. “We are not letting our guard down. It is too early to say that we will not see any more cases,” Bell said this week. She said it’s important that health care providers remain vigilant and continue to suspect measles when they see illnesses with a fever and rash. “That gives us the opportunity to immediately place people in isolation, to place their contacts in quarantine, if necessary,” she said. “If we let our guard down too early, then we just put ourselves in the position of allowing more disease to spread if we are not paying careful attention.” Before South Carolina can declare the outbreak over, there must be two incubation cycles – or 42 days – with no new cases, Bell said. In the meantime, spring break for many schools in the Spartanburg area is scheduled for early April, and state officials remain concerned that travel and socializing during the school break period could result in more measles cases.

March 20, 2026 – No new measles cases since Tuesday

Total outbreak cases: 997. New cases: 0.

State health officials, in their Friday update, announced no new measles cases had been identified since Tuesday. The last time there were zero new cases in one of their twice-weekly outbreak updates was more than four months ago on Nov. 4. There are two people in quarantine because of exposures. Their last date in quarantine is March 28.

March 24, 2026 – Again, no new measles cases

Total outbreak cases: 997. New cases: 0.

For the second update in a row, state health officials in their Tuesday update said no new measles cases had been identified. Two people remain in quarantine because of exposures, with a latest quarantine end date of March 28. Nobody is in isolation because of illness. It will take 42 consecutive days with no new cases – two incubation cycles of the virus – to determine that the outbreak’s transmission chain has been broken, the health department said. If the no cases trend continues, the last day of the outbreak will be April 26.

March 27, 2026 – No new cases, only one person in quarantine

Total outbreak cases: 997. New cases: 0.

South Carolina health officials announce they continue to detect no new measles cases. Just one person remains in quarantine because they lack immunity and were exposed – and that person is almost out of danger. Their quarantine ends March 28. One question lingers: Are there still some measles cases that aren’t being detected and reported? A report from outbreak modelers at the Centers for Disease Control and Prevention, completed earlier this month, said it was likely measles cases in the outbreak were going unreported, Healthbeat reported.

While Bell told Healthbeat she remains concerned about unrecognized cases, if they exist, the department doesn’t think there are a lot of them. “Our surveillance systems indicate this trend reflects a true decrease and not people avoiding health care,” she said. Before the outbreak can be declared over, a period of 42 days – two incubation cycles for the virus – must pass without any more measles cases. If that happens, the last day of the outbreak would be April 26.

March 31, 2026 – No new cases and nobody in quarantine

Total outbreak cases: 997. New cases: 0.

With no new cases reported again and also nobody in quarantine, the countdown to the end of the outbreak continues. The outbreak can’t be declared over until two incubation cycles of 21 days each have passed without any new cases. If that happens, the last day of the outbreak would be April 26, state health officials have said.

April 3, 2026 – Still no new cases

Total outbreak cases: 997. New cases: 0.

The countdown to an April 26 last day of the outbreak remains underway as state health officials again announce no new cases.

April 7, 2026 – Still no new cases as DPH scales back public updates

Total outbreak cases: 997. New cases: 0.

The countdown to an April 26 last day of the outbreak continues as state health officials again announce no new cases. Unless a new measles case is identified, the South Carolina Department of Public Health said it will reduce the frequency of its Wednesday media briefings to every other week. While Tuesday outbreak data updates will continue, Friday updates will be discontinued, the department said. “If a new case is reported, DPH will immediately notify the media and resume briefings and updates as appropriate,” the department said.

April 27, 2026 – DPH declares the outbreak over, risks remain

Total outbreak cases: 997.

After 42 days passed without any new outbreak cases, the South Carolina Department of Public Health declared the outbreak to be over.

“Though we reached nearly 1,000 cases, we are grateful that, by and large, it remained confined to one county and did not spread statewide, as was always our concern and fear,” Dr. Brannon Traxler, the department’s deputy director and chief medical officer, said at a news conference.

Traxler said there are three main reasons state health officials think the outbreak has ended: the large number of people infected, widespread community cooperation with quarantine and isolation, and increased vaccination against measles in recent months.

While this record-breaking outbreak is over, Traxler said conditions remain for another measles outbreak in the future, brought into the state through travel.

“If we don’t continue to see increases in vaccination, I’m worried that we could see another large – maybe not this large, but hopefully not – but another large outbreak in a community where it gets introduced from someone who had traveled.”

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48.

South Carolina’s measles outbreak is over: 7 things to know about largest U.S. outbreak in decades

2026-04-27T23:49:47+00:00

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Officials at the South Carolina Department of Public Health declared their record-breaking measles outbreak to be over on Monday after no new cases emerged during the past 42 days.

Here are seven things to know about the largest U.S. measles outbreak in more than 35 years:

Most people who got infected weren’t vaccinated

Of the 997 measles cases documented in the outbreak, 932 patients were unvaccinated, 19 had an unknown vaccination status, and 20 were only partially vaccinated with only one dose of the two-dose MMR (measles-mumps-rubella) vaccine, according to the department’s data.

Just 26 people were fully vaccinated with two doses of MMR vaccine. Two doses of the vaccine is about 97% effective in providing protection against measles infections; one dose is about 93% effective, according to the Centers for Disease Control and Prevention.

Infections, increased vaccination credited in stopping outbreak

The 997 people sickened with measles developed immunity to the disease, Traxler said. “Though that carried with it, of course, the risk of severe illness, a weakened immune system and the potential for devastating complications even years from now,” she said.

Another important factor in stopping the spread of the virus, she said, was that the “vast majority” of people who were infected or exposed followed public health instructions to stay home and avoid infecting others.

Lastly, thousands of people got vaccinated. In Spartanburg County, she said, an additional 3,788 doses of MMR vaccine were administered during the six months of the outbreak compared with the previous year.

“In particular, January and February were record months for MMR vaccination in the state,” she said.

Risks for future measles outbreaks continue in South Carolina

This outbreak may be over, but outbreak risks remain in Spartanburg County and across the state. Traxler noted that pockets of people who are not protected against measles remain in many communities.

“We’re going to continue to see sporadic cases that are going to be travel-associated most likely,” Traxler said, noting the goal is to keep one of these travel cases from sparking a larger outbreak.

State’s $2.1 million cost is only part of the outbreak’s bill

The department estimates that the outbreak response cost the state of South Carolina $2.1 million. But that was just the costs the department could calculate for staff time, vaccination costs, and other direct expenses.

It doesn’t include all of the costs to the health care system, schools, businesses, and beyond, she said. “What were the economic impacts to the state of parents who had to miss work?” she asked. It’s not part of that number.

Outbreak began with 5 cases, centered in Spartanburg County

The outbreak was first identified in early October, with just five cases. For weeks the virus seemed to spread slowly – then the holiday season began.

On the Tuesday before Thanksgiving, the state had logged 55 measles cases. By Dec. 12, there were 126 cases – and more than 300 people in quarantine, Healthbeat’s timeline of the outbreak shows.

By mid January – after the December holidays and multiple public exposures at schools and churches – the outbreak surged, with more than 100 new measles cases being identified every few days. By Jan. 20, the department had documented 646 cases. Cases slowed during February and March.

The last time the state announced a new case in the outbreak was on March 17, the day the case total reached 997.

Before the measles outbreak could be declared over, there needed to be two incubation cycles – or 42 days – without any new cases.

Winter break school closures delayed investigations, quarantines

During the critical December holiday period – before the outbreak surged – South Carolina health officials were hampered in their efforts to control measles exposures because of winter break school closures, Healthbeat reported earlier this year.

Internal department records, obtained by Healthbeat, revealed how outbreak investigators were delayed in their efforts to quickly quarantine schoolchildren exposed to measles right before the two-week winter break period began. Because schools were closed, outbreak investigators couldn’t reach anyone at multiple Spartanburg schools to get contact information for classmates, staff, and others who had been exposed to infected people.

To prevent similar communications gaps during the recent spring break period, the department contacted schools across the state’s 11-county Upstate region to identify a person who would be available to provide attendance and contact information during the spring break closures of schools and administrative offices.

Department’s response, lessons learned to be evaluated

“The outbreak is over, but our work to understand and prevent measles and future outbreaks is not,” Traxler said. “A thorough after-action review and analysis is being started. We believe our outbreak response team did a tremendous job under really unprecedented conditions. But there are always things that we can learn from and improve on in our future with future responses, and we are committed to doing so.”

One of the things the department did well, she said, was urging members of the health care community to be pro-active in immediately reporting any suspected measles case – even before any test results come back. That early heads-up, she said, allowed the department to immediately start educating the patient about the need to isolate and begin earlier contact tracing.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48.

Many babies sickened in ByHeart formula botulism outbreak needed more treatment after hospitalization

2026-04-24T22:15:24+00:00

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Most of the babies hospitalized in a recent nationwide outbreak of infant botulism linked to ByHeart baby formula have needed additional physical therapy and other medical support after going home, according to new data shared Friday.

“Although many infants are now progressing in their recovery, evaluating their outcomes is essential to understanding the progression and severity of illness observed during this outbreak,” said Myra Brooks, a member of the Centers for Disease Control and Prevention’s Epidemic Intelligence Service, who presented the data at the service’s annual conference in Atlanta. The conference highlights the work of the agency’s disease detectives.

Brooks, a first-year EIS officer, works with the CDC’s National Botulism Consultation Service and was part of the response to the outbreak linked to ByHeart infant formula last year. It is the first documented outbreak of infant botulism linked to powdered formula, she noted.

The CDC declared the outbreak over on Feb. 26, with 48 confirmed and probable cases of infant botulism in 17 states that were linked to the baby formula. All of the infants required hospitalization; there were no deaths. All of ByHeart’s Whole Nutrition Infant Formula products were recalled.

Infant botulism is caused by babies ingesting spores of Clostridium botulinum bacteria, which can activate in their intestines and produce a dangerous toxin that can cause muscle weakness and paralysis. Initial symptoms can include difficulty sucking and swallowing, constipation, and loss of head control. Without treatment, breathing difficulties can develop.

Health investigators were able to obtain and review the medical records for 46 of the 48 infants, which showed that most of those who were sickened had moderate to severe disease.

Those with moderate disease, 61% of the infants in the outbreak, required assisted feeding or non-invasive respiratory support, Brooks said Friday. Another 11% of the infants had severe disease. “During hospitalization, these infants experienced respiratory difficulty, requiring intubation or received a surgically placed feeding tube,” she said.

The remaining 28% of infants in the outbreak were classified as having mild disease, although they still needed hospitalization.

While the outbreak cases stayed in the hospital for a median of eight days, some of those with severe disease were hospitalized for more than a month, according to her presentation slides.

For many of the infants sickened in the outbreak, their medical treatments needed to continue after leaving the hospital, Brooks said.

“A third of infants were discharged with nasogastric tubes to supplement feeding, and two-thirds of infants had follow-up orders for physical, speech or occupational therapy,” she said.

The infant botulism outbreak was first identified in early November by the California Department of Public Health, which runs the national infant botulism program that distributes the only FDA-approved drug to treat children sickened by the toxin. The department noticed an increase in medication requests among babies who had consumed ByHeart formula and alerted federal officials.

Outbreak cases continued to rise in the weeks that followed amid delays by retailers in removing recalled formula from store shelves that were compounded by delays by the Food and Drug Administration in sharing information with state food safety officials about where the product was being sold.

While health officials initially thought babies had started falling ill in August 2025, they later identified cases going back to December 2023.

Although ByHeart’s products made up only about 1% of the formula products sold in the United States, the premium organic brand had a loyal following and the outbreak shook some consumers’ confidence in formula safety generally.

The federal investigation of how ByHeart’s formula became contaminated has in recent months focused on the product’s ingredients. Earlier this year, the FDA announced that tests had detected contamination with Clostridium botulinum – the bacteria that cause infant botulism – in some samples of powdered whole milk used to make the formula.

The FDA has said its investigation into the root cause of the contamination is ongoing, but the agency has not provided any update since Feb. 26.

ByHeart’s media team, in an email to Healthbeat late Friday, said the company continues to work with the FDA on its investigation. “Our root cause investigation remains ongoing, and we’ll share updates as they become available,” the email said.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48.

Where measles is spreading in the U.S.: Outbreaks fuel infections in states coast to coast

2026-04-09T21:27:09+00:00

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Measles infections continue to spread across the United States, largely fueled by outbreaks – large and small – in multiple states

Since January, there have been more than 1,670 confirmed cases of measles nationwide, with most states reporting at least one case to the Centers for Disease Control and Prevention.

States with 10 or more confirmed cases of measles since January include: Arizona, California, Colorado, Florida, Minnesota, New Mexico, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, South Carolina, Texas, Utah, Virginia, and Washington state, according to federal, state, and local data.

But health officials in multiple states have told Healthbeat they are concerned measles cases are going unreported because there are people who aren’t seeking diagnosis and treatment. They also are worried that recent spring break travel may contribute to more people falling ill with measles in the next few weeks. It can take two to three weeks for symptoms to appear after a person is infected.

The good news: South Carolina, the site of the largest U.S. measles outbreak in decades with 997 cases, hasn’t had a reported measles infection in more than three weeks and will be declared over if that trend continues through April 26.

The bad news: Utah’s outbreak – now the largest, still-growing outbreak in the country – is approaching 600 known cases.

The CDC defines an outbreak as three or more related cases. Here’s what to know about six places where measles has been spreading:

Utah: The largest outbreak that is still growing

Utah’s large outbreak, like others, began with just a handful of cases that started being identified last June. A few were in Utah County, around Provo. Others were in a rural area in the southwest corner of the state – where the virus continued to gain traction, becoming the focus of the outbreak throughout last year.

By the end of 2025, 197 people had been diagnosed with measles largely in that one corner of the state. Then in recent months the outbreak surged statewide. Since January, another 386 people have been diagnosed, bringing the outbreak’s total to 583 reported cases as of this week. At least 47 people have been hospitalized.

Dr. Leisha Nolen, Utah’s state epidemiologist, said the number of cases known to public health officials is an undercount. “I can say confidently that we are missing cases,” she said.

But it’s difficult to say how many.

In some communities that are particularly distrustful of government and public health, as few as 1 in 10 cases may go unreported, she said. Cases in remote rural communities, with limited access to health care, may also have higher rates of underreporting, while more cases may get counted in cities with easier access to doctors and hospitals.

One thing is clear: Utah’s outbreak is continuing to grow. In the last three weeks, state health officials have learned of 121 new cases.

“In the beginning of our outbreak, we did have mostly communities along the southwest border with Arizona affected, and we were really trying to contain it in that area and prevent spread,” Nolen said. “But as you know, people move around.”

A state high school wrestling championship in mid February contributed to the spread of the disease, health officials said. The state’s TriCounty Health District in northeast Utah, with 59 reported cases, has been particularly hard hit in recent weeks following the event.

Kirk Benge, TriCounty Health director, said the region’s outbreak has been centered around the city of Vernal, which is known as “Dinosaurland” because of the area’s rich deposits of dinosaur fossils and nearby Dinosaur National Monument.

“We started with quite a large number of cases in a school,” Benge said. “Now we’re seeing the household spread that comes from all of those cases started in a school setting.”

There are encouraging signs the outbreak in the Vernal area may be slowing, he said.

“We saw week over week doubling there for a little while, and I think it plateaued here this last week, and it may be declining right now. So hopefully that trend continues,” Benge said.

He said that since the local outbreak began, large numbers of parents are seeking vaccines for their children and the number of vaccines administered is up 500% over the same period last year.

“I think we have a lot more just hesitant people who have been confused by mixed messages on social media,” Benge said. This kind of vaccine hesitancy is different than the staunch opposition to vaccination found in some other communities in the state, he said.

Still, many other parts of the TriCounty area remain vulnerable to measles outbreaks because of low vaccination rates – something the county’s board of health warned in a December 2024 open letter to the community that cited an increase from 4.8% to 11.9% of local parents seeking to exempt their children from school vaccines. “We want all residents to understand that individual decisions regarding vaccination impact us collectively,” the letter said.

To prevent outbreaks of measles, 95% of people in a community need to be vaccinated against the disease.

Arizona: Measles outbreak from 2025 continues to grow

A measles outbreak has been underway in Mohave County, along the Arizona-Utah border, since August 2025.

Last year the county had 214 cases. This year, at least 61 cases have been reported, state data show. Officials with the Mohave County Department of Public Health did not respond to an interview request.

Oregon: ‘Worrisome’ infections without obvious source

There have been just 13 measles cases reported across the state of Oregon as of April 3. While not technically an outbreak, Dr. Dean Sidelinger, the state’s epidemiologist, is concerned about hidden spread of the virus.

While the source of some of Oregon’s known measles cases can be traced to travel to another state with an outbreak, disease investigators haven’t found a source for most of the cases.

“That’s very worrisome to us in public health, because that indicates a level of spread in the community that we’re not detecting,” Sidelinger told Healthbeat.

The state’s wastewater testing has also been intermittently detecting measles in areas that don’t correlate with where cases are being reported, he said.

While Sidelinger said 9 out of 10 parents in Oregon have chosen to fully vaccinate their children, the state has localized communities where there are concentrations of unvaccinated people.

“Many of our communities, not just in Oregon, but across the country, who have lower vaccination rates, often have various reasons for that. But some are in more close knit, often faith-based communities that don’t typically seek health care, or maybe have a little bit more of a mistrust or distrust of government,” he said. “We worry that if it gets into one of these communities that it could spread fairly quickly.”

Florida: Cases continue in county with university outbreak

A measles outbreak linked to Ave Maria University in southwest Florida’s Collier County has grown to 106 confirmed and probable cases through April 4, the most recent data available on the state health department’s website. Statewide, there have been 144 measles cases reported since January, including a handful of cases in Broward, Pinellas and Hillsborough counties, the data show.

In recent weeks, spring break travel has resulted in a surge of travelers prompting concerns about the potential for further spread of the virus. The state health department and Ave Maria University didn’t respond to interview requests.

North Dakota: Two outbreaks since February

Since March 23 there have been six cases of measles reported in Ransom County, North Dakota, a largely agricultural area in the southeastern part of the state with a population of about 5,600 people. One person has been hospitalized, according to state data.

Officials at North Dakota Health and Human Services issued a press release on April 1 about the first Ransom County case, saying that the person “likely acquired the infection within the state” and that the case was not linked to a measles outbreak in Pembina County.

A spokesperson for the department said staff were out of the office and unavailable to answer questions about the current status of the outbreaks and efforts to control the spread of the disease.

The outbreak in Pembina County, which is in North Dakota’s northeast corner, involves 23 cases reported in February and March, according to the state’s online data. Four of these people were hospitalized.

A total of 32 cases have been reported across the state since January.

California: An outbreak sparked by travel to South Carolina

In recent months the Sacramento, California region has been experiencing a measles outbreak that was sparked by an unvaccinated toddler who had recently visited South Carolina’s outbreak area.

The toddler’s illness was reported to Sacramento County health officials in late February, then nearby Placer County identified three more measles cases in siblings from a different household who had been exposed to the toddler, according to the California Department of Public Health.

Additional cases have continued to be identified in both counties.

This week, Sacramento County announced that two additional measles cases have been reported. Both are unvaccinated children, raising the county’s number of confirmed cases to five.

“These five confirmed Sacramento County measles cases in recent weeks show the disease is circulating in Sacramento County,” the county health department said in an announcement about the cases. “The overall risk to the general public remains low but residents, especially those who aren’t vaccinated against measles or whose vaccination status is unknown, should be hyper-aware and take steps to protect themselves and others.”

In Placer County, where there have been eight confirmed measles cases, officials also are concerned that measles is spreading in the community. “Nearly all of the measles cases thus far have some association with homeschool enrichment programs in the region, either directly or through family members,” the county health department said.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48.

Michigan measles outbreak shows high cost of stopping even a small number of infections from spreading

2026-04-03T22:40:20+00:00

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The small measles outbreak that health officials are combating in Michigan began last month with an unvaccinated young woman returning home from visiting Florida, a state where there have been more than 140 cases this year.

Her first symptoms around March 7 seemed like a cold. By the time the telltale measles rash appeared a few days later, she had exposed her family and scores of other people in public settings, according to health officials in Washtenaw County, near Detroit.

The Michigan outbreak is one of 17 new outbreaks nationwide reported to the Centers for Disease Control and Prevention since January. There have been 1,671 confirmed cases of measles reported this year across 32 states, according to CDC data.

Most of this year’s cases – 94% – have involved outbreaks. Some – like those in Texas and Florida – involve more than 100 infections. In a few, cases have surged into the hundreds, as is the case in the outbreak in Utah, which is still growing, and the outbreak in South Carolina, which appears to be ending.

Many of the outbreaks are small – just a few cases. But as public health officials in Washtenaw County, Michigan, are learning, the resources required to keep them that way can be enormous.

Staffing costs for managing a handful of measles cases: $45,000

“We’re still at seven cases,” Beth Ann Hamilton, communications coordinator for the Washtenaw County Health Department, told Healthbeat this week. “We’re definitely not out of the woods yet.”

Meanwhile, another measles case announced Thursday in neighboring Monroe County has state health officials concerned that measles may be silently spreading in the community. No definitive link has been established to the cases in Washtenaw County, but the timing and location of the new case are concerning, officials at the state health department said.

Because of this risk, the Michigan Department of Health and Human Services is recommending young children receive their first measles shot early – at 6 months to 11 months of age.

Yet even with just a handful of known measles cases, the containment workload is already taking its toll.

Spring break travel risks spread of measles across U.S.

At the Washtenaw County Health Department, measles control is taking priority over many other health department services as staff have been needed to help track down and counsel hundreds of exposed people, test them for immunity to measles when they don’t have vaccination records, and monitor those in quarantine.

“Seven cases may not seem like a lot, but it is, and it’s hundreds and hundreds of contacts that our staff have to follow up on and monitor,” Jimena Loveluck, the department’s health officer, told the Washtenaw County Board of Health on March 27.

“We’re not able to get other work done,” she said. “We just don’t have the capacity to respond and then continue all our regular level of services. The expense also is tremendous.”

Exposures have occurred at a popular mall in Ann Arbor, a community college, hospital, urgent care clinics, several stores, and a restaurant.

Investigating and managing the exposures of just the initial three or four cases cost $45,000 in staff time, Ruth Kraut, the department’s deputy health officer, told the board. Other health department staff noted that $100,000 in funding from the state to help with the outbreak had been largely spent.

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Is South Carolina’s record-breaking measles outbreak nearing its end? ⁠ ⁠ The state has gone more than two weeks without health officials learning of any new cases, but questions remain about how many measles infections have been going unreported. ⁠ ⁠ Healthbeat’s Alison Young breaks down what needs to happen before the outbreak can be declared over. ⁠ ⁠ 🔗 Check out our timeline of South Carolina's outbreak — and stay up-to-date with developments in outbreaks across the country — at Healthbeat.org. #measles #southcarolina #publichealth #outbreak
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“It’s been a huge effort,” Dr. Juan Luis Marquez, the department’s medical director, told the board. “We get lists of students or patients or whatnot. We don’t have much information to go by other than their name and date of birth. So that basically means our team of nurses and other folks calling everybody to verify their immunization status.”

Because two doses of measles-mumps-rubella vaccine is 97% effective at preventing the disease, public health officials are mostly trying to identify those who aren’t protected so they can be advised to quarantine at home and not spread the disease to others.

But people often don’t remember whether they’ve been vaccinated or don’t have access to their immunization records, Marquez said. So then they need to come to the health department clinic to have a blood test to check to see if they have measles immunity from past vaccination or infection.

The result is that the health department’s clinic is largely focused on measles and vaccine response, he said, and communicable disease efforts are being limited to measles and other high-risk cases.

Like forest fires, measles outbreaks are ‘sending out sparks’

A significant challenge for public health officials is that it’s difficult to know which small measles outbreaks can be quickly and easily contained, and which ones will spread to hundreds of people.

Dr. William Moss, a professor at the Johns Hopkins Bloomberg School of Public Health and director of the school’s International Vaccine Access Center, compared the measles landscape across the United States to a map of forest fires.

“You’ve got these bigger outbreaks, they’re kind of sending out sparks,” Moss said. “If that spark lands in a county or a community with high vaccine coverage, you don’t get much spread. And so you see one of these small outbreaks. But if it does land in a community with a large number of individuals who are under vaccinated or unvaccinated, then you get these larger outbreaks.”

It would be helpful to overlay measles cases onto maps with detailed vaccination coverage data, he said. But sources of vaccination data are limited and fragmented, and while school vaccination data can be helpful, it doesn’t include information about adults in the community.

“We and many other groups have been trying to develop ways to predict or forecast, as best we can, where the hotspots are. It’s just very difficult with measles,” Moss said.

Moss said that to know how easily measles will spread requires having detailed information about the coverage levels of vaccination and immunity within very localized communities where people socialize. But such data isn’t readily available, he said.

The places Moss and his team are watching closely are those where cases have been increasing the most in the past few weeks. That includes Hudspeth County, Texas, where the Johns Hopkins U.S. Measles Tracker has tallied 31 cases in recent weeks, and several counties in Utah, which is in the midst of a surge in its outbreak. Many of the cases in Hudspeth County, Texas involve a federal detention facility.

Since it began last year, Utah’s measles outbreak has sickened 559 people, 362 since January. South Carolina’s measles outbreak, the largest in the United States in decades, has had 997 known cases since October – more than 660 of them since January.

The good news: South Carolina health officials haven’t had a measles case reported to them in more than two weeks. If that trend continues for 42 consecutive days – which is two incubation cycles for the measles virus – that outbreak will be declared over after April 26.

As of early March, the South Carolina Department of Public Health told Healthbeat it had spent $1.6 million on its response to the outbreak.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

No new measles cases in South Carolina for a week, but CDC outbreak models warn about underreporting

2026-03-27T09:00:00+00:00

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For the first time since South Carolina’s record-breaking measles outbreak began last fall, the state has gone a full week without health officials learning of any new cases.

It’s an encouraging sign that the outbreak – which has 997 documented cases – may be nearing its end. However a report from outbreak modelers at the Centers for Disease Control and Prevention, completed earlier this month, raises questions about how many measles infections have been going unreported.

“There are likely some undocumented cases of measles in the affected region, raising the risk of spread to other populations in the region or nearby regions,” according to the March 3 risk assessment from the CDC’s Center for Forecasting and Outbreak Analytics.

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Is South Carolina’s record-breaking measles outbreak nearing its end? ⁠ ⁠ The state has gone more than two weeks without health officials learning of any new cases, but questions remain about how many measles infections have been going unreported. ⁠ ⁠ Healthbeat’s Alison Young breaks down what needs to happen before the outbreak can be declared over. ⁠ ⁠ 🔗 Check out our timeline of South Carolina's outbreak — and stay up-to-date with developments in outbreaks across the country — at Healthbeat.org. #measles #southcarolina #publichealth #outbreak
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The assessment says the extent of this underreporting is among several key uncertainties in predicting the future of the largest U.S. measles outbreak in decades.

Before the outbreak can be declared over, there must be a period of 42 days with no new cases – an important sign that chains of transmission of the virus have been broken. The last day of the outbreak would be April 26 if no more cases are reported, Dr. Linda Bell, South Carolina’s state epidemiologist, said Wednesday.

“We remain concerned about the possibility of unrecognized measles transmission, and we remain vigilant in monitoring any potential cases and spread,” Bell said.

State health officials worry spring break travel will spread measles as infections rise across the U.S.

Bell noted that the CDC’s modeling report was completed three weeks ago.

“Since that time, our measles case reports have continued to decline, our surveillance systems indicate this trend reflects a true decrease and not people avoiding health care,” Bell told Healthbeat.

Tests of wastewater in the outbreak area are not detecting measles, nor is there any sign from people going to emergency departments for measles-like symptoms, she said.

CDC officials did not grant interviews, and the agency’s written statements did not answer Healthbeat’s questions about information in the agency’s measles outbreak forecast report for South Carolina.

Scott Thorpe, executive director of the Southern Alliance for Public Health Leadership, said he thinks the state health department is using the best data it has available in its announcements last Friday and again Tuesday that no new measles cases had been reported.

“I think it’s very unlikely we’re at zero,” Thorpe said. “One of the really challenging, frustrating things about measles is that there absolutely can be cases we don’t catch, mild cases in particular.”

The last time South Carolina’s health department reported zero measles cases was on Tuesday, Nov. 4, when the outbreak had just 34 cases. But by Friday, Nov. 7, a case was reported, department records show. State health officials provide case number updates only on Tuesdays and Fridays.

Thorpe said he continues to be concerned about the upcoming spring break travel period increasing measles cases in the area. Many schools in Spartanburg County, where the outbreak is centered, are scheduled to be off for spring break during April 6-10.

It’s a concern Bell has previously expressed as well. South Carolina’s outbreak surged after the winter holiday break period.

‘Inconsistent’ or ‘sub-optimal’ compliance with isolation, quarantine

Outbreak modeling teams at the CDC have produced three “outbreak scenario” assessments for the South Carolina measles outbreak, the first on Jan. 2, plus two updates on Jan. 20 and March 3.

“Throughout the outbreak, our assessment consistently indicated that a larger outbreak, lasting at least six months, with some spread beyond the affected community, is the most likely outcome,” the agency’s outbreak modelers said in a March 6 web post that detailed their assessments.

The South Carolina outbreak was first identified in early October with five known cases.

As of early March, the CDC modelers said positive signs for the outbreak were that the rate of new cases was declining and that there were zero or minimal cases “outside of the affected community in the affected region” and that exposure settings affecting the “general population” had become limited or infrequent. Another positive sign: The number of households, schools, churches, and health care facilities with ongoing measles transmission was limited – a significant improvement from mid- to late January when the outbreak surged.

But in addition to concerns about the likelihood of some underreporting of measles cases, the CDC modelers also wrote that compliance with stay-at-home recommendations by infected and exposed people was “sub-optimal or inconsistent,” and that there had only been low to moderate immunization with the measles-mumps-rubella (MMR) vaccine among unvaccinated people in the area.

“Currently, there is no evidence that unvaccinated residents of the affected region are receiving MMR vaccine in high enough numbers to substantially reduce transmission,” the CDC report said.

How the South Carolina measles outbreak grew from 5 to 997 cases

However, Bell, who is leading South Carolina’s outbreak response, credits increased measles vaccination in recent months as a key reason the number of new measles cases being identified has slowed to a trickle throughout March and to zero reported in the past week. She said that in addition to people who got vaccinated, it is important to also consider that the nearly 1,000 people sickened with measles in the outbreak also acquired protective immunity to the virus through their infections. “That is a very risky way to get immunity,” she said.

“I should also add that our disease containment strategies, our investigation of cases while they’re infectious, and making sure that people remain in isolation, and making sure that people have guidance about being in quarantine, also contributes to preventing ongoing transmission in communities,” Bell said.

CDC forecasts note ‘close-knit’ low-vaccination community

The CDC modelers noted that Spartanburg County, where the outbreak has been concentrated, “is home to a large, close-knit community of about 15,000 people with low vaccination coverage,” and that in schools countywide, just 88.9% of students are vaccinated against measles, compared to a statewide average of 93.7%.

To stop measles from spreading within communities, 95% of the population needs to be vaccinated.

Neither the CDC nor South Carolina’s state health department would identify the “close-knit” community referenced in the CDC outbreak modeling assessments. However state health officials have previously acknowledged outbreak cases and multiple exposure incidents at Slavic-language churches whose members speak Ukrainian and Russian, as well as schools serving students from those communities.

Vaccine hesitancy among Ukrainian and Russian-speaking communities in the United States has been fueled in part by historic distrust of the former Soviet government and its health system, health officials in other states have found.

The CDC’s outbreak assessment updated on March 3 says that the “size of close-knit communities with low vaccination coverage” in the outbreak area, as well as their level of connection to other similar communities across South Carolina is a key uncertainty in predicting the outbreak’s future path.

The assessment notes that much is unknown about the extent of measles vaccination coverage in the region, “particularly among close-knit, under-vaccinated communities.” Use of school vaccination data can be used to help estimate community-wide immunization rates, the report said, but rates vary widely in the region.

Some of South Carolina’s earliest known outbreak cases and exposures involved Global Academy of South Carolina, a public charter school in Spartanburg whose founders are Ukrainian immigrants. Only 21% of Global Academy’s students were up-to-date on their school vaccinations, according to state data.

The Way of Truth Church in Inman, S.C., was identified as the location of a measles exposure incident in early November.

One church, Way of Truth Church in Inman, S.C., was identified as the location of an outbreak exposure incident in early November that resulted in at least 30 measles infections during the weeks that followed, according to state outbreak updates. Over the Christmas holiday period, multiple Slavic churches were associated with measles cases and exposure incidents, according to state outbreak updates. School and church officials have declined or not responded to past interview requests.

‘Intrusion into your life’ when families seek care for measles

Another key uncertainty impacting the future of the outbreak, according to the CDC outbreak modelers, is how quickly people who are experiencing measles symptoms or who have been exposed get tested and seek health care.

The report says “avoidance of testing or health care could give the impression that transmission is slowing when that is not the case.”

The CDC outbreak modelers are not alone in their concern about underreporting of measles cases in the South Carolina outbreak.

Dr. Robin LaCroix, a pediatric infectious disease specialist with Prisma Health, one of the major health systems treating measles cases in South Carolina’s Upstate outbreak area, said earlier this month that underreporting is a “big concern.” LaCroix noted the potential “intrusion” of public health investigations after health care providers notify health officials, as required, about measles cases.

“I think that we have captured only a fraction of the people who have become infected with measles because if you were not ill enough to seek medical care, you are never captured in the numbers that are reported, “ LaCroix told the Why Should I Trust You podcast.

“When you began to see what happened when you sought medical care – you had a call from the DPH, who wanted to know everywhere you had been for the four days before you became ill, or your child became ill, and there was a lot of intrusion into your life and activities related to that,” said LaCroix.

In addition, she said, an infected child’s school also would get reported to public health and other unvaccinated children who were exposed would be sent home for 21 days of quarantine.

“There were big community consequences around coming forward that my child has measles, and so then you open yourself up for again some ostracization within the community, that you caused us to have to send all of our children home. So I do think that there is an underreporting,” LaCroix said.

Prisma Health spokesperson Tammie Epps said LaCroix was unavailable for an interview with Healthbeat.

While Bell said she remains concerned that there may be some unrecognized measles cases, if they are out there and aren’t seeking medical care, she doesn’t think there are currently many because there are no signs of them in wastewater testing and other surveillance systems.

“We don’t see indications there are large numbers of unrecognized measles cases because people are self-isolating,” she said.

“No surveillance system captures 100% of cases,” Bell said, “but with a highly infectious disease like measles, if ongoing transmission were occurring from many unreported cases, it is more likely to be detected by at least one of these means in addition to provider reporting.”

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

5 From the Field Q&A: Trust for America’s Health CEO Nadine Gracia on making the case for public health

2026-03-26T13:31:13+00:00

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As the child of Haitian immigrants, Dr. J. Nadine Gracia says her professional journey into public health began with her parents’ courage and her own desire to have a career of service.

She initially gravitated toward medicine as a way of caring for others, then served in government, eventually becoming deputy assistant secretary for minority health and director of the Office of Minority Health at the U.S. Department of Health and Human Services during the Obama administration.

Since 2021, Gracia has served as president and CEO of the Trust for America’s Health, a national nonprofit, nonpartisan public health research and policy organization that for 25 years has worked across administrations recommending evidence-based policies to improve public health. She previously served as the organization’s vice president and chief operating officer.

In this 5 From the Field interview, Gracia shares insights on five questions about her work in public health and what she sees as key issues that must be addressed. This interview has been edited for clarity and length.

Federal agencies have been undergoing a lot of changes. What did you learn from your time inside government?

What I saw was really the responsibility and the privilege that we had of being public servants to address the needs of the population.

I had the opportunity to learn from and work with so many career government staff. I just learned so much because of the institutional knowledge, the relationships and partnerships that they brought to the agencies, the subject matter expertise, whether it was scientific expertise or other particular areas of expertise.

What I understood there was the power and importance of partnerships, of engaging with community, of listening to identify priorities, of assuring that if policies did not reach or were not helping to support certain groups and populations, that we needed to be able to address those kinds of structural and systemic barriers to health and well-being, and that government has a key responsibility and lever to be able to create that type of change.

What are the most pressing public health issues that you and the Trust for America’s Health are working on?

Public health is at an inflection point.

How do we continue to protect the public’s health and in that, protect and support the nation’s public health system at all levels? And then on the other side of that: How do we take this moment to reimagine and consider the future of public health?

We know that the public health system wasn’t perfect before. This is an opportunity as well to think about how we strengthen and bolster the public health system. It’s important not only to protecting health. It’s also important for strengthening our economy. It’s important for our national security, and we know that public health has been chronically underfunded.

How do we modernize public health? So many of our systems have been antiquated in terms of data and other areas. It’s also thinking about how we stretch and further enhance partnerships.

So really ensuring that we’re providing Congress, the administration, other federal officials, with the evidence and the information to make informed decisions about funding is critically important.

Where do you see opportunities for partnerships?

Strengthening our partnerships with health care. One would think that these two systems [public health and health care] work seamlessly on a day-to-day basis. But often it’s in times of emergency that we see these systems working more closely together.

We can do even more in non-emergency times to really create this broader health ecosystem.

It’s working, for example, with the business community, because we know that good health is good business. Ensuring that employers understand how to protect the health of their workers.

It’s also looking at the design of communities. It can extend to things like transportation and housing, because we know that our health is influenced more by what happens in the places in which we live, where we grow, where we age, and when we work, than just in the four walls of a doctor’s office or the hospital.

What is something the public doesn’t understand about public health?

One is just an understanding of what public health is and the value of public health.

It often is said that many don’t know what public health is until there is an emergency, until there is an outbreak or a pandemic, until there is some kind of weather-related emergency, like a hurricane or tornado.

Yet public health is working each and every day in every community. It’s making sure that the air that we breathe, the water that we drink, the food that we eat, is safe. It’s ensuring that kids can have a healthy start in life, and mothers are able to thrive through pregnancy and early motherhood.

Public health really needs to be a core part of the infrastructure of every community, that it should have significant investment so that we have a strong system that is able to protect and promote the health of its residents.

What’s at risk – and what is the opportunity – for public health right now?

We risk, for example, the gains that we have made over more than a century in life expectancy. The vast majority of the gains in life expectancy in the country are due to public health interventions.

We are seeing the further rise of rates and chronic disease and other health conditions in terms of rising health care spending. The U.S. spends the most among peer nations in terms of health spending, and yet we have the worst health outcomes across many areas, like infant mortality and maternal mortality, and highest rates of chronic diseases.

When we don’t invest in public health, we have to understand that that’s also not investing in our health security. That is the system that is doing disease detection, that is doing the monitoring for outbreaks and other types of emergencies.

My hope is that the path we chart forward is a path where we understand the value of public health and the return on investment that public health brings to communities and to the nation.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

Spring break 2026: Travel season risks spread of measles across U.S., state officials tell Healthbeat

2026-03-19T09:00:00+00:00

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The spring break travel season is underway, with tens of thousands of people every day clogging U.S. airports in their quest for sun, surf, theme parks, big city excitement, and other getaways.

It’s a scene that worries public health officials amid another bad year for measles across the country – and the potential for increased spread of the highly contagious disease during this busy travel period.

“It feels like whack-a-mole right now,” said Scott Thorpe, executive director of the Southern Alliance for Public Health Leadership. “Just as the numbers are dying down in South Carolina, you see this big jump in cases in Utah. Then you see cases starting to pop up in other places across the South.”

State health department officials in multiple states – including California, Utah, Colorado, Georgia, and South Carolina – told Healthbeat they are concerned about spring break travel and the potential for measles to spread within and between states.

Driving those concerns: Spring break is happening with the United States on a trajectory to exceed last year’s record-breaking number of measles infections – the worst since 1992.

This year the Centers for Disease Control and Prevention has already logged 1,362 confirmed cases of measles across the country through mid-March, mostly among unvaccinated children and teens. In less than three months, that’s more than half of the 2,284 measles cases confirmed during all of last year.

Since January, there have been at least 14 new measles outbreaks identified across the country, including in Florida, California, Washington state, Texas, and Colorado. These are in addition to ongoing outbreaks that began last year in South Carolina, Utah, and Arizona. Across the country, 30 states have reported at least one measles case this year, CDC data show.

Measles, which is one of the most contagious viruses for humans, is transmitted through the air when an infected person breathes or coughs. The virus can linger in a room for up to two hours.

The disease is preventable with vaccination. Two doses of the measles-mumps-rubella shot are 97% effective in preventing measles; one dose is 93% effective.

Most of those being infected with measles aren’t immunized. Nationwide, about 92% were unvaccinated or had an unknown vaccination status, according to CDC data.

“As vaccination rates have just broadly declined across all these communities, it’s just incredibly hard to stop. And that’s just going to get worse,” Thorpe said. “Short of something crazy happening, we’re absolutely going to blow through what our numbers were for last year.”

The contribution of spring break exposures to these national measles case counts won’t be known for several weeks.

After a susceptible person is exposed to the virus, it can take one to three weeks for them to start falling ill with initial symptoms that may seem like a cold or the flu. By the time the hallmark measles rash appears, they will have been infectious for four days – potentially spreading the virus to even more people.

“Everybody’s on high alert,” said Pat Endsley, president-elect of the National Association of School Nurses.

Top spring break destination Florida is No. 3 for measles

Dr. Rana Alissa, president of the Florida chapter of the American Academy of Pediatrics, told Healthbeat she’s very concerned about the potential for spring break travel to spread measles infections – especially in her home state, which already has measles cases in several communities, plus a large outbreak linked to a university.

Florida – with 116 confirmed measles cases since January – ranks No. 3 in the nation for 2026, behind South Carolina and Utah, which continue to battle outbreaks that began last year, according to the latest CDC data.

“Everyone wants to come to Florida,” Alissa said. “It’s always crowded. Orlando is going to be crazy, Daytona Beach, Clearwater, Miami.”

With these crowds comes an increased risk that some of the people are carrying measles. “It is very scary,” said Alissa, who is advising unvaccinated infants and children, as well as people with weakened immune systems, to avoid crowded areas because of the risk of measles.

Besides a fever and rash, measles can cause serious and sometimes life-threatening complications, including pneumonia and dangerous swelling of the brain, as well as “immune amnesia,” which increases a person’s susceptibility to other diseases in the future. Pregnant women and their babies are also at increased risk of complications from measles.

In addition to being a top state for measles this year, Florida is a perennial spring break hot spot. Cities throughout the state continue to be among the nation’s top spring break destinations, according to 2026 booking data from AAA and Booking.com.

At Tampa International Airport, the spring break travel surge is underway, with about 75,000 to 80,000 passengers a day expected through April 13. The biggest travel day, the airport predicts, will be this coming Sunday, when 90,000 travelers are expected to pass through the airport.

In Orlando, airport officials expect this week to bring some of their highest passenger volumes of the spring break period, with nearly 212,000 passengers arriving and departing last Sunday, plus another 205,000 passengers on Monday.

Florida health department won’t discuss large measles outbreak

Officials with the Florida Department of Health did not answer questions from Healthbeat since March 6 about the risks posed by spring break travel to and from the state, and what kinds of measles prevention and control activities the department is performing.

The department’s top official, Florida Surgeon General Joseph Ladapo, last fall announced plans to end all school-age vaccine requirements in the state, a move that has faced resistance in the legislature. In 2024, during a measles outbreak at a South Florida elementary school, Ladapo sent a letter to parents allowing them to keep sending their unvaccinated children to class, despite their risk of infection.

Most of Florida’s measles cases this year are part of a large outbreak linked to Ave Maria University in southwest Florida’s Collier County, about 35 miles northeast of Naples. At least 98 confirmed and suspected measles cases have been diagnosed in the county through March 7, according to state health department data. Five of those cases were reported during the first week of March, the data indicate.

Despite repeated requests, officials at the Catholic university did not respond to Healthbeat’s questions, including about the current status of the outbreak and any actions being taken to address the potential health impact of the school’s Easter break, scheduled for April 2-6.

Florida’s health department also wouldn’t discuss the university’s outbreak or answer Healthbeat’s questions about other locations in the state where ongoing spread of measles may be occurring, and how many people statewide are in quarantine because of measles exposures. While such information – which doesn’t involve identifying specific patients – is routinely made public in other states, the Florida health department’s media relations team said it was unable to discuss ongoing epidemiological investigations because of state confidentiality statutes.

The department’s data show at least 12 other Florida counties have reported confirmed or probable measles cases since January. They include the Tampa-St. Petersburg area, where six cases have been diagnosed in Pinellas County, and two more in Hillsborough County. In the Jacksonville area, Duval County has reported six cases; in the Pensacola area, Escambia County has identified five cases; and in South Florida, two cases have been diagnosed in Broward County and one in Miami-Dade County .

Concerns about measles extend beyond spring break hot spots

In response to interview requests and questions about rising U.S. measles cases and spring break travel sent earlier this month to the CDC, a spokesperson for the U.S. Department of Health and Human Services emphasized the risk of measles being imported from other countries.

“The risk of measles remains low for most of the United States due to high population-level immunity from MMR vaccination,” press secretary Emily Hilliard said in an email Tuesday night to Healthbeat. “That said, anyone who is not protected against measles is at risk if exposed. Since measles is common in many countries, unvaccinated travelers can bring measles to the United States at any time, and it can spread to other people who are not protected against measles.”

Hilliard said the CDC is supplying technical support and funding to states dealing with outbreaks and that vaccination is the best protection, “especially if you plan to travel internationally or to a place with a measles outbreak.”

While international travel can play a role in U.S. measles cases, according to CDC data, only nine of the 1,362 confirmed U.S. measles cases since January involved international visitors; last year just 25 of the 2,284 confirmed cases were international visitors. In both years, most of the measles cases across the country have involved outbreaks where the virus has spread from person to person within U.S. communities with low vaccination rates, such as those that have occurred in South Carolina, Texas, Arizona, New Mexico and other states.

As a growing number of states are already dealing with measles cases this year, officials at several state health departments expressed concerns about the risks posed by spring break travel.

This year California has had three outbreaks of measles – the first outbreaks in the state since 2020. Some of these California cases are linked to an unvaccinated toddler who had recently traveled to a measles outbreak area in South Carolina.

As of Monday, California has had 29 confirmed cases of measles; two have been hospitalized, according to the California Department of Public Health.

“International or domestic travel during spring break carries a risk of transmitting measles to Californians,” the department said in an email. “CDPH continues to closely monitor measles and to work with medical and public health partners to limit its spread during and after the spring break travel season.”

Georgia Department of Public Health spokesperson Nancy Nydam Shirek said that while people who are not immunized against measles are at high risk any time they are exposed to the virus, “that risk increases if they visit crowded tourist destinations, travel through airports, or go to areas with ongoing measles outbreaks.”

Two doses of the measles-mumps-rubella shot are 97% effective in preventing measles; one dose is 93% effective.

Two cases of measles have been reported this year in Georgia. One involved a baby too young to be routinely vaccinated who became infected during international travel. State health officials said they don’t know how the other case, a resident of Bryan County near Savannah, became infected and they cannot rule out unrecognized spread of the virus within the state, Healthbeat reported earlier this month.

In Utah, the spring break travel surge comes at a precarious time in the state’s measles outbreak, which began last year and has resulted in 443 reported infections as of Tuesday.

“What is concerning to me is we are seeing spread of this disease through our entire state,” Dr. Leisha Nolen, Utah’s state epidemiologist, said at a media briefing earlier this month. “For a while it was really limited to the southern part of the state, but it is now expanding, and we are having people diagnosed in every part of our state. And these are not just mild infections.”

Measles infections in Utah have resulted in more than 120 people going to emergency rooms, 31 needing to be admitted overnight, and three needing treatment in an intensive care unit, she said.

While the disease has spread in a variety of settings, Utah officials said cases involving school activities are noteworthy.

“We have definitely seen people get infected with measles from wrestling events, from dance-drill teams and from basketball. So we really encourage people to protect their children,” she said. “The measles vaccine is the best thing to protect your child. It is how we can stop this infection.”

In Colorado, where as of Monday 11 cases of measles have been identified along with multiple locations where infectious people potentially exposed others, state health officials said they are working to raise public awareness through media campaigns and provider webinars. The department also is doing direct outreach to families whose children are overdue for their MMR vaccines. In 2025 and 2026, this outreach resulted in 48% of the contacted families getting their children immunized, the department said.

South Carolina shows how holiday breaks can fuel outbreaks

“Measles is spread very easily to anyone who is susceptible,” said Dr. Linda Bell, state epidemiologist in South Carolina, where officials worry spring break travel could reignite an outbreak that has sickened nearly 1,000 people since last fall.

The outbreak has slowed to a trickle in recent weeks. After months of tracking cases, quarantining exposed people, and urging vaccination, the state health department announced Tuesday just one new measles case, bringing the total to four cases identified in the past week.

“The risk of spread is increased by the number of people exposed,” Bell said, “so things like air travel and people visiting tourist attractions during holiday breaks are a concern.”

It’s a risk South Carolina officials watched play out in mid-January, when measles cases surged to hundreds of cases a week after the winter holiday break period where gatherings with families and friends fueled the spread of the disease – not only within South Carolina, but to other states. The department’s measles control efforts were further hampered because outbreak investigators couldn’t get contact information from schools during winter break closures, delaying the quarantine of exposed students, an issue the department is trying to fix for spring break.

As infected South Carolina residents traveled the country during the winter break period, internal health department records show they exposed others to measles at travel convenience stores in Georgia and Florida, at a hotel and a youth conference in Kentucky, and at a hospital and a hotel in Florida, Healthbeat revealed last month.

Many schools in Spartanburg County, the epicenter of South Carolina’s outbreak, are scheduled to close for spring break the week of April 6-10.

State officials remain concerned there could be another surge in cases.

“It is far too early for us to let our guard down,” Bell said Wednesday. “We will see what happens with spring break.”

The problem is there are still many more unvaccinated people in South Carolina and across the country for the virus to infect.

To stop measles from spreading within local communities, 95% of the population needs to be vaccinated. But in most states, statewide vaccination rates among kindergartners have fallen below that “herd immunity” level, according to CDC data. And even where vaccination rates may seem high on a statewide or countywide level, pockets of unvaccinated children and adults within localized communities can still fuel outbreaks, experts said.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48.

South Carolina wants to avoid a spring break measles outbreak surge, enlists school help during closures

2026-03-12T21:28:16+00:00

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Amid concerns that spring break could reignite South Carolina’s measles outbreak, state health officials are trying to avoid a repeat of the communication gaps that delayed measles exposure investigations when schools were closed for winter break.

Healthbeat revealed last month that the South Carolina Department of Public Health was hamstrung in late December in its efforts to quickly warn and quarantine students and staff who had been exposed to measles. The problem: Schools were closed over winter break and they had nobody available to provide contact information to outbreak investigators.

The result was that people who were unaware they were infectious continued to interact with others in the community during the busy winter holiday season. In the weeks that followed, cases of measles surged dramatically and the South Carolina outbreak became one of the largest in decades.

“We are concerned that we may see another surge in cases,” Dr. Linda Bell, South Carolina’s state epidemiologist said. “So we have actually been in contact with schools to work with them more closely, to make sure that we have points of contact.”

Bell said Thursday that the department has sent letters to schools in South Carolina’s 11-county Upstate region asking them to identify a person who will be available during the spring break vacation period – when schools and administrative offices are closed – who can provide school attendance and contact information if it is needed for measles exposure investigations.

Here's how the S.C. measles outbreak grew after the holidays

“We’ve been receiving steady responses from the schools for those points of contact,” she said.

The health department said late Thursday that the letters, which requested contact information by March 10, were sent to all public school superintendents in the Upstate region. Only 11 of the 23 superintendents had supplied contacts as of Thursday. “DPH has previously established contacts at private and charter schools that have been impacted by the outbreak,” the department said.

Of the 993 measles cases recorded since the outbreak was identified in October, 936 have been in Spartanburg County and most of the others in nearby Upstate counties, according to state data. Almost all of those who have been infected were unvaccinated and most have been school-age children and teens.

In recent weeks, the number of new measles cases being reported to the department has slowed to a trickle. On Monday, the health department said just two new cases had been identified since Friday.

In Spartanburg County, spring break is scheduled for April 6-10 for many schools, but dates vary throughout the state.

“We’re very encouraged by the decline in cases, but we won’t be able to declare this outbreak over until we’re certain that measles transmission has ended,” Bell said. School holiday break periods pose an increased risk for the spread of measles because they often involve people traveling and socializing more.

The winter holiday break was a time of significant spreading of measles in the Spartanburg area.

Between early October – when the outbreak began – and Dec. 22, when Spartanburg County schools closed for winter break, there had been a total of 144 measles cases during the nearly three-month period. Then, in just the three weeks after schools reopened in January, there were more than 500 new cases of measles, state data show.

When Healthbeat asked South Carolina’s health department last month why it hadn’t reached out to schools to have contacts in place before winter break, the department said: “DPH cannot direct school employees to come to work to assist with outbreak investigations.”

Bell on Thursday said the new outreach to schools is an example of the department incorporating lessons learned into its outbreak response. “DPH has made the ability to communicate with school officials who have access to the information needed for case investigation a priority ahead of the upcoming spring break,” she said.

Measles is highly contagious and spreads through the air when an infected person breathes, coughs, or sneezes. The virus can linger in a room for up to two hours after an infectious person has left. Because a person is infectious for four days before the telltale measles rash appears, and initial symptoms may seem like a cold, many people spread the disease before they know they have it.

While two doses of the measles-mumps-rubella vaccine is 97% effective in preventing measles, those who are unvaccinated are at high risk of infection if they are exposed.

Christian school refused to share student information

Based on internal health department records, Healthbeat reported last month that during winter break there were delays quarantining people who had been exposed to measles – just prior to the holiday recess – at three public schools and one private Christian school.

In most cases, the schools were closed and didn’t have anyone available to provide information.

But when outbreak investigators reached Westgate Christian School in Spartanburg, the principal refused to provide information required to ensure those at risk of spreading the disease knew of the need to stay in quarantine, according to a health department warning letter to the school that Healthbeat recently obtained under South Carolina’s public records law.

According to the Jan. 9 letter, Westgate Christian School Principal Gail Grab responded to requests for information about exposed students by sending an email on Dec. 30 that said in part: “We will not provide personal details and immunization status information for the students in our school.”

Then when Grab sent outbreak investigators a list of exposed students on Dec. 31, the only names on it were the siblings of the person who had measles.

The department’s “final warning” letter on Jan. 9 gave the school until 1 p.m. the next day to provide the required information about all students who were had contact with the person with measles or the department would issue a public health order, under which the school could face fines of $1,000 per day for each exposed student’s name left off the list.

“Your continued failure to comply with this lawful demand has significantly impeded DPH’s ability to conduct mandatory case investigation, contact tracing, and quarantine monitoring,” the letter said. “This lack of cooperation places quarantined students, school staff, and the families of your students at increased and unnecessary risk of measles exposure, a highly contagious and serious disease.”

The school did comply before the deadline, Bell said.

Grab did not respond to requests for an interview on Wednesday. Pastor James Wooten, Westgate Christian’s president, replied Wednesday to emailed questions about the letter by saying he was traveling. He previously told Healthbeat that the school thought it had provided all necessary information on Dec. 31. He did not previously disclose that the school’s principal had sent an email refusing to provide required information.

Plans unclear at schools with past delayed measles investigations

Officials at the other three schools where state investigations of measles exposure incidents were delayed during winter break did not answer Healthbeat’s questions Wednesday and Thursday about any changes they have made for the upcoming spring break period.

Mark Robertson, principal at Global Academy of South Carolina, a public charter school where state records show only 21% of students are up-to-date with school immunizations, said he had no comment.

A vaccination rate of 95% is needed in communities to stop the spread of measles.

South Carolina has spent $1.6 million to combat its huge measles outbreak – and it’s not over yet

Cynthia Robinson, a spokesperson for Spartanburg County School District 6, did not respond to emails and calls on Wednesday and Thursday. Delays investigating measles cases over winter break occurred at the district’s Jesse S. Bobo Elementary School, where state data show 94% of students are up-to-date on vaccines.

Other schools that had delayed measles exposure investigations over winter break were in Spartanburg County School District 2: Sugar Ridge Elementary, where state data show 78% of students are up-to-date on vaccines, and Boiling Springs Elementary, where 80% of students are up-to-date on vaccines, also had delays investigating measles exposures during winter break, Healthbeat previously reported.

Adrian Acosta, a District 2 spokesperson, did not answer Healthbeat’s questions about what the district will do differently during spring break to avoid the winter break problems providing health officials with measles contact tracing information.

Acosta first sent a statement saying a district nurse supervisor is available 24/7. Then when asked if this person will be available during the spring break vacation period, Acosta emailed another statement saying school administrators are “always on the job.” Acosta added: “If an administrator knows they will be out of touch or unreachable, then it is expected that they have a communication plan in place.”

But Acosta did not respond to questions about what the district will do differently during spring break to prevent a recurrence of the delays.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

Controversial federal vaccine advisory committee: Deadline is Thursday to comment on March ACIP meeting

2026-03-09T15:51:20+00:00

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A controversial federal vaccine advisory committee, which is scheduled to meet next week to discuss Covid-19 vaccine injuries and Long Covid has set a Thursday deadline for the public to submit comments.

The Advisory Committee on Immunization Practices has disclosed few details about its agenda for the meetings on March 18-19 at the Centers for Disease Control and Prevention in Atlanta. The committee was supposed to meet last month, but cancelled its sessions amid an ongoing lawsuit and after failing to post agenda information, as required.

The formal notice for the March meeting published in the Federal Register says the committee’s agenda will include updates on the committee work groups and “discussions on COVID-19 vaccine injuries and Long-COVID and ACIP recommendation methodology. Recommendation votes may be scheduled for COVID-19 vaccine injuries and Long-COVID and ACIP recommendation methodology.”

No additional details were provided about these topics and the notice also says that the group’s agenda items “are subject to change as priorities dictate.” The ACIP meeting webpage also did not provide any additional details as of Monday morning.

The public can submit written comments online through the Federal Register meeting notice. Comments must be received by Thursday, the notice says.

The committee will also provide time for members of the public to make oral comments. The notice says: “Oral public comment will occur before any scheduled votes, including all votes relevant to the ACIP’s Affordable Care Act and Vaccines for Children Program roles.” Priority will be given those who file a request to speak at the meeting by Thursday. Details on how to make a request to speak at the meeting are found on the ACIP meeting webpage.

The committee, which meets three times a year, had all of its members replaced last summer by Health and Human Services Secretary Robert F. Kennedy Jr. and has come under fire from major medical professional associations that have said the reconstituted committee has been making changes to vaccine recommendations that lack scientific merit.

An ongoing lawsuit brought by American Academy of Pediatrics and other medical groups over the Trump administration’s vaccine changes has sought to stop ACIP’s next meeting because of concerns the committee will take a vote that will result in removing funding for certain vaccines for children from low-income families or who lack adequate insurance. Several state attorneys general are also suing HHS over recent changes to the childhood and adolescent vaccine schedule.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48.

Source of Georgia measles case remains a mystery as people who were exposed continue quarantine

2026-03-05T19:25:28+00:00

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How and where an unvaccinated Georgia resident recently became infected with measles remains unknown and multiple unvaccinated people continue to be in quarantine because they are at risk of developing the disease, according to the state’s health department.

It is unknown whether the person – a resident of Bryan County, near Savannah – became infected in Georgia through undetected measles spreading within the state, or if the infection occurred during recent travel to Washington, D.C., the Georgia Department of Public Health said Thursday in response to questions from Healthbeat.

“We cannot definitively determine whether the individual was infected in Georgia or during travel, but there is no record of exposure to a known case of measles,” said department spokesperson Nancy Nydam Shirek.

The District of Columbia has reported no confirmed cases of measles through Feb. 26, according to the Centers for Disease Control and Prevention. While the D.C. health department has issued alerts about infectious visitors potentially exposing others to measles at events in the nation’s capital, the Georgia person didn’t attend any of those kinds of gatherings, Nydam Shirek said.

Here's how the South Carolina measles outbreak grew

Nationwide, the United States is on track to have another record year of measles cases. During 2025, there were 2,281 confirmed measles cases across the country, according to the CDC. In just the first two months of this year, the CDC has confirmed 1,136 measles cases.

While infectious, state health investigators determined that the Bryan County resident exposed “several dozen” other people in Georgia to the highly contagious measles virus. Most were protected against the disease with up-to-date vaccinations. However, “fewer than 20” were not vaccinated against measles and are in quarantine or under active monitoring, Nydam Shirek said.

While it usually takes about seven to 14 days after exposure for an infected person to start showing symptoms of measles, it can take as long as 21 days. The incubation period for those exposed to the Bryan County person ends on March 15, Nydam Shirek said.

“To date, there are no reported cases of secondary measles infection,” she said.

The department has not announced any locations of public places where the infected person exposed others to the virus. According to media reports, officials at Bryan County Schools last month notified parents that the infectious person was at Bryan County Middle High School on Feb. 13. The district’s spokesperson, Melissa Roberts, did not respond to Healthbeat’s questions on Wednesday and Thursday.

Nydam Shirek said the state health department does not issue public notifications about school exposure incidents. “When there is a school exposure, the communication comes from the school, not DPH,” she said. In other states, such as South Carolina, which is experiencing a major outbreak, the health department also alerts the public about school exposures.

There were no other public locations, such as restaurants or stores, where exposures occurred, Nydam Shirek said, and all people who were exposed have been notified.

So far this year, Georgia has identified one other measles case. It involved a baby who was too young to be routinely vaccinated against measles who became infected during international travel, state health officials said in January.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48.

South Carolina has spent $1.6 million to combat its huge measles outbreak – and it’s not over yet

2026-03-04T23:49:23+00:00

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South Carolina has spent an estimated $1.6 million so far on public health efforts to combat its huge measles outbreak, according to information the state’s health department provided to Healthbeat on Wednesday.

The outbreak, which began with just five known cases in October, surged in January following the winter holidays, and has slowed in recent weeks. The total number of people infected in the outbreak, which is centered around Spartanburg County, reached 990 this week.

Most of the estimated $1.6 million spent so far on the outbreak response has been for personnel, the South Carolina Department of Public Health said in response to Healthbeat’s questions.

As the outbreak grew, the number of staff assigned to work full-time on the outbreak grew to as many as 90 people, said Dr. Linda Bell, the state epidemiologist.

Most of these staff, Bell said, have been involved in doing investigations of individual measles cases and tracing their contacts to help identify and quarantine those at risk of infection and further spread of the disease.

S.C. measles cases surged after holiday school closures delayed outbreak investigations

Funding for some of the outbreak’s public health costs has come from the Centers for Disease Control and Prevention, through an immunizations cooperative agreement, which helps with outbreak response activities, the South Carolina DPH said. Additional funding has come from a H5N1 Public Health Crisis Response Cooperative Agreement, which funds influenza and other public health emergency preparedness and response, the department said, as well as some other state and federal funds.

Although the number of new measles cases being detected each week has dropped significantly, the outbreak continues. The department said that final costs will be calculated once the outbreak is over.

But the threat the outbreak could surge again remains – especially with the potential for the virus to spread during the upcoming spring break travel period, Bell said.

“We remain concerned and must be mindful of the fact that we can see cases increase again from the low number that we’re seeing now,” she said. In recent weeks, the outbreak has slowed to about 10 new cases a week amid increases in measles vaccination in the Spartanburg County area and across the state.

The increased travel during school spring break raises the potential for the kind of increased spread of measles that South Carolina experienced over schools’ winter break period. “In the two consecutive weeks following the Christmas holidays, we had over 200 cases reported in each of those weeks,” Bell said.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48.

Trump surgeon general pick Casey Means: How her medical experience compares to previous doctors in role

2026-03-04T17:28:51+00:00

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President Donald Trump’s pick for U.S. surgeon general defended her credentials to serve as the nation’s next top doctor during a Senate committee hearing last week.

Dr. Casey Means, a wellness entrepreneur and best-selling author, received her bachelor’s degree in human biology and her medical degree from Stanford University. She then began her residency in otolaryngology, which involves head and neck surgery, at the Oregon Health and Science University in Portland.

But Means quit her medical residency training in the final year of the five-year program. Her medical license is listed as inactive.

A Healthbeat review of the medical backgrounds of every surgeon general confirmed during the past 50 years shows all completed a medical residency and many also had significant leadership experience in academia or government service before becoming surgeon general.

Some have been confirmed despite questions about their credentials. They include the nation’s 17th surgeon general, Dr. Richard Carmona, who took eight years to become board certified for general surgery. Dr. C. Everett Koop, the nation’s high-profile 13th surgeon general, was technically too old for the role, until the rules were changed for him.

As surgeon general, Means would lead the U.S. Public Health Service Commissioned Corps, whose 6,500 members provide health and medical services throughout the federal government. It is one of the nation’s eight uniformed services.

Means has said she resigned her residency “to focus on reforming the ‘sick care’ paradigm in American health care.” The chairman of the otolaryngology department, where Means quit her residency, told Vanity Fair last year that Means left because she found surgical work “too stressful.”

According to the American Medical Association, a residency is a “crucial phase in a physician’s training.” The length of a residency program’s supervised, on-the-job clinical training can range from three to seven years, depending on the medical specialty.

4 calls to action from public health leaders who served in Republican and Democratic administrations

Means has noted she would bring other experiences to the job of surgeon general, including her work as an entrepreneur and health communicator.

In 2019, Means co-founded the wellness company Levels, which sells health improvement memberships that include the use of continuous glucose monitors. In 2024, she published the book “Good Energy: The Surprising Connection Between Metabolism and Limitless Health” with her brother, Calley Means, who is an adviser to Health and Human Services Secretary Robert F. Kennedy Jr.

“My professional history is a feature, it’s not a bug,” Means told senators during last week’s hearing. “I have had a unique history that has merged entrepreneurship, public health advocacy, faculty course direction at Stanford University, as well as being an editor of a medical journal and a biomedical researcher. And in these complex times for American health care, that type of multidisciplinary history is going to be extremely valuable for the American people.”

She compared her credentials to past surgeons general.

“I practiced medicine. I owned my own medical practice, and I’ve seen thousands of patients, and I did over four years of surgical training, which is more than many of our past surgeon generals completed who did medical specialties,” she testified.

Here is the medical background for each of the 10 surgeon generals whose nominations have been confirmed during the past 50 years:

Julius B. Richmond – 12th surgeon general

Service: 1977-81

Nominated by: President Jimmy Carter

Education: B.S., University of Illinois at Urbana; M.S. in physiology and MD, Illinois’s College of Medicine in Chicago

Dr. Julius Richmond

Medical background before nomination: After medical school, Richmond had a rotating internship at Cook County Hospital in Chicago, according to his official surgeon general biography. He then began two pediatrics residencies, with the first at Chicago’s Municipal Contagious Disease Hospital and the second – which was interrupted by World War II – at Cook County Hospital. During World War II, he served as a flight surgeon with the Air Force’s Flying Training Command. After the war, he completed his residency and became a professor, holding various academic positions at the State University of New York Upstate Medical Center in Syracuse, where he became the dean. Over the years, he examined how poverty impacted the psychosocial development of children, becoming the first director of Head Start in 1965. At the time Carter nominated Richmond for surgeon general, he was a professor at Harvard Medical School, where he held multiple leadership positions, including serving as chief of psychiatry at Children’s Hospital Medical Center in Boston.

C. Everett Koop – 13th surgeon general

Service: 1982-89

Nominated by: President Ronald Reagan

Education: B.A., Dartmouth College; MD, Cornell Medical School; D.Sc., University of Pennsylvania Graduate School of Medicine

Dr. C. Everett Koop

Medical background before nomination: After a one-year internship at Pennsylvania Hospital in Philadelphia, Koop did further postgraduate training at the University of Pennsylvania School of Medicine, Boston Children’s Hospital, and the University of Pennsylvania Graduate School of Medicine. Koop’s surgical residency training at the University of Pennsylvania Hospital, which began in 1942, was allowed to be completed in half the usual nine years because of the demand for surgeons during World War II and his skill, according to his National Library of Medicine biography. He was surgeon-in-chief at the Children’s Hospital of Philadelphia from 1948 to 1981, where he established the nation’s first neonatal intensive care nursery and helped establish the American Academy of Pediatric Surgeons, according to his official surgeon general biography. In 1981, Reagan initially appointed Koop as deputy assistant secretary of health “with the promise that he would be nominated as surgeon general.”

Of note: Koop’s nomination was delayed because of rules that required the surgeon general to be younger than 64 – and he was 64 at the time. The rules were eventually changed, according to a 1981 article in CQ Almanac. He then faced significant opposition for his anti-abortion views and opposition to certain birth control methods. The American Public Health Association and the National Organization for Women were among groups opposing his nomination, CQ Almanac reported.

Antonia C. Novello – 14th surgeon general

Service: 1990-93

Nominated by: President George H.W. Bush

Education: B.S., University of Puerto Rico at Rio Piedras; MD, University of Puerto Rico School of Medicine at San Juan; MPH, Johns Hopkins University

Dr. Antonia Novello

Medical background before nomination: After medical school, Novello completed an internship and residency in nephrology at the University of Michigan Medical Center in Ann Arbor, where she also did a fellowship in the Department of Internal Medicine, according to her official surgeon general biography. She did an additional fellowship in the Department of Pediatrics at Georgetown University before working in a private pediatrics practice for a few years. In 1978, she joined the U.S. Public Health Service Commissioned Corps and held various positions at the National Institutes of Health. By 1986, she had become deputy director of the National Institute of Child Health and Human Development and began working on pediatric AIDS.

Of note: Novello was the first woman and first Hispanic surgeon general.

M. Joycelyn Elders – 15th surgeon general

Service: 1993-94

Nominated by: President Bill Clinton

Education: B.A. in biology, Philander Smith College; MD, University of Arkansas Medical School; M.S. in biochemistry, University of Arkansas

Dr. Jocelyn Elders

Medical background before nomination: Before going to medical school, Elders worked as a nurse’s aid in a Veterans Administration hospital, then spent three years in the Army, where she received training as a physical therapist. She then got her medical degree, completed an internship at the University of Minnesota Hospital and a pediatrics residency at the University of Arkansas Medical Center, where she went on to serve as a professor with a focus on childhood sexual development. In 1987, Clinton – then governor of Arkansas – appointed Elders to be director of the Arkansas Department of Health. The year before she became surgeon general, she was elected president of the Association of State and Territorial Health Officers.

Of note: Elders, who was the first Black surgeon general, advocated for sex education in schools. She was forced to resign because of comments she made relating to masturbation being a less risky form of sex that “perhaps should be taught.” She made the comments following a World AIDS Day speech.

David Satcher – 16th surgeon general

Service: 1998-2002

Nominated by: President Bill Clinton

Education: BS, Morehouse College; MD, PhD, Case Western Reserve University

Dr. David Satcher

Medical background before nomination: After receiving his medical degree, Satcher received his residency and fellowship training at Strong Memorial Hospital, University of Rochester, UCLA, and King-Drew Medical Center in Los Angeles, according to his official surgeon general biography. Satcher was a professor and chairman of the Department of Community Medicine and Family Practice at the Morehouse School of Medicine in Atlanta, then served as president of Meharry Medical College from 1982 to 1993 before becoming director of the Centers for Disease Control and Prevention in November 1993. Satcher was CDC director when Clinton announced his nomination for surgeon general in September 1997. Before becoming surgeon general, Satcher had received high-profile professional honors, including being elected to the Institute of Medicine of the National Academy of Sciences in 1986.

Of note: Although initially nominated by Clinton, Satcher served out a four-year term that ended during the administration of President George W. Bush.

Richard H. Carmona – 17th surgeon general

Service: 2002-06

Nominated by: President George W. Bush

Education: Associate of arts degree, City University of New York; B.S. and MD University of California, San Francisco; MPH, University of Arizona

Dr. Richard Carmona

Medical background before nomination: After medical school, Carmona completed a surgical residency at the University of California, San Francisco, and also a National Institutes of Health-sponsored fellowship in trauma, burns, and critical care, according to his official surgeon general biography. He had served as chairman of the State of Arizona Southern Regional Emergency Medical System; as a surgeon and deputy sheriff for the Pima County Sheriff’s Department; and as a professor of surgery, public health and family, and community medicine at the University of Arizona.

Of note: After his nomination, the Los Angeles Times reported that it took Carmona eight years to receive his board certification for general surgery after he twice failed the exam. During Carmona’s Senate confirmation hearing in July 2002, U.S. Sen. Edward Kennedy, the committee’s chair, questioned Carmona about this. “There was never any issue with my competence,” Carmona testified. “I passed the required test for the American Board of Surgery in the time allotted by the American Board of Surgery. That is a voluntary process. No one has to undergo these testing. Most of us do it on a voluntary basis. The Board of Surgery has a window of opportunity that you can apply and take the test. I did so, and passed within the time.” And Carmona added: “As far as my competency or the capacity as a medical professional, a single test is probably not a very good indication of anybody’s specific knowledge. I would say that probably my couple of decades of practice would be a far better indicator of my level of competence.” At the conclusion of the hearing, Kennedy told Carmona: “I am confident you will be confirmed.”

Regina M. Benjamin – 18th surgeon general

Service: 2009-13

Nominated by: President Barack Obama

Education: B.S., Xavier University of Louisiana; MD, University of Alabama at Birmingham; MBA, Tulane University

Dr. Regina Benjamin

Medical background before nomination: After receiving her medical degree, Benjamin completed her residency in family medicine at the Medical Center of Central Georgia in Macon. In 1990, she founded the Bayou La Batre Rural Health Clinic in Bayou La Batre, Ala., where her work received national attention and awards for continuing to treat patients in the aftermath of Hurricanes Georges in 1998 and Katrina in 2005. In 2008, the year before her nomination, Benjamin was the recipient of a MacArthur Foundation Fellowship, a prestigious honor sometimes referred to as the “genius grant.” The foundation cited her work as “a rural family physician forging an inspiring model of compassionate and effective medical care in one of the most underserved regions of the United States.” When she became president of Alabama’s state medical association in 2002, she also became the first Black woman to be president of a state medical society, according to her official surgeon general biography. She also had served as associate dean for rural health at the University of South Alabama College of Medicine and was a past-chair of the Federation of State Medical Boards of the United States.

Of note: While the Senate confirmed Benjamin’s nomination on a voice vote, some raised concerns about her paid service on an advisory board for the fast food company Burger King, which said her work involved nutrition advice. Other critics focused on her weight.

Vivek H. Murthy – 19th and 21st surgeon general

Service as 19th Surgeon General: 2014-17

Nominated by: President Barack Obama

Service as 21st Surgeon General: 2021-25

Nominated by: President Joe Biden

Education: B.A., Harvard University; MD, MBA, Yale University

Dr. Vivek Murthy

Medical background before nomination: After finishing his medical degree and master’s in business administration, Murthy completed his internal medicine residency training at Brigham and Women’s Hospital and Harvard Medical School, then joined the school’s faculty as an internal medicine clinician-educator, according to his official surgeon general biography and personal website. He was a co-founder of VISIONS, an HIV/AIDS education program in India and the United States; and he also was a co-founder of the Swasthya project, which trained women in rural India to be health providers and trainers. He was the co-founder and chair of a software technology company, TrialNetworks, that provides tools for clinical trials.

Of note: Murthy’s confirmation was delayed for more than a year after the National Rifle Association and others promoted posts by Murthy on social media in which he said guns were a health issue. Murthy also drew opposition from Republicans, who cast him as a politically connected supporter of Obama and the administration’s Affordable Care Act. Murthy’s experience prior to his first confirmation hearing included being a co-founder of a nonprofit group called Doctors for Obama, which later became Doctors for America. When he was confirmed for his first term as surgeon general in December 2014, Murthy, who was then 37, became the youngest person appointed to the position and the first person of Indian descent to hold the position.

Jerome M. Adams – 20th surgeon general

Service: 2017–21

Nominated by: President Donald Trump (first term)

Education: Bachelor’s degrees in biochemistry and psychology, University of Maryland, Baltimore County; MPH, University of California at Berkeley; MD, Indiana University School of Medicine

Dr. Jerome Adams

Medical background before nomination: After receiving his medical degree, Adams completed an internship at St. Vincent’s Hospital in Indianapolis and a residency in anesthesiology at Indiana University. His past experience included working as a general anesthesiologist at Ball Memorial Hospital in Muncie, Ind., as a physician rapid responder at Indianapolis Orthopaedic Hospital, as an assistant professor of clinical anesthesiology at Indiana University School of Medicine, and as a staff anesthesiologist at Eskenazi Health. In 2014, then Indiana Gov. Mike Pence, who would later become Trump’s first vice president, named Adams to be commissioner of the Indiana State Department of Health.

Of note: Unlike Trump’s current surgeon general nominee’s hearing last week, Adams’ confirmation hearing in 2017 was described in media accounts as being “mostly collegial” and “largely friendly.”

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

4 calls to action from public health leaders who served in Republican and Democratic administrations

2026-02-27T00:24:54+00:00

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Public health is inherently political because it often involves policy decisions, but it shouldn’t be partisan.

That was among the key messages during the 2026 State of the Public Health Union webinar Thursday with three former directors of the Centers for Disease Control and Prevention and a former U.S. surgeon general who served under Republican and Democratic administrations. The 90-minute event, which can be watched on YouTube, is organized annually by the American Journal of Public Health.

Here is one takeaway from each of the four speakers.

Dr. Tom Frieden, former CDC director (2009-17)

Frieden served as CDC director under President Barack Obama. He is now president and CEO of Resolve to Save Lives, a global health organization.

“I don’t agree with the statement that we have to get the politics out of public health. I think we need to get the partisanship out of public health. There are decisions about public health that communities should make. At what [blood alcohol] level should we tell people that they shouldn’t drive? … Should we take over land to make safe water for our community? Does a community decide to be smoke-free in their restaurants or bars or parks? These are community decisions. They’re policy decisions. What has infected public health over the past few years is a partisanship. I think this is something that all of us – right, left, Democratic, Republican, progressive, conservative – should try to address. Sen. [Daniel Patrick] Moynihan used to say that you’re entitled to your own opinion, but not to your own facts. And unfortunately, today, it seems like people feel they’re entitled to their own facts.”

Dr. Jerome Adams, former U.S. surgeon general (2017-21)

Adams served as surgeon general during President Donald Trump’s first term. He is now executive director of the Center for Community Health Enhancement and Learning at Purdue University.

“We’ve got to reclaim public health as consistent with conservative principles, not against conservative principles. It’s about personal responsibility, strong families, a ready workforce, military preparedness, and reducing wasteful downstream spending. Those are all conservative principles. Prevention aligns with fiscal responsibility. Clear, accurate information aligns with individual liberty, because you can’t make an informed choice without trustworthy facts. Second, we need trusted messengers. And in many conservative communities, people are going to be far more likely to trust their pastor, their local physician or pharmacist or nurse practitioner, their sheriff, or their governor than they are any federal agency. So that means empowering state and local leaders and respected voices within conservative circles to speak clearly and consistently about evidence-based health information. And then third, we’ve got to be willing to call out misinformation even when it’s politically inconvenient to the point I raised earlier. If we stay silent, when bad information spreads because it benefits our side, we lose credibility.”

Dr. Robert Redfield, former CDC director (2018-21)

Redfield served as CDC director during Trump’s first term. He is now a senior visiting fellow for biosecurity and public health policy at the Heritage Foundation, a conservative think tank.

“We need to learn how to share our differences of opinion on public health issues, but to do it respectfully ... I’ve said many times that vaccination, I think it’s one of the most important gifts of science to modern medicine. And it’s very disconcerting to see people being encouraged to leave it on the shelf rather than to embrace it. But I think if we could just have a little more honest debate among ourselves about different opinions on what policy directions we think we should go, but to do it in a respectful way, knowing that, you know, each of us really cares deeply about the public health of our nation, and we may see things slightly differently … When we see things that are obviously true, we need to speak out and clearly say that they’re true. For example, we’re dealing as you know now with measles in South Carolina, in Florida, in Texas, in Arizona. And we all know that the best way to stop the measles pandemic is to get the American public vaccinated against measles. Period. There doesn’t need to be any qualifiers around that.”

Dr. Mandy Cohen, former CDC director (2023-25)

Cohen served as CDC director under President Joe Biden. She is now a national adviser at Manatt Health, a health care consultancy.

“In order for us to fulfill our mission of protecting health and improving lives, we need the federal government – and state and local governments – all working well and working together. But there are things that you do not want to create, state by state by state. Some of that is certainly a data architecture, right? … [Public health cannot do its job] if you don’t have that visibility of what’s going on, both around you and, frankly, internationally as well. So CDC certainly has to maintain those connectivities and the data systems. But then it’s also expertise. We have wonderful experts at the state level, but they can’t be an expert in every rare pathogen. And so having both the laboratory expertise, the pathogen-specific expertise at the federal level is really important … I am very concerned about us pulling back in our global footprint. And that is something that needs to be done in a coordinated way at the country level, at a federal level, so that we are making sure to protect us here at home. So those are the things the feds need to do.”

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

Huge S.C. measles outbreak slows, fueling cautious optimism it may end earlier than predicted

2026-02-25T21:56:44+00:00

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South Carolina’s huge measles outbreak has slowed significantly in recent weeks, raising hopes among health officials that the disease’s spread might end sooner than expected, the state’s epidemiologist said Wednesday.

Since Feb. 17, the South Carolina Department of Public Health has documented 17 new measles cases. That’s far fewer than the 100 or more new cases being identified every few days during mid-January, when the outbreak spiked following the winter holidays.

“We’re encouraged with the downward trend, particularly in the last two weeks,” said Dr. Linda Bell, who has been leading the state’s response since the outbreak was identified in October with an initial five cases.

Since then, 979 people – mostly school-age children – have been sickened with measles. All but 52 of the cases have been in Spartanburg County; about 95% have been among people who were not vaccinated.

“No one should underestimate the hard work and long hours that front-line, often entry level epidemiologists have put into this response, and [who] are largely responsible for this downward trend that is actually occurring a bit earlier than previously projected,” Bell said.

Earlier in the outbreak, Bell said that modeling had suggested the outbreak might last for as long as six months.

“The case counts per week now are really down to the level that we were seeing at the beginning of December,” she said. “We are now 22 weeks into this and we hope, with that continued downward trend, in parallel to the hope that vaccination coverage will increase, will help us end this sooner than was originally projected.”

Bell said the department has asked the Centers for Disease Control and Prevention to assist the department in the coming weeks to do studies to help learn from the outbreak, including studies that examine chains of transmission and the costs associated with the public health response to the outbreak, as well as health care costs.

Officials remain concerned, however, that the outbreak has the potential to spike yet again. “This is not over yet. It’s not nearly over yet,” Bell said. “It is these pockets of under-vaccinated people who remain susceptible. That ongoing susceptibility in our population may continue to fuel ongoing spread.”

To stop measles outbreaks from spreading in localized communities, at least 95% of people need to be vaccinated. But in Spartanburg County, state health officials have said measles vaccination rates for school children across the county are just 90% – and they are even lower within some individual schools and communities.

“Many of the schools in Spartanburg County have some of the lowest vaccination coverage rates in the state,” Bell said. “So all of those are contributing to the reason that the outbreak has been focused in Spartanburg County, because of higher risk there, because of lower coverage.”

This is also a likely contributing factor for why measles cases identified recently in a few other South Carolina counties haven’t spread widely in those locations, Bell said. Of the 979 cases in the South Carolina outbreak, 927 involve people in Spartanburg County.

“Even if we are only seeing a dozen or so cases per week, the risk we can surge remains,” Bell said.

Bell noted that schools will be going on spring break in the coming weeks, bringing with it the risk of people who have been exposed to measles becoming infectious and spreading the disease to others at tourist attractions and while traveling. “This is a great concern,” she said.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

Chaotic federal vaccine committee meeting: It’s off, now it’s on again. But still no word on agenda.

2026-02-24T20:53:32+00:00

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The federal Advisory Committee on Immunization Practices now plans to meet March 18 and 19, according to updated information posted on the committee’s website at the Centers for Disease Control and Prevention.

No information had been posted Tuesday about what topics or votes will be on the meeting’s agenda, how the public can comment on agenda items, or even what time the meetings will start and end.

The committee, which meets three times a year, had long planned to meet this Wednesday through Friday in Atlanta. But as the meeting date approached, the committee failed to make public – as required – its planned agenda, jeopardizing its ability to meet legally, Healthbeat reported last week.

The cancellation also followed efforts in a lawsuit filed by the American Academy of Pediatrics and other medical groups that have sought to stop the group’s next meeting because of concerns that ACIP will take a vote that will result in removing funding for certain vaccines for children from low-income families or who lack adequate insurance.

Officials at the CDC and the U.S. Department of Health and Human Services did not immediately respond to questions about the rescheduled meeting.

Federal advisory committees are required to give the public advance notices about their meeting agendas and other basic information about how the public can attend or watch the meetings. Historically committees were required to give at least 15 calendar days notice before a meeting, but in December the Trump administration reduced that to seven calendar days.

On Tuesday, the American Academy of Obstetricians & Gynecologists announced that it was withdrawing as a liaison member of the vaccine advisory committee, citing an array of concerns, including what it said was ACIP’s cherry-picking of data and unilateral changes to childhood and adolescent vaccination schedules without expert input.

“The recent reconstitution of the committee; the removal of ACOG experts from ACIP workgroups; and HHS’ unilateral changes to vaccine recommendations, which bypassed established scientific and clinical processes, represent a fundamental departure from the scientific rigor and impartiality that have been the hallmark of this committee for 60 years,” said ACOG President Dr. Steven J. Fleischman.

The committee had all of its scientific advisers replaced last summer by HHS Secretary Robert F. Kennedy Jr.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

Preventing maternal deaths: 5 From the Field Q&A with childbirth safety expert Dr. Elliott Main

2026-02-24T10:00:00+00:00

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Maternal deaths and serious childbirth complications in the United States are often preventable.

Dr. Elliott Main, a professor of obstetrics and gynecology at Stanford University and a founder of the California Maternal Quality Care Collaborative, has spent decades studying why mothers die or nearly die from pregnancy and childbirth — and what can be done to protect them.

Main helped pioneer the creation of what have become national “patient safety bundles” and toolkits to help hospitals and health care providers standardize their use of evidence-based best practices for identifying complications early and providing effective treatments.

In recent years, about 650 to 1,200 women across the United States have died annually from causes related to pregnancy, according to federal data. Thousands more have been at risk of dying because of severe complications, including from hemorrhaging, cardiac and blood pressure issues, and infections.

The rate of maternal deaths is far higher for Black mothers (43.3 deaths per 100,000 live births) than it is for white (13.8 deaths), Hispanic (11.1), and Asian (12.8) mothers, according to provisional data from the Centers for Disease Control and Prevention for the 12-month period ending in September.

In the context of all of the births that occur each year, maternal deaths and severe complications are relatively rare. But each statistic is a person’s life and case reviews have found that 80% of deaths could have been prevented.

“We do need to do better, and we can do better,” Main told Healthbeat as he recently provided insights on five questions about making pregnancy and childbirth safer.

This 5 From the Field interview has been edited for clarity and length.

Are we where we need to be on maternal safety?

There is lots of room for improvement.

One of the biggest struggles we see is with disparities among different races. It’s not just Black mothers. It’s other mothers, too, that may not speak English well, or who are in some ways different from their care providers.

How do you create trust between the physician and the nurses with the patients if they are from very different backgrounds? That’s a challenge. You’re in labor and things change rapidly and you’re making life and death decisions. The best physicians have developed skills to sit down and ask what the patient’s goals are, what she’s fearful of and work out ways of working together. Trust is a common issue that we’re failing at in some circumstances.

Another significant issue is support, particularly in transitions of care. One of the biggest areas of weakness in the medical system is when you transition from the hospital to home.

Why do some hospitals struggle more than others when it comes to preventing maternal deaths and serious complications?

Obstetrics is way undervalued in the current medical reimbursement system. That means there’s not much incentive to make investments in obstetric care, and that’s particularly an issue in hospitals that are less well-funded, rural hospitals, inner city hospitals. And in certain parts of the country that are poorly funded to begin with, in particular the South, that has terrible outcomes for maternity care.

Looking at public health data from my state, that has over 200 hospitals, and in other states, there is great variation that we see among hospitals. All the measures show extreme variation. And that shouldn’t really be.

How connecting with nature helps Black women have healthier pregnancies

In medicine we have a long tradition, unfortunately, of blaming the patient. And that’s really clear in this setting. When you control for patient conditions, the degree of hypertension or diabetes or advanced maternal age or obesity, there is still huge variation.

What I’ve seen over the years is that hospitals – if they are doing poorly on the national measure, they will first blame the patient, then blame how the data is collected, then blame the measure itself. But they should be spending the time figuring out how they can learn from others and improve their care.

You need to have leadership, both at the physician and nursing levels, for there to be meaningful change. It’s hard to change practice behaviors or the culture of a unit unless you have strong leaders involved.

Why are so many maternal deaths and severe complications preventable?

There are two driving forces. One is that, in general, maternity goes well in at least 95% to 97% of the cases. Everyone gets kind of lulled by the expectation of normality. So we tend to overlook deviations from that. You don’t want to over-call things because most of the time it goes fine.

The second issue is that many of the symptoms of significant complications are actually easily confused with the symptoms of normal pregnancy.

One of the biggest killers in the postpartum period is cardiac disease. The symptoms of heart failure are tiredness, shortness of breath, and having a hard time sleeping. And you know, most postpartum women are tired – but what degree of tiredness is abnormal?

Many postpartum women are much more focused on the care of their infant than themselves. So, things get delayed. Doctors tend to not respond to phone calls about such generalized symptoms. And so it spirals until it’s too late.

Where has standardizing maternity care made the biggest difference?

We have done better in the U.S. for hemorrhage, so it’s no longer the leading cause of death here as it is worldwide. But it is still the biggest cause of major complications for morbidity.

Essentially about 3% to 5% of women will have a significant amount of extra bleeding at birth. And that was the first thing we tackled, and we realized that every doctor had a different way of approaching it. No one had a standardized approach, or even a standardized definition of how much bleeding was too much.

So that was the genesis of a safety bundle, of having all the tools you need in a hemorrhage cart or kit that could be immediately brought into a room. You had a standardized procedure that you could teach and practice, you do drills and then assess afterwards. And then having a

standardized way of collecting the blood, so you could see exactly where you were in the process. It’s so easy to say she’s bleeding a little, but not that much, and lose count.

Those kinds of standardized approaches actually made a really big difference. And they have become now a national safety bundle, supported by bodies like the American College of OB/GYN and even the Joint Commission. CMS is now wanting every hospital in their Medicaid reporting system to document they have included it. And the WHO is supporting the bundle approach worldwide.

What still needs to be done?

We have to keep the momentum up for supporting change in the medical system. One of the things we’ve helped support is the development of perinatal quality collaboratives in every state in the country. Those can be based in or partnered with public health departments.

We now have bundles and toolkits for hemorrhage, hypertension and sepsis, cardiac disease, and mental health. But the trick is always about implementation. That’s always the hard part – how you implement that in every hospital, in every practice in your state.

That’s where you want a collaborative that includes medical leadership, organizations like the American College of OB/GYN and the maternal fetal medicine society, the nursing societies… all the providers, the payers, Medicaid and the insurance companies, and community organizations.

Data is the critical piece. This is where public health organizations can play an important role. Everybody wants to think that they’re doing well, and everyone is surprised when the data doesn’t show that. The data really does drive change.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48.

CDC vaccine advisory committee ‘in violation’ of public meeting rule cancels next week’s sessions

2026-02-20T00:21:24+00:00

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A controversial federal vaccine advisory committee has canceled a planned meeting next week, a spokesperson for the U.S. Department of Health and Human Services said Thursday.

The cancellation of the meeting of the Advisory Committee on Immunization Practices came after the committee failed to make public – as required – the details of its planned agenda for next week’s sessions, which raised questions about whether the meeting could legally occur, Healthbeat reported Wednesday.

It also follows efforts by the American Academy of Pediatrics and other medical groups to have a federal court in Massachusetts stop the ACIP meeting, court records show. The medical groups, which are suing HHS over changes made in January to the childhood vaccination schedule, told the court it feared the group would take a vote at the meeting that would remove funding for certain vaccines for children who are from low-income families or lack adequate insurance.

HHS spokesperson Andrew Nixon would not elaborate on why next week’s meeting was canceled. “We will not hold the ACIP meeting later this month,” Nixon said in a brief statement Thursday. “Further information will be shared as available.”

The American Academy of Pediatrics and other medical groups, in court filings this week, said that they anticipated the ACIP would be voting at its February meeting to downgrade from “routine” to “non-routine” several vaccines that are no longer routinely recommended under the contested January vaccine schedule. Such a vote, the groups said, would cut off access to hepatitis A, hepatitis B, rotavirus, influenza, and meningococcal vaccines to children who rely on the federal Vaccines for Children program to pay for their immunizations.

The medical groups noted to the court that although no agenda had been posted for the ACIP meeting, the committee Vice Chair Robert Malone had publicly written on his Substack about how “the ACIP will need to vote during their next meeting to approve language aligning the Congressionally mandated Vaccines for Children Program [VFC] with the new schedule.”

Lawyers for HHS on Wednesday countered that concerns the vaccines would be removed from the Vaccines for Children program were “purely speculative.” On Thursday they filed a notice with the court saying that the ACIP meeting, which had been scheduled for Feb. 25-27, had been “postponed” and that the committee would not be meeting in February.

The committee – which in its last meeting made significant changes to the childhood vaccine schedule – had not made public its agenda or other key details for the meeting next week at the Centers for Disease Control and Prevention, despite federal requirements.

“Legally, I believe that HHS is in violation of federal law,” Lawrence Gostin, Founding O’Neill Chair in Global Health Law at Georgetown University, told Healthbeat on Wednesday. “But Secretary Kennedy has long been flouting federal law, especially when it comes to good governance, transparency and administrative practice.”

Officials from HHS and the CDC did not answer questions about why no meeting notice and agenda information had been posted in the Federal Register or on the ACIP’s website before Wednesday.

The committee – which last summer had all of its scientific advisers replaced by HHS Secretary Robert F. Kennedy Jr. – has become a front line in the political, cultural, and scientific war over vaccines. During its last meeting, in December, Republican U.S. Sen. Bill Cassidy, a Louisiana physician, called the committee “totally discredited” for seeking a briefing from a lawyer and vaccine critic with ties to Kennedy.

The late cancellation of the upcoming ACIP meeting is just the latest controversy for the group.

Federal advisory committees historically have been required to let the public know about their meeting agendas and other basic information at least 15 calendar days in advance of the meeting. In December, the Trump administration reduced the advance notice to at least seven calendar days before a meeting. Wednesday was seven days before the ACIP meeting date listed on the CDC website.

Federal rules require that the public be told – through a posting in the Federal Register – details such as the time and location of the meeting, how to attend electronically, and whether registration is required for attendance. The rules also called for the committee to post a summary of the agenda, topics to be discussed, and instructions for how to access meeting materials, as well as how the public can comment in writing or in person.

The only way a committee can give less than seven days of notice, the rules say, is “if the President determines this is necessary for reasons of national security, or if the head of an agency determines this is necessary due to exceptional circumstances,” with the reasons being included in the Federal Register meeting notice.

“These meetings are one of the few opportunities for the public to make their voices heard,” said Michaela Jackson, program director for prevention policy at the Hepatitis B Foundation. “When notice comes too late, people lose the chance to share their experiences and help shape policies that directly affect their health, their families, and their communities.”

Jackson said it takes significant research for stakeholders to prepare for ACIP meetings. “Contributors want to present the strongest evidence available to support our positions, but it is extremely difficult to craft meaningful or relevant comments when no agenda or list of topics is provided in advance.”

Gostin said the lack of required public notice for the ACIP meeting ran afoul of both the Federal Advisory Committee Act and the Administrative Procedure Act. He said the public should care because it’s important to have thoughtful public input into government decisions – such as vaccine policy – that will impact people’s lives.

“Advance notice and comment are the hallmarks of transparency, good government, and democracy,” Gostin said. “Without advanced notice and an opportunity to comment, major stakeholders cannot weigh in and feel as though they are left in the dark, which they are.”

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48.

S.C. measles cases surged after holiday school closures delayed outbreak investigations

2026-02-17T10:00:00+00:00

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South Carolina’s state health department faced a significant problem in the critical weeks before the state’s measles outbreak surged in January.

As schoolchildren continued to fall ill with measles in late December, outbreak investigators needed help from schools to get contact information for the classmates, staff, and others who had been exposed. They needed to be warned quickly so they wouldn’t spread the virus to others if they were infected.

But schools were closed for their two-week winter break. Nobody was available at most schools to provide the information health officials needed, according to South Carolina’s state epidemiologist and records obtained by Healthbeat.

This communication gap between the South Carolina Department of Public Health and schools in Spartanburg County – the outbreak’s epicenter – resulted in delays quarantining people who were at risk of unknowingly spreading the highly contagious disease. An infected person is contagious beginning four days before the tell-tale measles rash appears.

At the same time, the state health department was grappling with its own holiday staffing challenges, according to the internal DPH outbreak reports that Healthbeat obtained under South Carolina’s public records law.

While the number of measles cases grew in December, the number of DPH staff assigned to combat the outbreak dropped. The internal DPH reports repeatedly note concerns about holiday staffing, workloads, burnout, the availability of backup staffing, and “limited support due to workforce reduction in April 2025.”

Only after New Year’s Eve did outbreak staffing begin to increase significantly, records show.

Dr. Linda Bell, the state epidemiologist who is leading South Carolina’s outbreak response, said that despite challenges, public health staff “worked diligently throughout the holidays.”

“DPH made many efforts to reach impacted schools over the holidays with limited success because the schools were closed,” Bell said in written responses to Healthbeat’s questions.

By early January, the South Carolina measles outbreak surged to become one of the largest in the United States in decades.

“It’s impossible to know exactly what impact school closures and the resulting delays had on the spike in cases,” Bell told Healthbeat.

However, the delays hampered one of the department’s key strategies for slowing the virus’ spread: Rapid identification and home quarantine of exposed children and adults who were at risk of developing and further spreading the disease because they aren’t vaccinated.

This occurred during a time of increased socializing over the holidays, she noted.

It usually takes a week to 12 days, and sometimes as long as three weeks, for people infected with measles to start showing symptoms. The virus spreads through the air when a contagious person breathes, sneezes, or coughs.

Before Spartanburg County schools closed for winter break on Dec. 22, the state health department had logged 144 measles cases since the outbreak began in early October, state data show. In the three weeks after schools reopened during the week of Jan. 5, outbreak investigators were chasing after more than 500 new cases of measles.

The outbreak continues to grow, reaching 950 confirmed cases in South Carolina as of last week, a tally that doesn’t include cases sparked in other states.

School officials with Spartanburg County’s District 2 and District 6, whose elementary schools were among those with delayed exposure investigations during winter break, have declined repeated requests from Healthbeat for interviews or information about their procedures for providing time-sensitive public health information during extended school break closures.

Both districts have had multiple measles exposure incidents in their schools since the outbreak began last fall, requiring dozens of students to be excluded from class due to quarantines.

What happened in South Carolina is a cautionary tale for health departments and schools across the United States – especially as measles makes a resurgence amid declining vaccination rates. So far this year, at least 24 states have reported measles cases to the Centers for Disease Control and Prevention.

In the coming weeks, schools across the country will be closing again for spring break.

“I just want to emphasize how normal Spartanburg is,” said Scott Thorpe, executive director of the nonprofit Southern Alliance for Public Health Leadership, noting that the pockets of low vaccination rates that have fueled the South Carolina measles outbreak are also common in other communities. “I hope that everybody is really preparing for this, because I don’t think it’s going anywhere anytime soon.”

With some communities having multiple school districts plus numerous private schools, Thorpe said that strengthening lines of communication between public health and schools takes time. “To try to figure out how to interact successfully in all these circumstances, in a crisis situation, is really hard,” he said.

School nurses, staff often not paid to work over breaks

Pat Endsley, president-elect of the National Association of School Nurses, said school breaks can pose a special challenge for health departments doing infectious disease contact tracing because school nurses and other staff often aren’t being paid to work during those periods – and they may even be traveling out of town.

With every state operating differently, Endsley said she’s not aware of any national best practice for addressing school contact tracing for measles during extended school break periods. A lot of the best practices were written specifically to address the emergence of the Covid-19 pandemic, she said.

“The gold standard would be to have some kind of person who is at the school, who’s not going anywhere, who could have access to information,” said Endsley, who served as a school nurse in Maine for 23 years and now teaches full time.

“Maybe that’s something that would come out of South Carolina, or Texas, or these other places with measles,” she said. “Based on this information, we could develop some exemplars of communication.”

How the South Carolina measles outbreak grew from 5 to over 900 cases

In at least some communities, health departments have found ways to ensure measles exposure investigations aren’t thwarted by school breaks.

Health officials battling another large measles outbreak along the Utah-Arizona border said they had no difficulties reaching impacted schools over the recent winter break.

“Our epidemiologists report that contact tracing and other issues involving students ran uninterrupted over the winter holidays, mainly due to frequent communication with an established point of contact with our largest school district,” said David Heaton, a spokesperson for the Southwest Utah Public Health Department. The school contact was available to help over the holidays, Heaton said.

Dani Lagana, a spokesperson for the Mohave County Department of Public Health in Arizona, said the department’s measles response activities are not dependent on school calendars.

“Effective contact tracing in school-associated cases relies on established communication protocols and coordination between public health and education partners,” Lagana said by email. “Health departments routinely plan for coverage during holidays and breaks to ensure appropriate notification and follow-up when needed.”

It’s unclear why – before winter break closures began – similar arrangements weren’t put in place between the South Carolina DPH and schools in Spartanburg County.

“DPH cannot direct school employees to come to work to assist with outbreak investigations,” the South Carolina department said in an emailed statement to Healthbeat.

The department said it has contact lists for school administrators, but these administrators may not have access to the detailed information outbreak investigators need when schools are closed.

“Comparisons of response activities from one jurisdiction to the next should be made with caution,” the state health department said. “Each jurisdiction has unique circumstances including differences between centralized vs. autonomous county public health agencies.”

Winter break delays in investigations of measles exposures occurred at Boiling Springs Elementary, where 80% of students are up-to-date on vaccines.

In South Carolina, public health activities are centralized and provided by state DPH employees at offices across the state. Arizona and Utah, have multiple local health departments covering a single county or multi-county region, in addition to state health departments.

Healthbeat asked each of Spartanburg County’s seven public school districts whether they had any policies or procedures that would specifically enable rapid sharing of student contact information during holiday breaks with public health officials who are trying to control infectious disease outbreaks. None of the districts provided answers to these questions.

Schools play an important role in helping public health investigators quickly determine which students, teachers, staff, and visitors may have been exposed to the infected individual. Not only does measles spread through the air, the virus can linger in a room for two hours after the contagious person has left.

School staff can provide health investigators detailed information about the movements of an infected student – and who was around them while they were contagious – by going through class schedules and rosters of those participating in extracurricular activities and riding on school buses. They also know which students lack immunity to measles because school records show which ones have exemptions from vaccine requirements for medical or religious reasons.

Rapid notification of at-risk individuals is critical, health officials say, so they know to quarantine at home and watch for early signs of measles that might otherwise be mistaken for a cold or the flu. In the four days before measles’ hallmark rash appears – and the person is already contagious – their earliest symptoms are typically a fever, cough, runny nose, and red, watery eyes.

“I definitely can see the issue that DPH had during winter break with schools closed two to three weeks, and no way to do that school notification, contact trace, get information from nurses,” said Dawn MacAdams, president of the South Carolina Association of School Nurses. “But then you run into: nurses don’t get paid during that time.”

MacAdams said that during Covid, school nurses faced overwhelming workloads and long hours helping with contact tracing without being paid for the extra work. “Nurses were working Christmas Eve, Christmas Day, New Year’s because the numbers were exploding and the guidance was changing,” she said.

MacAdams said she’s not sure what the solution is for ensuring timely contact tracing of school-associated measles exposures when schools are closed.

“That’s a really good question to think about with DPH on what are the things we can do,” she said. “Most spring breaks are somewhere the first or second week of April this year. So we’re going to be in another desert of the availability of school personnel to provide information.”

Records show quarantine delays at five Spartanburg schools

Internal South Carolina DPH reports show there were delays during winter break notifying and quarantining people who had been exposed to measles at three public schools, one public charter school, and one private Christian school.

For the exposure incidents at these schools, the department’s internal daily outbreak summary reports during winter break repeatedly listed that health officials were reaching out to the facilities or that the status of quarantine actions were still “TBD” – or to be determined.

It’s unclear how many exposed students and staff weren’t contacted quickly because these schools were closed. “Parsing out all those we were working to reach, whether students or others, during that time when cases were surging is not possible,” Bell said.

Measles investigation and quarantine delays occurred at Global Academy of South Carolina, a public charter school where only 21% of students are up-to-date on required school vaccines.

One of the schools where winter break investigation and quarantine delays occurred is Global Academy of South Carolina, a public charter school where only 21% of students are up-to-date on required school vaccines, including the measles, mumps and rubella shot. To prevent measles outbreaks, 95% coverage is needed.

It took Global Academy until Jan. 9 to provide outbreak investigators with a requested “line list” detailing the names and contact information for exposed students and staff, the DPH documents obtained by Healthbeat show. The school’s winter break was Dec. 22-Jan. 2.

“Global Academy finally provided a line list yesterday, and we are going through it,” a DPH official said in a Jan. 10 email updating the South Carolina governor’s office on the outbreak response.

The school’s principal, Mark Robertson, did not answer Healthbeat’s questions and told a reporter to contact DPH.

Global Academy was one of the first two schools to have confirmed measles cases when the outbreak began in early October. The school has had repeated rounds of students being quarantined and excluded from class.

Other schools that had delayed winter break investigations of measles exposure incidents included large public elementary schools in Spartanburg County School Districts 2 and 6, the records show. Throughout the outbreak, the district’s schools have had exposure incidents requiring students to quarantine, state records show.

In District 2, winter break delays occurred in investigations of exposures at Sugar Ridge Elementary, where state data show 78% of students are up-to-date on school vaccines, and at Boiling Springs Elementary, where 80% of students are up-to-date on vaccines.

In District 6, the delays also occurred at Jesse S. Bobo Elementary School, where state data show 94% of students are up-to-date on school vaccines.

Officials with both districts have declined repeated requests from Healthbeat since Jan. 9 for interviews or answers to specific questions about the outbreak’s impact on student health, as well as the circumstances surrounding the exposure investigation delays over the winter break.

Health officials’ efforts to get complete exposure contact information from one school were so protracted coming out of the winter break that they were preparing to issue a formal public health order to force compliance. The school says it promptly provided information.

Maternity unit, BMW plant among groups exposed in South Carolina measles outbreak, records reveal

In January, the state health department issued a “final notice letter” to Westgate Christian School in Spartanburg because of the school’s continued “noncompliance,” Healthbeat reported earlier this month. The school was closed for its Christmas break from the afternoon of Dec. 19 through Jan. 2.

Outbreak investigators had been asking for contact information for exposed students and staff since Dec. 29, Bell said. A list that the school provided on New Year’s Eve was deemed “insufficient.”

When Westgate Christian’s break was over and the requested information still hadn’t been provided, Bell said the department issued a “final notice” to the school on Jan. 9. The letter warned that if the information wasn’t received by 1 p.m. on Jan. 10, the department “would issue a Public Health Order pursuant to S.C. Code § 44-1-140 compelling compliance.”

The issue was resolved the next day when the school provided the requested information, Bell said.

Pastor James Wooten, Westgate Christian’s president, said that until the school’s administrator received the “final notice” email – at 5 p.m. on Friday, Jan. 9 – she thought the health department had been provided everything it needed on Dec. 31.

“Other than a thank you acknowledging receipt, she received no further correspondence or request for information until the final notice warning,” Wooten told Healthbeat last week. School officials wonder why, if outbreak investigators needed more information, “they didn’t simply reply to the email and request it,” Wooten said.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

S.C. hospital system with maternity unit measles exposure to require masks

2026-02-04T23:51:32+00:00

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South Carolina’s measles outbreak is prompting Prisma Health, one the state’s major health care systems, to begin requiring masks for anyone entering its hospitals’ labor and delivery units and other birthing areas, as well as its emergency departments.

Prisma Health’s announcement on Wednesday came two days after Healthbeat revealed measles exposure incidents in the labor and delivery unit at Prisma Health Greer Memorial Hospital and in the emergency department of Prisma Health Greenville Memorial Hospital, as well as at some of the system’s other urgent care and private practice offices.

At a press conference, Prisma physicians said the new masking requirements are an additional safety measure being taken in response to the growing outbreak, which has had a spike in new cases since the holidays. As of Tuesday, state health officials had confirmed 876 measles cases, mostly in and near Spartanburg County.

Maternity unit, BMW plant among groups exposed in South Carolina measles outbreak, records reveal

“There is no incident that has prompted this,” said Dr. Kendreia Dickens-Carr, a Prisma Health OB-GYN. “This is a public health concern, and the measures that we are taking is to prevent any more [cases].”

Dickens-Carr said obstetric floors at Prisma Health hospitals across South Carolina, just like the emergency departments, will enforce masking on entry for all patients and those accompanying them until they have been evaluated to determine if they have an infectious disease.

In labor and delivery and other birthing areas, any patient or care partner who has a fever, rash, or respiratory symptoms will be asked to keep wearing their mask, the Prisma press release said.

Internal state health department records obtained by Healthbeat under South Carolina’s public records law list several public exposure incidents during December and January across Prisma Health facilities, from hospitals to urgent care centers and pediatrics practices. Similar measles exposure incidents have also occurred in facilities operated by the region’s other major health provider, the Spartanburg Regional Healthcare System, the records show.

The exposure at the labor and delivery unit at Prisma Health Greer Memorial Hospital, which is located between Spartanburg and Greenville, is of particular concern, experts say, because of the increased risks measles poses to unvaccinated mothers and their babies.

Prisma Health has not answered Healthbeat’s questions since last week about how and when the exposure occurred at the labor and delivery unit and whether anyone became infected. The Prisma Health representatives at Wednesday’s press conference again declined to answer these questions.

The risks of pregnant women being exposed to measles was among issues highlighted Wednesday by South Carolina state epidemiologist Dr. Linda Bell in her weekly call with reporters about the current state of the outbreak.

How the South Carolina measles outbreak grew from 5 to 876 cases

Bell said the South Carolina Department of Public Health has learned of 19 people, including children and adults, who have required hospitalization for complications of measles since the outbreak started last fall. These complications have included measles encephalitis in children – a dangerous swelling of the brain that can have long-term consequences.

“Additionally, several pregnant women were exposed to and required administration of immune globulin to protect against the high risk of complications for measles to pregnant women and their newborns that they could infect,” Bell said.

Immune globulin is a type of protective antibody treatment. Bell declined to provide additional details or say whether the exposures occurred in health care settings.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48.

Maternity unit, BMW plant among groups exposed in South Carolina measles outbreak, records reveal

2026-02-02T10:00:00+00:00

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In South Carolina’s surging measles outbreak, infectious people have exposed others to the virus in the labor and delivery unit of a hospital – where babies are at high risk of infection, as well as in the workplaces of some of the region’s major employers, including manufacturing plants for BMW and Michelin.

Internal records obtained by Healthbeat from the South Carolina Department of Public Health’s outbreak response reveal more about the scope of the outbreak’s impact within the state and across the country than has been previously made public.

The documents, obtained under South Carolina’s public records law, also show the state’s outbreak has resulted in measles exposure incidents in public locations in several other states. They include infectious people from South Carolina who attended a large youth conference in Kentucky, went to a hospital in Florida, and visited busy travel convenience stores in Georgia and Texas.

How the South Carolina measles outbreak grew from 5 to 847 cases

Within South Carolina, the department’s internal outbreak reports, as well as emails updating the state’s governor’s office, reveal numerous measles exposure events inside health care facilities. Many have involved urgent care clinics. Others have occurred when infectious people exposed others to the virus at hospitals and pediatrics practices.

The reports note the challenges state health department officials have faced trying to stop one of the largest measles outbreaks in decades, including making sure those in quarantine understand they need to stay at home and away from others, and dealing with some schools that have been slow to cooperate with outbreak investigations. The records reveal the department issued a final notice last month to a private Christian school, warning that it was about to face enforcement action for failing to fully share information about exposed students.

After initially growing slowly since the outbreak was identified on Oct. 2 with just five cases, the number of measles cases exploded in January, nearing 850 confirmed infections by the end of the month. For now, the outbreak is mostly in and near Spartanburg County, in the northwest part of South Carolina, where it’s being fueled by clusters of unvaccinated children and adults.

South Carolina travelers expose people in other states

While health officials in Washington state, North Carolina, and California have announced recent measles cases in their states that are linked to the South Carolina outbreak, the documents obtained by Healthbeat list additional states and locations where infectious people who are part of the outbreak have traveled.

According to the South Carolina DPH’s internal briefing reports for its director, there were exposure incidents during December and January involving contagious South Carolina residents who traveled to Kentucky, where exposures occurred at a “Large NYE Youth Conference” and also at a Hyatt Place hotel; in Georgia at a Love’s travel center; in Texas at a Buc-ee’s travel center; and in Florida at an Embassy Suites hotel.

In addition, there was a potential public exposure at a hospital in Florida, according to a Dec. 29 email from the South Carolina health department to the South Carolina’s governor’s office. The email did not include the hospital’s name or location.

The other reports released to Healthbeat provide little information about the circumstances of the public exposure sites or whether anyone became infected. In most cases, the reports only list the names of sites of public exposures that have occurred in the previous 21 days – which is the maximum period of time it can take for a person to develop symptoms after being exposed to measles.

The South Carolina DPH told Healthbeat its staff was not able to quickly provide more details about the locations listed in the records. Officials with Hyatt, Love’s, Buc-ee’s, and Embassy Suites’ operator Hilton did not answer Healthbeat’s questions about the exposure incidents listed in the reports.

A spokesperson for the Texas Department of State Health Services said it had not been notified of a measles exposure incident at a Buc-ee’s there during this time period. Officials at the Florida Department of Health did not respond to questions from Healthbeat seeking more information about the hospital and Embassy Suites exposures there.

It’s also unclear exactly where or when the “Large NYE Youth Conference” occurred in Kentucky. The South Carolina DPH said it doesn’t have specific details of the event. Officials at the Kentucky Department for Public Health did not answer Healthbeat’s questions about the conference or the separate exposure incident at a Hyatt Place hotel, which appears to have resulted in the infection of a Kentucky resident.

Last month, the local health department in Lexington-Fayette County, Kentucky, issued a measles alert saying an “unvaccinated, out-of-state traveler” stayed at the Hyatt Place in Hamburg, Kentucky, from Dec. 31 through Jan. 2, and also visited a Panera in Hamburg on Jan. 1. No mention was made of the South Carolina outbreak.

An unvaccinated Kentucky resident who was exposed to this “out-of-state traveler” later tested positive for the disease, the Kentucky DPH announced on Jan. 15. A department spokesperson did not answer Healthbeat’s questions about whether the Hamburg exposures and measles infection are linked to the South Carolina outbreak.

Exposures include hospitals, a maternity unit, urgent care centers

Within South Carolina, the state health department’s internal outbreak reports reveal more measles exposure locations than just the schools and stores, restaurants, businesses, and others that have been publicly shared in the information released to the public.

South Carolina state epidemiologist Dr. Linda Bell, in emailed comments to Healthbeat, said the state only notifies the public of the locations of measles exposure incidents when the department knows the specific date and time the exposure occurred, and when it cannot notify all those who have been directly exposed to the infectious person.

In recent weeks, Bell has spoken at media briefings about health care facilities – without naming names – as a place where measles exposures and infections have been occurring.

“We have seen transmission associated with exposures in health care settings,” Bell said during a Jan. 28 briefing. She said the department continues to encourage health care facilities to put masks on people who arrive with symptoms of respiratory illness, which can be early symptoms of measles, and isolate them from waiting areas where other people might be exposed.

Bell said health facilities also should make sure their workers – including administrative and intake staff – are vaccinated. “We are having to track a number of workers across disciplines and health care settings who have been exposed,” Bell said.

As U.S. is poised to lose measles-free status, RFK Jr.’s new CDC deputy downplays its significance

State health officials and members of the medical community have been urging that anyone who may have measles call before visiting health facilities, so that arrangements can be made to safely provide assessment and care – such as through a remote telemedicine appointment, an after-hours office visit, or admission to a special hospital isolation unit.

The newly released documents detail the names of hospitals, urgent care clinics, and some practice locations where infectious people have exposed others to measles.

Two of the major health systems serving the South Carolina Upstate region at the center of the outbreak – Spartanburg Regional Healthcare System and Prisma Health – have had multiple incidents where infectious people went into their facilities and exposed others to measles in the December through January period, the state health department’s records show.

One of the listed exposure incidents occurred in the labor and delivery unit at Prisma Health Greer Memorial Hospital, which is located between Spartanburg and Greenville. A spokesperson for Prisma would not answer questions about the incident or whether any infections were associated with it.

Measles is especially dangerous to babies, who are too young to be vaccinated, according to the Centers for Disease Control and Prevention. The virus spreads through the air and infectious particles can remain in a room for two hours after the infected person has left the area.

“Exposure to measles in a labor and delivery unit is highly concerning because measles is extremely contagious and poses serious risks to both pregnant people and those who may not be fully protected against measles,” said Dr. Michael Warren, chief medical and health officer for the March of Dimes, who previously served as the associate administrator of the federal Health Resources and Services Administration’s maternal and child health bureau.

While not commenting on the specific incident in South Carolina, Warren told Healthbeat that the ability of the measles virus to linger in the air for hours increases the likelihood of exposures occurring in that kind of a health care setting. The Birthplace at Greer Memorial Hospital has 10 labor, delivery, recovery and postpartum and recovery rooms, according to a promotional video on its website.

“Labor and delivery units care for multiple patients, with pregnant and postpartum women, newborns, and health care workers in close proximity, so even a single measles exposure can lead to rapid spread if not identified and managed quickly,” Warren said. He added that because newborns and pregnant people can’t receive the measles vaccine, those who are exposed may need special treatment with immunoglobulin, a substance that helps fight infections.

In addition to the exposure incident at Greer Memorial Hospital, other Prisma Health facilities that are listed in the records as sites of public measles exposures include: Greenville Memorial Hospital and its emergency department; Prisma Health Pediatrics in Greer; Prisma Health Urgent Care locations in Boiling Springs and Greenville; and Prisma Pediatrics - Spartanburg.

A South Carolina Department of Public Health nurse holds a box containing vaccine for a mobile clinic in Spartanburg County. Two doses of the vaccine is 97% effective at protecting against infection with measles, according to the Centers for Disease Control and Prevention.

Prisma Health did not answer questions about whether it is aware of any measles infections occurring in association with exposure incidents in its facilities. In a brief emailed statement, a spokesperson for the system noted that measles is highly contagious and that people can spread the virus before they are diagnosed.

“Prisma Health has taken extensive proactive measures during the measles outbreak to protect patients, visitors, and team members, including visitor restrictions, enhanced masking policies, additional precautions, and broad patient and community education,” the statement said.

Spartanburg Regional Healthcare System also wouldn’t answer questions about the specific exposure incidents inside its facilities and whether any have resulted in infections. Among the system’s facilities noted in the records for exposures: Spartanburg Regional Medical Center, Spartanburg Regional ER, and Pelham Medical Center.

In an emailed statement, the system said it has taken several actions to address the risks of measles exposure in its facilities. They include signs posted at Medical Group of the Carolinas practices to inform patients about the signs and symptoms of measles and instructing them to stay in their vehicles, call the practice’s phone number, and wear a mask. Masks are being required in all of the system’s emergency rooms and immediate care centers. “Associates and providers also are taking airborne precautions – such as wearing masks – when evaluating patients who might have measles,” the system said.

Measles enters BMW, Michelin manufacturing plants

Beyond health care facilities, the documents also show exposures at some major employers in the Spartanburg area that have not been included in the information the state health department has released publicly.

The most prominent of the employers listed in the records are BMW and Michelin.

BMW Manufacturing employs more than 12,000 people at BMW Group Plant Spartanburg, which assembles BMW sports activity vehicles and coupes on what the company describes as its 10 million-square-foot campus. Michelin has had a major tire manufacturing presence in the Spartanburg area for decades.

The state health department flagged the exposures at the BMW and Michelin plants to the state’s governor’s office in a Jan. 12 email with outbreak updates.

In a statement to Healthbeat, BMW said: “The Plant Spartanburg workforce has been informed about the measles cases at the plant. We are following guidance from the South Carolina Department of Public Health and are in regular communication with our teams regarding recommended health protocols.”

The BMW statement said it is providing measles vaccinations onsite and that the company is sharing updates and resources with employees. “We will continue to monitor the situation closely and encourage anyone who is unvaccinated or uncertain about their vaccination status to contact their health care provider promptly,” the company said.

A spokesperson for Michelin declined to answer questions about its exposure and what actions the company is taking in response.

Outbreak investigators face challenges at some schools

Since the South Carolina outbreak began in October, hundreds of students in the Spartanburg area have needed to quarantine at home – and stay out of classes – because they have been exposed to someone who was contagious with measles.

While many schools have helped the state health department’s outbreak investigators identify which students have been exposed and need to be quarantined because they are not fully vaccinated or lack immunity from prior infection, the records obtained by Healthbeat show that others have been slow to provide information.

As measles exploded, officials in Texas looked to CDC scientists. Under Trump, no one answered.

In one case, the health department got to the point of threatening enforcement action.

Last month, the South Carolina DPH issued a final warning to Westgate Christian School in Spartanburg that it was about to be served with a public health order and face possible penalties because of its failure to comply with an outbreak investigation, according to the records and additional information Bell provided in response to Healthbeat’s questions.

“Being able to identify and notify staff and students who may have been exposed and are at risk for measles is very important to our efforts to limit the spread of measles to the greatest degree possible,” Bell said. “In order to do so, we require lists from the school of those who may be at risk. Schools that don’t provide the full information needed to contact those at risk within 48 hours are considered noncompliant.”

According to Bell, on Dec. 29 the state health department provided a formal, written request to Westgate seeking contact information for students identified as close contacts of a person with measles. The list that the school provided on Dec. 31 was “insufficient,” Bell said.

Bell said the department issued a final notice to the school on Jan. 9, warning that if the requested information wasn’t received by 1 p.m. on Jan. 10, the department “would issue a Public Health Order pursuant to S.C. Code § 44-1-140 compelling compliance.” Under its authority to collect information to address threats to public health, she said the department can take enforcement actions including fines and other legal actions when organizations fail to comply.

Bell said the school provided the required information on Jan. 10, resolving the issue.

Pastor James Wooten, who is listed as the school’s president, told Healthbeat that the school drew the warning because of “some confusion.” The school is a ministry of Westgate Baptist Church. Wooten said that the final notice was unexpected and that the school thought it had provided the health department with the requested information.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

ByHeart baby formula outbreak prompts global safety study as U.S. struggles to find botulism source

2026-01-08T16:06:51+00:00

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An international food standards committee of the United Nations and World Health Organization has called for a scientific risk assessment of botulism spores in powdered infant formulas as a result of the U.S. outbreak linked to ByHeart products.

The action by the Codex Committee on Food Hygiene, supported by attendees from 50 member countries, noted the “global implications” of contaminated baby formula. It was taken as U.S. health agencies have struggled since early November to determine how ByHeart’s formula became contaminated.

Investigations have been ongoing since early November.

At least 51 U.S. babies have been sickened with infant botulism in the outbreak, with no new cases identified in recent weeks; all required hospitalization. The U.S. Food and Drug Administration has said it was first alerted on Nov. 6 to an initial cluster of illnesses linked to ByHeart formula and that its investigation has been underway since then.

ByHeart has recalled all of its formula products. Federal officials have said they cannot rule out the possibility the company’s formula – which was marketed as a premium, organic formula “closest to breast milk” – has been contaminated with botulism bacteria since it was first put on the market in March 2022.

Food safety advocates said they supported the international risk assessment, but noted it will likely take years to result in any reforms to protect against future outbreaks.

A well-functioning food safety agency would have some answers by now about what caused the outbreak and would be committed to doing widespread product testing to ensure other formula brands are safe.”
Sarah Sorscher, director of regulatory affairs for the Center for Science in the Public Interest

“It’s a really bad sign for Americans when a slow-moving international scientific agency has now initiated public plans, and yet our own regulators responsible for preventing this outbreak haven’t taken any public action,” said Sarah Sorscher, director of regulatory affairs for the Center for Science in the Public Interest, a consumer advocacy group in Washington, D.C., that focuses on food issues.

“A well-functioning food safety agency would have some answers by now about what caused the outbreak and would be committed to doing widespread product testing to ensure other formula brands are safe,” Sorscher told Healthbeat. “Instead, we have utter silence. It’s a complete failure of leadership.”

Officials with the FDA, Centers for Disease Control and Prevention, and U.S. Department of Health and Human Services said their investigations are ongoing but they did not answer Healthbeat’s questions this week about what challenges may be contributing to delays in finding the cause.

They also didn’t respond to questions about whether it’s surprising that a source of ByHeart’s botulism bacteria contamination hasn’t yet been identified.

Federal regulators haven’t decided whether a U.S. risk assessment is needed

Infant botulism is caused by babies ingesting spores of Clostridium botulinum bacteria, which can take 30 days to start growing in their immature guts and produce a toxin that can cause symptoms ranging from constipation, loss of head control, difficulty swallowing and breathing, and respiratory arrest.

Recent tests by government investigators and ByHeart have detected botulism bacteria in some containers of the company’s formula. The company received a formal warning letter from the FDA in August 2023 about contamination issues with a different type of bacteria and its plants have been cited by FDA inspectors for manufacturing and sanitation issues.

A HHS spokesperson, in an email to Healthbeat, said the FDA advocated for the Codex committee’s request for the international risk assessment. Staff from the FDA and U.S. Department of Agriculture participated in the Codex meeting, the meeting’s report shows.

ByHeart baby formula recall exposes dangerous gaps in food safety

“We welcome any and all scientific evidence that can inform recommendations on this important public health matter,” HHS said.

When asked whether the FDA or CDC would be doing their own U.S. assessment of risks for infant formula contamination with Clostridium botulinum bacteria, which cause infant botulism, HHS said that has not yet been determined. The FDA will decide the need for any additional risk assessment after more information is gathered about the current outbreak, HHS said.

“Additional testing by ByHeart, FDA, CDC, and state partners is currently underway, and more results are expected in the coming weeks,” HHS said. No details were provided about the types of testing being done.

ByHeart said the ongoing investigation “includes a rigorous audit of every step of our supply chain” and that the company is working closely with regulators to identify the source of the contamination.

HHS Secretary Robert F. Kennedy Jr., in launching Operation Stork Speed last spring, said that “safe, reliable, and nutritious” infant formula is a priority of the administration.

During the Codex Committee on Food Hygiene, which held its multi-national meeting Dec. 15-19 in Nashville, Tenn., members discussed the need for scientific input to inform a potential revision in the international code of hygienic practice for powdered infant formula. The code has sections that need updating, including sections on cleaning and environmental monitoring when producing formula, participants said.

Global review seeks to identify safety gaps in powdered formula manufacturing

“While Members acknowledged that historical data had not always categorized Clostridium botulinum as a major risk in these products, the importance of investigating whether current gaps in [the powdered infant formula code] contributed to the risk was underlined,” according to the report of the meeting.

The committee’s request seeks a risk assessment of spore-forming pathogens in powdered infant formula, and specifically cites Clostridium botulinum, which causes infant botulism, and Bacillus cereus, which can produce a toxin that causes nausea, vomiting and diarrhea.

Nestle is undertaking a global recall of certain infant formulas because of possible contamination with the toxin produced by Bacillus cereus. The company said a potentially contaminated ingredient is the culprit. While the recall involves formula sold in dozens of countries, the company’s recall advisory as of Thursday morning did not list the United States.

The Codex committee also has asked for an update to the existing risk assessment and scientific advice on environmental pathogens, such as Cronobacter and Salmonella, and to provide additional scientific advice to inform recommendations for strengthened pathogen control measures in all stages of the formula manufacturing process.

During last month’s meeting, a representative of the Food and Agriculture Organization of the United Nations, also referred to as the FAO, said that the scientific advice requested by the committee would be provided by an international scientific expert group called JEMRA – the Joint FAO/WHO Expert Meetings on Microbial Risk Assessment. The FAO did not respond to questions from Healthbeat about how long the risk assessment process will take or what it will involve.

Elisabeth Sterken, a nutritionist with the International Baby Food Action Network Global Council, said actions to address infant botulism and other microbial risks in powdered infant formula need to be taken sooner than will occur through this process. IBFAN is an international coalition that advocates for public policies that favor breastfeeding and investigates the marketing of infant formula.

“From JEMRA, which will likely take years, its recommendation will then go back to the Codex Committee on Food Hygiene, and any changes in the Code of Hygienic Practice will take at least another two years,” Sterken told Healthbeat.

Moms say ByHeart recall has shaken their trust in baby formula safety

“From there the final recommendations go to national regulatory bodies,” she said. “In the meantime, infants will continue to be at risk from the serious health consequences of potentially contaminated powdered infant formula.”

HHS, the FDA, and CDC have not responded to a Dec. 8 letter from the Safe Food Coalition, a group of major food safety organizations, that has called for actions to address “dangerous deficiencies” in the nation’s food inspection and regulatory systems that they say have been highlighted by the ByHeart recall and infant botulism outbreak.

Sorscher, whose organization – the Center for Science in the Public Interest – is a member of the coalition, called the lack of any response to the five-page letter “unacceptable.”

“These agencies owe answers to the public, and the silence at this point speaks volumes about their current ability to protect our food,” she said.

The letter, among many recommendations, has called for the FDA to declare contamination with Clostridium botulinum to be a hazard that requires prevention and must be addressed in manufacturers’ food safety plans. And it urges the FDA to conduct a nationwide sampling program to test infant formula for this type of bacteria, which causes infant botulism.

Other coalition members that signed the letter include the Center for Food Safety, Consumer Federation of America, Consumer Reports, Government Accountability Project, the Institute for Food Safety and Nutrition Security at George Washington University, and Stop Foodborne Illness.

The HHS last month told Healthbeat it has received the letter and will be responding to it.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

South Carolina measles outbreak grows in wake of holiday season

2026-01-06T21:39:20+00:00

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The ongoing measles outbreak in South Carolina – one of the nation’s largest in recent months – continues to grow in the wake of the holiday season, with 26 new infections reported Tuesday.

This surge in new cases raises to 211 the total number of people infected in the outbreak, which began last fall and is centered in Spartanburg County, along the state’s northwestern border.

Nearly all of those infected have been children and teens, and nearly all have been unvaccinated, according to the South Carolina Department of Public Health. Four people, including children and adults, have been hospitalized for complications of the disease.

“The sharp increase in cases and the number of people currently in quarantine does not indicate the outbreak is waning,” said Dr. Linda Bell, the state epidemiologist who is leading the department’s measles response.

“The primary challenge to controlling measles spread is the lower than needed vaccination coverage to achieve herd immunity in the community,” she said.

Statewide, the percentage of students who are fully vaccinated with two doses of measles vaccine has fallen below the 95% needed to protect against outbreaks. At some individual schools, vaccination rates can be significantly lower.

South Carolina’s outbreak is among 49 U.S. outbreaks reported during 2025, according to the Centers for Disease Control and Prevention. Nationwide, these outbreaks were responsible for most of the 2,065 confirmed measles cases nationwide last year, according to CDC data that was most recently updated on Dec. 31.

While scientists race to study spread of measles in U.S., Kennedy unravels hard-won gains

It’s the first time in more than 30 years that the number of measles cases in the United States has exceeded 2,000. There were three deaths.

Arizona, which also is experiencing a recent outbreak of measles along the Arizona-Utah border, had identified 214 infections as of its update on Tuesday. In Utah, 156 people had been diagnosed with measles in that outbreak as of Dec. 30.

Texas, which announced the end to its significant measles outbreak in August, confirmed more than 760 cases, with 99 people hospitalized and two deaths of school-age children.

The United States was deemed to have eliminated measles in 2000. But the ongoing outbreaks that began last year have put the country at risk of losing its measles elimination status.

In South Carolina, state health officials on Tuesday said 144 people are in quarantine and seven more are in isolation. For those in quarantine, the latest end date is Jan. 28.

The outbreak shows no signs of being brought under control. The state health department said the newly identified cases potentially exposed others to measles in multiple public settings, including schools and churches.

It typically takes 7 to 12 days – but sometimes up to 21 days – after exposure for people to start showing initial symptoms, such as cough, runny nose, red eyes, and a fever, which are later followed by a rash. That means those who were exposed and became infected in late December will start showing symptoms now and in the coming days.

“This disease finds pockets of unvaccinated folks and just runs through those pockets like wildfire,” said Dr. Robert Oliverio, chief medical officer for ambulatory care and population health for Roper St. Francis Healthcare in Charleston. “It tends to hit hard. These couple of school systems in the Upstate now are really getting decimated.”

While the outbreak has so far been centered around Spartanburg County on the northern edge of the state, he said he wouldn’t be surprised to see cases in other parts of the state. “I can’t imagine that we’ll get through this season, particularly with schools getting back in and kids traveling around.”

A person who has measles is contagious starting four days before the disease’s hallmark rash appears and continues to be able to spread the virus through four days after symptoms appear. South Carolina health officials have emphasized that this means people can spread the disease before they know they are infected.

“It is very important for those with mild illness or who are in quarantine to stay home to protect others,” the state health department said Tuesday. “We encourage employers to support workers in following DPH recommendations to stay out of work while ill or in quarantine. which also protects businesses, other workers, and clients.”

Among the places where new public exposures to measles have occurred: Sugar Ridge Elementary and Boiling Springs Elementary on Dec. 18 and 19, prior to the schools’ winter break. Nine students of these schools are in quarantine, state health officials said.

Between Dec. 19 and Dec. 25, exposures occurred at four churches: Tabernacle of Salvation Church, Slavic Pentecostal Church of Spartanburg, Unitarian Universalist Church of Spartanburg, and Ark of Salvation Church.

Over the weekend, South Carolina health officials issued another public alert that a person infected with measles – who was unaware they were infectious – had made Christmas Eve visits in Greenville, S.C., to a Best Buy store and a downtown gastropub called the Nose Dive. Then on Dec. 27, the person attended a planetarium show at the Spartanburg Library.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

5 From the Field: Q&A with Harris County Public Health official Ericka Brown

2025-12-24T12:00:00+00:00

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Dr. Ericka Brown, the local health authority at Harris County Public Health in metro Houston, began her career as a physician providing clinical care.

But Brown was always focused on helping underserved communities, she said, initially working in Harris County’s safety net health system and now serving as the county health department’s division director for community health and wellness.

We recently spoke with Brown to get her insights on five questions about her public health work in Texas’ largest county by population. This 5 From the Field interview has been edited for clarity and length.

What drew you to a career in public health? Is it something you planned? Did you stumble into it?

It’s a little bit of both. I am a family medicine physician by training, and when I trained, there was not much education or exposure to public health. It was strictly clinical practice. I always practiced with underserved communities. As a provider, that’s just my love.

Now I get to affect the lives of patients and vulnerable populations, not just one patient at a time, but really thinking about it from a more global perspective, and driving the health of the community forward.

What are the one or two most pressing public health issues that your department is working on right now?

Immunizations. It’s really a huge issue since Covid and the politicization of immunizations. There is a lot of misinformation, which leads people to make misinformed decisions. So providing factual, scientific, evidence-based information about immunizations is one of the key issues we’re working on.

The other issue is equity, specifically equity for marginalized, vulnerable populations. Not just around their medical care, but around all the social support drivers that make a community healthy.

Access is one of the biggest issues. Providing education to the community and support about what is out there and what is everyone eligible for, what’s available. Then working with those partners to make sure that there is direct access and that the barriers to that social support service or medical service are removed, whether it be a language barrier, transportation barrier, or financial barrier.

How has declining public trust impacted the work your department is doing in the community?

It makes it more difficult.

The role of the community health workers and our outreach teams is very important to make sure we are reaching into communities from a culturally responsible perspective. I can say for Harris County Public Health, that is something that we do very well.

We are still a trusted member of the community, and I think that that is something that was built over time, and it is withstanding what is happening now.

We have a huge network of community health workers, both internal to our department and with external partnerships. These are people who are trusted advisers in the community, who are of the communities and part of that culture.

This goes a very long way to be able to speak to different communities in a culturally competent way, so that they can hear and receive the message that we are trying to give, hear and receive information about resources, about prevention. And they can trust that the information is factual.

What public health accomplishments are you particularly proud of?

My division holds all of the clinical and some of the social support services for the county public health department.

The team has done a phenomenal job at standing up a maternal-child health program, a Healthy Start program, and one of the leading WIC programs. Harris County, unfortunately, has one of the highest Black maternal mortality rates in the country.

It is our role to not only provide a strategy on how to move the needle in improving those outcomes, but to bring the community together and then to also provide programming around that.

Our clinical services for those who are vulnerable, in marginalized populations, who may be uninsured or under-insured, provides a range of health services, such as dental services, preventive services, STI [sexually transmitted infection] testing and treatment. Our substance use department is doing a phenomenal job at educating the community about the substance misuse problems that we have in our county, what to do about them, how to destigmatize those who are suffering from that condition.

Those are just some of the things that I’m just extremely proud of that we’ve been able to make a difference in improving the health of the community.

It’s the holiday travel season. Do you have any personal best practices for staying healthy when you travel?

When I’m sick, or when my children or someone in my family is sick, I stay home. You may not have the flu, you may not have Covid, but you have something. Nine times out of 10 that something is contagious. So, I try to stay home and keep my germs to myself.

If I’m traveling on a plane, I am one of those people that has my own sani-wipes, and I wipe my space down.

Certainly when we’re traveling, hand washing with soap and water is really key because all of those things we’re touching, other people are touching. It’s a naturally occurring thing that germs are around.

I am a huge proponent of vaccinations for myself, for my children, for my family. I do think they keep the public and myself and my family safer. So getting vaccinations at least two weeks prior to travel, because immunity has to have time to build up.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

ByHeart baby formula recall: What to know about 4 new developments

2025-12-19T23:30:03+00:00

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It’s been six weeks since ByHeart Inc. began recalling its popular organic baby formula amid a nationwide outbreak of infant botulism – and nearly two years since children started becoming infected across the country.

Here are four things to know about the latest developments in the outbreak investigation and formula recall.

Some good news: No new cases of sick infants discovered in the past week

The U.S. Food and Drug Administration announced this week that the identification of new infant botulism cases linked to ByHeart infant formula has slowed, with none identified during the past week.

The number of infants known to have been sickened in the outbreak remains at 51 – and all of them required hospitalization. The infants live in 19 states. There have been no deaths.

The most recent date a child started showing signs of illness was Dec. 1, according to the FDA.

The lack of new cases is an encouraging sign. ByHeart did an initial, limited recall of its formula products on Nov. 8, followed by a recall of all of its products on Nov. 11.

But it can take up to 30 days after an infant ingests botulism spores for the bacteria to start growing in the child’s immature gut and produce a toxin that causes symptoms, such as constipation, poor eating, loss of head control, difficulty swallowing and breathing, and potentially respiratory arrest. And ByHeart formula remained on the shelves of some stores for weeks after the recall. (More on this below.)

Some bad news: The discovery that babies started being sickened two years ago

Until recently, federal health officials had said the earliest outbreak illnesses began in August. But they’ve now identified children who were fed ByHeart formula who were hospitalized with infant botulism as far back as December 2023.

The Centers for Disease Control and Prevention has expanded its outbreak case definition to include any infant with botulism who was exposed to ByHeart baby formula at any time since the product first went on the market in March 2022.

Initially, investigators were focused only on infants sickened since Aug. 1, 2025. When they looked at earlier infant botulism cases, they identified 10 additional children who consumed ByHeart products and fell ill from December 2023 through July 2025. Those cases are included in the 51 total outbreak cases.

While no cases have been identified before December 2023, the investigation is ongoing, and the FDA said it “cannot rule out the possibility that contamination might have affected all ByHeart formula products.”

Federal officials and ByHeart say they are still investigating how botulism bacteria spores got into ByHeart formula.

FDA issues warning letters to retailers that kept selling recalled ByHeart formula

Retailers across the country continued to sell ByHeart infant formula for weeks after the recall began on Nov. 8 and was expanded to include all products on Nov. 11.

State and local food safety officials along with FDA inspectors performed more than 4,000 spot-checks of retail stores across the country to ensure recalled ByHeart’s formula was no longer being sold. Yet they continued to find ByHeart products on store shelves at more than 175 locations in 36 states, the FDA said.

However, those checks of retail stores, Healthbeat reported last month, were slowed by FDA delays in sharing ByHeart product distribution lists with state and local officials.

The FDA says it hasn’t received any reports of recalled ByHeart formula still being on store shelves since Nov. 26.

At a Target store in Arkansas, state inspectors on Nov. 20 discovered ByHeart single-serve “anywhere pack” sticks on a shelf with a promotional “Sale!” sign offering a $2 discount more than a week after all of the company’s products were recalled because of botulism risks.

This week the FDA called on food industry officials across the country to improve their compliance with protecting the public from recalled products.

The FDA also announced it sent formal warning letters on Dec. 12 to corporate officials at Target, Walmart, Kroger, and Albertsons Companies for failing to remove ByHeart products from their store shelves.

At a Target store in Arkansas, state inspectors on Nov. 20 discovered a promotional “Sale!” sign offering a $2 discount off recalled ByHeart single-serve “anywhere pack” sticks from Nov. 16 to Nov. 22, according to the FDA’s warning letter to the company.

Investigators found recalled ByHeart formula on Target store shelves across 20 states from Nov. 12 to Nov. 20, the FDA’s letter said.

Workers at Target stores – as well as those at Walmart stores in 21 states, Kroger stores in 10 states, Albertsons Companies’ stores operated under various names in 11 states – gave state and local inspectors a variety of explanations for the presence of ByHeart formula in stores after the recalls were launched, the letters say.

Explanations included that store associates weren’t aware of the recall and that there was confusion over which specific lots were recalled. Workers also told investigators that there were failures to remove all of the recalled products from shelves and that stocking of shelves occurred when recalled products arrived after the recall notification, the warning letters say.

The four companies have 15 days to respond to the FDA warning letters with steps they are taking to address violations or provide information supporting why they believe they haven’t violated the law.

In a statement to Healthbeat, Walmart said: “We take all reports of inaction seriously and will respond to the letter.” The company said it “moved swiftly” to issue a sales restriction and remove the product from its stores and online platform.

Albertsons Companies said they have procedures to address product recalls and that ByHeart products have been removed from their stores. Target and Kroger did not immediately respond to Healthbeat’s requests for comment on their warning letters.

Food safety groups call for botulism testing, investigation of recall delays

The ByHeart formula recall and outbreak has “exposed dangerous deficiencies” in the nation’s food inspection and regulatory systems, according to a letter sent to the heads of the FDA, CDC and Department of Health and Human Services by the Safe Food Coalition, whose members are national food safety advocacy groups.

The five-page letter calls for a range of reforms to strengthen food safety inspections and regulations and improve the speed of recalls. It also urges fully funding food safety work and illness surveillance systems at the CDC’s National Center for Emerging and Zoonotic Infectious Diseases.

Citing Healthbeat’s reporting, the coalition is calling for the FDA to investigate bureaucratic delays in releasing to state food safety regulators the names of retailers that received ByHeart’s recalled products. It’s a lengthy process “that can and must be streamlined not just with respect to recall communication, but for all communication with state regulators,” the Dec. 8 letter said.

The Safe Food Coalition letter, among its many recommendations, also calls for the FDA to declare contamination with Clostridium botulinum to be a hazard that requires prevention and must be addressed in manufacturers’ food safety plans. And it urges the FDA to conduct a nationwide sampling program to test infant formula for this type of bacteria, which causes infant botulism.

“I think it’s critically important that the agency go out there in the field and do a survey of all the infant formula out there to reassure consumers and to understand whether this is a broader problem,” Sarah Sorscher, director of regulatory affairs at the Center for Science in the Public Interest, told Healthbeat.

Other groups in the Safe Food Coalition that signed the letter include the Center for Food Safety, Consumer Federation of America, Consumer Reports, Government Accountability Project, the Institute for Food Safety and Nutrition Security at George Washington University, and Stop Foodborne Illness.

Federal officials have not yet replied to the coalition’s letter. “HHS is in receipt of the letter and will respond directly to the requestors,” HHS said Friday in an email to Healthbeat.

“FDA acted quickly to protect the public, issuing multiple warnings alongside the firm’s initial and expanded recall,” HHS said in its email.

The FDA has previously not responded to Healthbeat’s questions about delays in sharing ByHeart’s product distribution lists with local and state food safety regulators.

HHS said Friday that the FDA began conducting its own recall effectiveness checks “at the corporate level of large retailers” on Nov. 10 – two days after ByHeart announced its initial recall of two batches of formula.

The FDA didn’t receive ByHeart’s product distribution lists from the company until Nov. 12, the day after the company expanded the recall to all products, HHS said. The list was shared the same day with a subset of state food safety regulators who had information-sharing agreements on file with the FDA, the HHS said.

HHS acknowledged that the FDA had to go through a process to obtain exceptions for local and state regulators that lacked information agreements and “where such sharing of commercial confidential information would be otherwise prohibited under the Trade Secrets Act.”

Healthbeat reported last month that according to the Association of Food and Drug Officials – whose members are state and local regulators – the FDA didn’t start fully sharing ByHeart’s product distribution lists with all state and local officials until a teleconference held at 6 p.m. on Nov. 14 – nearly a week after the formula was linked to the outbreak and the company had launched its initial recall on Nov. 8.

HHS did not say how many states had information sharing agreements with FDA that allowed them to receive the distribution lists on Nov. 12. The department only said a “majority” of the 50 states and the District of Columbia have the agreements.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

Hospitals mum on how they’ll handle new guidance on hepatitis B shots for newborns

2025-12-18T00:11:17+00:00

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Maternity hospitals across the country will now play a significant role in whether babies will universally be vaccinated against hepatitis B at birth as the federal government drops its long-held recommendation for the shot.

But many of the nation’s largest maternity hospitals wouldn’t answer questions over the past week about their current policies and how they will handle the changing guidance.

The guidance now only recommends a birth dose of the vaccine for a subset of babies whose mothers test positive for the hepatitis B virus or whose status is unknown. They further suggest that mothers who test negative for the virus but still want to vaccinate their babies delay the shots for at least two months after birth – a dramatic change that major medical societies say will cause a resurgence of liver disease.

Late Tuesday, the Centers for Disease Control and Prevention announced that its acting director, Jim O’Neill, had approved the vaccine recommendations made early this month by an advisory panel that had been reconstituted to only include members selected by Health and Human Services Secretary Robert F. Kennedy Jr., a vaccine critic.

Healthbeat asked 10 of the nation’s largest maternity hospitals and systems that deliver the most babies about their existing policies for hepatitis B birth doses and whether they are changing as a result of the new CDC Advisory Committee on Immunization Practices guidance. These 10 hospitals and systems delivered more than 227,000 babies in 2024, according to the American Hospital Association’s annual survey data.

All but two of these large maternity hospitals wouldn’t answer specific questions – in writing or in an interview – about their hepatitis B birth-dose policies, existing standing orders for newborns, or any impact of the new federal guidance.

“Unfortunately we will not be able to provide anyone to speak on this matter at this time,” said a spokesperson for Northside Hospital in Atlanta. The spokesperson didn’t respond to questions about why.

Vaccine panel’s hepatitis B vote signals further turbulence for immunization policy, public trust

At Orlando Health Orlando Regional Medical Center in Florida, a spokesperson responded similarly and without explanation: “We are unable to assist with this request.” Healthbeat received similar responses from several of the other large maternity hospitals.

HCA Healthcare, one of the nation’s largest hospital chains, equivocated without answering questions about individual hospital policies or how they may change. HCA helps operate St. David’s North Austin Medical Center in Texas, which is listed among the American Hospital Association’s largest maternity hospitals.

“As a health system, it is our practice to support our physicians by providing information and best practices, including the latest guidance from CDC as well as professional societies, so they can use their extensive training and experience to exercise their independent medical judgment to assess patients’ needs and determine appropriate care,” HCA said in a statement to Healthbeat.

Other hospitals and systems that didn’t answer Healthbeat’s questions included: NYU Langone Hospitals in New York City, Parkland Health in Dallas, AdventHealth Orlando in Florida, and Northwestern Memorial Hospital in Chicago.

A spokesperson for the American Hospital Association said the group had no comment on why so many of the nation’s largest maternity hospitals seemed reluctant to discuss how they are responding to the change in federal guidance.

Two large maternity hospitals told Healthbeat they plan to continue to offer and recommend universal hepatitis B vaccination for babies born at their facilities regardless of whether their mothers have tested positive, a practice that continues to be endorsed by the American Academy of Pediatrics, the American Academy of Family Physicians, and numerous other major medical societies.

At Memorial Hermann Greater Heights Hospital in Houston, the birth dose of hepatitis B vaccine will continue to be offered to all newborns, said Dr. Luis Ostrosky, chief epidemiology officer for the Memorial Hermann Health System.

“Following best evidence and guidance from major medical societies, Memorial Hermann will continue to offer and recommend neonatal hepatitis B vaccination, in line with the American Academy of Pediatrics immunization schedule,” Ostrosky said. “Parents will continue to have the choice – as has always been the case – to accept or decline the recommended guidance, in consultation with their health care provider.”

Babies born on the Inova Fairfax Medical Campus, located in Falls Church, Virginia, near the nation’s capital, also will continue to be universally offered a birth dose of the vaccine, which a spokesperson for the system said remains a part of its standard newborn nursery order to be given within 24 hours of birth with parental consent.

“Inova follows the American Academy of Pediatrics recommendation for universal Hepatitis B vaccination at birth due to the decades of clinical and scientific evidence demonstrating its safety and efficacy in preventing serious illness,” the health system said in an email to Healthbeat. “Decisions regarding vaccination are always made collaboratively between Inova patients and their care providers.”

It appears that New York-Presbyterian Hospitals in New York City also are continuing to provide universal birth doses. This system gave an obscure, one-sentence response to Healthbeat without providing details of its birth dose policies or standing orders. It said: “All our hospitals follow NYSDOH guidance and established best practices,” referring to the New York State Department of Health. The department’s website says it continues to recommend the universal birth dose.

The CDC had recommended universal vaccination of newborns since 1991. Since that time the annual number of reported cases among U.S. infants and children has dropped by 99%, from 16,000 to less than 20, according to the American Academy of Pediatrics.

The birth dose of the vaccine prevents the virus from being transmitted to babies during childbirth and protects them during childhood against infections that can be spread by family members and other caregivers who often are unaware they are infected.

The virus is highly contagious and spreads through contact with blood and body fluids. It can spread through sharing personal items such as razors, toothbrushes, and nail clippers, as well as through sexual contact and the use of unsterile needles.

RFK Jr. wants to delay the hepatitis B vaccine. Here’s what parents need to know.

“This is a vaccine that we have several decades of experience with. We know it’s safe, we know it’s effective, and we know that it’s important,” said Dr. Michael Warren, chief medical and health officer for the March of Dimes, who previously served as the associate administrator of the federal Health Resources and Services Administration’s maternal and child health bureau.

Warren said it’s unclear whether the changing federal guidance will create any barriers to families accessing birth doses for their infants when they deliver at hospitals across the country.

“Hospital policy absolutely does matter,” Warren said. “Almost all babies in this country are born in hospital settings, and so the hospital is really this important front door to a life of good health, and that starts with that routine newborn care, including that birth dose of hepatitis B vaccine.”

If hospital policies were to create barriers, it would contribute to a decrease in vaccination rates and an increase in cases of hepatitis B infections, which can cause cirrhosis, liver failure, and liver cancer, he said.

Warren said he can’t speculate why hospitals seemed reluctant to answer Healthbeat’s questions about their policies and response to the federal guidance. He said he’s heard anecdotally that some hospitals are planning to continue offering universal birth doses.

In Michigan, several health systems – Corewell Health, Henry Ford Health, McLaren Health Care, Munson Healthcare and the University of Michigan Health – have said they will continue to provide universal hepatitis B immunization of newborns, according to the Detroit Free Press.

Warren noted that several state health departments have issued recommendations encouraging parents to continue to have their babies universally vaccinated at birth. A few have issued standing orders or executive directives that authorize providers to administer the doses.

“I hope that their hospitals and those states will follow those recommendations,” Warren said.

Parents who want their babies to receive the birth dose or who have questions about the vaccine can talk with their obstetricians and pediatricians, he said.

“We hope that families are always asking questions about routine newborn care and why it’s important to have these recommended pieces of care done,” Warren said.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

5 From the Field: Q&A with dean Ali Khan on the path forward for public health

2025-12-16T19:30:08+00:00

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Trust, transparency, and sustained investment in public health will help determine how well the United States responds when the next public health crisis arrives, according to Dr. Ali Khan, dean of the College of Public Health at the University of Nebraska and a former assistant surgeon general.

Healthbeat spoke with Khan to get his insights on five questions about issues facing public health, including the “dismantling” of the Centers for Disease Control and Prevention, where he had a 23-year career that included serving as director of the Office of Public Health Preparedness and Response.

Despite financial and physical threats across the country, Khan says he remains optimistic about the opportunity public health professionals have to reshape and grow their relationships with their communities. This 5 From the Field interview has been edited for clarity and length.

You have a long history with the CDC. What are your biggest concerns about the changes underway there?

We’re not reforming the agency. We’re dismantling the agency. Sometimes it feels like we’re humiliating the agency.

We need to go back to what we are: a science-driven, neutral public health agency that was trusted by the American people.

I hear these complaints that we need to rebuild trust in public health. Unfortunately, the people saying they need to rebuild trust in public health are the ones who destroy the trust.

CDC came out of concerns about malaria in war areas. The U.S. has depended on CDC again and again. Whether it was the Cutter incident around contaminated polio vaccine [in 1955], foodborne outbreaks, Ebola, and our hurricane responses. After Hurricane Katrina, I was left on the tarmac in New Orleans with the advice to do good work, and the plane takes off. What I have is my team and access to a humvee and that was it. We reestablished a rudimentary public health system in that city to keep people safe.

That is the CDC I know. It’s very response oriented.

CDC was in a very uncomfortable position [during the pandemic]. CDC gives advice that for a respiratory pathogen, wearing a mask, staying away from other people, and getting vaccinated saves lives. Somehow we have forgotten that there was a point in time when we were thinking about can you use one ventilator for two people.

Across multiple administrations, CDC has not had the leadership that’s understood the culture of the agency. We need to make sure we have the right leadership at CDC.

CDC has always been a science-based, boots-on-the-ground agency. Just give them the opportunity to do that again without this partisan interference in what they do.

What drew you to public health?

I tell people I’m an accidental public health practitioner. I wanted to be an infectious disease doctor after reading about Louis Pasteur. I’d done my residency in internal medicine and pediatrics.

I was lined up to do an infectious disease fellowship, and had a great mentor who said: Why don’t you go to CDC? And I said: How do you spell that?

So there I am, off to the EIS, the Epidemic Intelligence Service disease detective program.

I fell in love with public health and the ethos of public health, the mission of public health to address the health of people writ large, worldwide, millions at a time, not just one at a time, and really not about sick care, but about helping people be healthy and promoting health within communities.

What was supposed to be a little two-year stint as a disease detective has now become almost a 35-year career working at the interface of medicine and public health. That’s the space I’m in every day, and I love it. I whistle to work every day.

What challenges are your students facing that the faculty didn’t have to contend with at the start of their public health careers?

It’s a completely different landscape for our students. A lot of this has to do with how they now manage a mistrustful public.

We need to develop our own trust with our communities, and we need to be visible in the work we do. Also better skills around information and disinformation. We are awash in data. How do they use that data to drive better policies? We have to train them differently.

They need to be more visible at community events, more visible at the legislature and county meetings. I’ve gone beyond telling my students that they need to have good relationships with policymakers and politicians, to saying they should become policy makers and politicians.

Also more time with their expertise spent on social media. I want to see more public health influencers.

But I’m excited about public health because they get to do something I didn’t get to do, which is they get to define what public health looks like in the 21st century, and they get to reintroduce public health to America and say: This is what I do for you, and I am so much more than infectious disease preparedness work.

What are some of the most pressing public health issues right now?

I think it’s a duality of chronic diseases and health equity in the United States.

If you look at, for example, obesity, 40% of Americans are obese. If I flip to other high-income countries, it’s somewhere between 18% and 25%.

I like to show that discrepancy globally to remind people we get to choose how healthy our community is. That’s a choice. There’s nothing biologically about Americans that make us obese. It’s about a social system and structure around us that allows this to happen.

Social justice, to me, is the heart of public health, and that includes equity issues for our community.

We need to recognize that your ability to be healthy is a function of what’s called social determinants of health. Do you have a job? Do you have transportation? Do you have shelter? Do you have access to fresh fruits and vegetables?

The second thing is the erosion in public health people and systems that we’re seeing across the nation.

There’s been a significant attrition in the systems and the people we need to keep our communities healthy. And the workforce is burnt out, not well paid, and many of them are threatened – not just mentally, but physically. Heck, somebody shot up CDC.

The core science we’re doing right. I think about the genomics, the data science, and the clinical advances. And when I tell somebody their ZIP code is more important than their genetic code, people generally don’t scratch their head anymore. They sort of get it. So that part we’re doing right.

What we’re not doing right is the way our systems are structured. Prevention is not at the heart of our health system in America. It’s actually sick care that is at the heart of the American health care system.

We’ve underinvested in public health systems at the state and local level. We’ve underinvested in our data systems. We’ve definitely underinvested in our ability to formulate and move policy within our communities.

What do you see as the root causes of the decline in public trust and what can be done?

I think we should be honest with ourselves that trust issues have deep roots. It’s not brand new.

If I talk about vaccine hesitancy, even [Edward] Jenner had to deal with vaccine hesitancy [in the 1800s] around his cowpox vaccine.

We need to be honest that actions on behalf of CDC and local and state public health officials over years have also undermined some of this trust, recognizing that the large decline in trust we saw was definitely during the pandemic.

Some of the communication failures, our inability to frame scientific uncertainty the way it should have been framed, so that when we make changes, it’s not like all of a sudden we decided this. It’s because science has changed. When we say follow the science, people think science is fixed. That’s not true about evolving science around an emergency. You get new information.

Social media has made this so much more possible. There has been a weaponization of science. It’s highly partisan right now.

I think we need to take the blame or however we want to frame it, for our missteps as public health practitioners and how we communicate with communities.

We’ve been invisible too long. The first time you hear from your public health practitioner should not be when they stand in front of a microphone and they put on a mask, and you go: Who are you telling me what to do?

They should have known that even before you were born, public health practitioners were worried about putting folate in cereal so that this child didn’t have a birth defect. And after you’re born, making sure that you’re vaccinated so you don’t have hepatitis B from your mom, the people putting you in a car seat, the people who are inspecting your restaurants, the people making sure you can turn on the tap and drink the water.

We’ve been too invisible for too long and that needs to change.

We also need to realize some people will never change.

While our vaccination rates are not 95%, which is what we’d like them to be, 92% of Americans – despite all of the misinformation and disinformation out there – still believe our advice and are going out to get kids vaccinated.

Maybe I should focus on educating the 92%, which is across the political spectrum, across race, ethnicity, every divide.

For that 92%, how do we have them trust us better as public health practitioners?

A lot of that is about radical transparency, talking about what matters to them at the local level, reminding them what public health does every day. We are the kids who help you think about what’s the right car seat size. We’re the kids who make sure when you walk into a restaurant you don’t get food poisoning.

I want to focus on the 92% in a nonpartisan way. I don’t want to lose that 92% because we’re becoming too shrill or becoming too personally partisan to remind people why they have a CDC. And I’d rather that happen before the next pandemic, as we’ve undermined our pandemic preparedness across the United States.

I’m hopeful. I’m going to give you a Warren Buffett quote because I’m in Nebraska. He said, “Never bet against the United States.” I know he meant it in a financial standpoint. But I’m going to say it in terms of public health and taking care of our communities.

I’m never going to bet against us.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

Vaccine panel drops recommendation that all newborns get hepatitis B shot

2025-12-05T20:33:43+00:00

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A longstanding recommendation that all babies be vaccinated at birth against hepatitis B was abandoned in a divided vote Friday by a federal advisory panel at the Centers for Disease Control and Prevention.

Members of the committee who voted in favor of the change hailed it as supporting informed vaccine choice by parents, who they say have been abandoned and marginalized by pediatricians when refusing or delaying immunizations.

“True choice has not been existing in practice,” said committee member Hillary Blackburn, a doctor of pharmacy. “No child should lose their medical home because their parents are engaging in the very individually based decision making we’re encouraging.”

Those who voted against the change said parents always have the final say in what vaccines their children receive, and that the new recommendations lacked scientific evidence and will result in children suffering needless infections and serious liver damage.

“We know that three doses given according to the existing schedule are safe and effective in preventing hepatitis B,” said Dr. Cody Meissner, a professor of pediatrics at Dartmouth’s Geisel School of Medicine. “We are doing harm by changing this wording, and I vote no.”

All of the committee’s members were chosen by Health and Human Services Secretary Robert F. Kennedy Jr., who has long been critical of vaccine safety. Kennedy dismissed the panel’s previous members during the summer, then fired Trump administration CDC Director Susan Monarez for what she told Congress was her refusal to rubber stamp future recommendations of the committee.

The CDC Advisory Committee for Immunization Practices voted 8-3 that women who test negative for the hepatitis B virus should consult with health care providers to “decide when or if“ their child should be vaccinated against the virus, with any initial dose “suggested” to be administered “no earlier than 2 months of age.”

The committee did not change the current recommendation that a birth-dose of the vaccine be given to infants born to women who test positive for the hepatitis B virus.

U.S. Sen. Bill Cassidy, the Republican chairman of the Senate Health Education, Labor, and Pensions Committee urged acting CDC Director Jim O’Neill to not sign the recommendations and maintain the current standards.

“As a liver doctor who has treated patients with hepatitis B for decades, this change to the vaccine schedule is a mistake,” Cassidy, whose vote was instrumental in Kennedy’s confirmation as HHS secretary, said on the social media platform X.

“The hepatitis B vaccine is safe and effective. The birth dose is a recommendation, NOT a mandate,” Cassidy said, noting that before the birth dose was recommended, 20,000 newborns a year were infected with hepatitis B. “Now, it’s fewer than 20. Ending the recommendation for newborns makes it more likely the number of cases will begin to increase again. This makes America sicker.”

The committee makes recommendations to the CDC director, who can accept or reject them. O’Neill is a deputy secretary at HHS in addition to serving as acting CDC director. CDC and HHS did not immediately respond to questions from Healthbeat about O’Neill’s timeframe for making a decision on the recommendations.

Major medical and public health associations – including the American Academy of Pediatrics, the American Medical Association, the Infectious Diseases Society of America and the National Association of City and County Health Officials – had urged the committee not to change the recommendation that all babies receive the birth dose.

The American Academy of Pediatrics has said it is not going to change its recommendation to pediatricians that all babies should receive a first dose of hepatitis B vaccine shortly after they are born.

The associations noted that babies born to mothers who test negative for hepatitis B virus remain at risk of infection early in life from families, caregivers, and other close contacts who may be infected but often do not know it.

The hepatitis B virus is highly contagious and spreads through contact with blood and body fluids. It can cause severe liver damage and cancer. The virus can spread from person to person through sharing of personal items such as razors, toothbrushes, and nail clippers, as well as through sexual contact and use of unsterile needles.

Universal infant and childhood vaccination against hepatitis B, recommended since 1991, has reduced by 99% the number of reported cases among U.S. children, adolescents, and young adults.

“Recommendations are not mandates,” Dr. Flor Muñoz, representing the Infectious Disease Society of America at Friday’s meeting, told the committee as it prepared to vote. “The issue of consent is not being solved with these changes … 30 years of information regarding the safety and efficacy of these vaccines are very strong to continue to support the existing recommendation.”

Committee members Meissner and Dr. Joseph Hibbeln, a psychiatrist and neuroscientist, objected throughout the meeting to what they said was a lack of evidence supporting the new recommendations. No data were presented to the committee to support recommending a two-month delay before babies born to hepatitis B negative moms get their first vaccine, they said.

“We have no basis for saying that. That’s been kind of pulled out of the air,” Meissner said.

“I am hopeful that pediatricians will continue to administer the birth dose within the first 24 hours of delivery and before discharge from the hospital. I think to follow any other course is not in the interest of the infant,” Meissner said.

Added Hibbeln: “This specific point is the reason why we tabled this issue for three months to more fully discuss it. However, we have still not had any information or science presented or discussed with regards to this issue of [giving the first dose of hepatitis B vaccine ] before or after 2 months of age. This is unconscionable.”

The committee also voted to recommend parents consider antibody testing to evaluate the hepatitis B vaccine’s effectiveness before getting subsequent doses. The vote passed with six members in favor, four opposed, and one abstaining.

This blood testing, the recommendation says, should be used to determine whether adequate protection against hepatitis B has been achieved. The recommendation says the cost of the testing should be covered by insurance.

Hibbeln objected to this testing recommendation being added to what had been a changing series of proposed recommendations shared with the committee with little time for advance consideration. “This fourth iteration of votes in 96 hours is still incredibly problematic,” he said.

“There is an absolutely novel concept being put forth here to vote, that a serology test should be offered” after the first dose, he said. “There has been no data presented that this plan would actually work.”

Dr. Raymond Pollak, a transplant immunobiologist, expressed similar concerns. “We have no data whether monitoring serology actually implies immunity,” he said.

Dr. Kirk Milhoan, a pediatric cardiologist who recently was appointed the committee’s chairman, said the tests could help parents decide how many vaccines their child needs.

“I would be very happy if we were to vote to simply recommend that this needs to be studied. That would also serve the purpose,” said Milhoan, noting “there is a paucity of data.”

But none of the committee’s members made a motion to do this.

This story has been updated with more details from Friday’s meeting.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

Vaccine panel delays votes on hepatitis B shot for newborns

2025-12-05T01:20:58+00:00

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A federal vaccine advisory committee delayed votes Thursday on changes to hepatitis B immunization recommendations for infants as a top Republican senator called the group “totally discredited.”

U.S. Sen. Bill Cassidy, chairman of the Senate Health, Education, Labor, and Pensions Committee, expressed outrage over a scheduled briefing to the Advisory Committee on Immunization Practices on Friday by lawyer and vaccine critic Aaron Siri.

“Aaron Siri is a trial attorney who makes his living suing vaccine manufacturers. He is presenting as if an expert on childhood vaccines. The ACIP is totally discredited. They are not protecting children,” Cassidy, a Louisiana Republican and a physician, said on the social media platform X.

It’s unclear whether Cassidy plans to take any further action. His spokespeople did not immediately respond to questions from Healthbeat.

The committee, based at the Centers for Disease Control and Prevention, has become a flashpoint for controversy since this summer when Health and Human Services Secretary Robert F. Kennedy Jr. dismissed all its members and appointed replacements.

At Thursday’s ACIP meeting, CDC vaccine subject matter experts were largely sequestered in a “SME room” away or remote offices, away from where the committee members meet and providing expert input through video connections only when asked.

Siri, a Kennedy ally, is scheduled to brief the committee Friday morning on the childhood and adolescent immunization schedule, the evolution of the schedule, and a comparison of the U.S. schedule to those in other countries. The meeting’s agenda, as of Thursday, did not disclose any details about his presentation.

Siri, who compared himself to consumer advocates like Ralph Nader, fired back at Cassidy on X, saying vaccine manufacturers regularly speak before the committee. “Yet, I have never heard you take issue with those presenters,” he wrote.

On Thursday, the committee’s focus was on a push by some of its members to reduce the number of infants who are vaccinated at birth against hepatitis B, a serious infection that can cause chronic liver disease and cancer. The committee’s work group was led by ACIP committee member Vicky Pebsworth, research director of the National Vaccine Information Center, a group that warns against vaccine risks.

“It’s been 35 years since the universal birth dose policy was implemented,” she said. The work group was asked to assess whether the universal birth dose should continue to be given to children of mothers who test negative for the virus.

Since the universal birth dose started being given in 1991, there has been a 99% decline in cases of hepatitis B among children, adolescents and young adults.

Pebsworth said the review was prompted to address parent and stakeholder concerns about administering the hepatitis B vaccine at birth.

The committee voted 6-3 to postpone until Friday votes on any changes to the current recommendation that all infants be vaccinated against hepatitis soon after birth.

The decision to delay came after some committee members objected that they had no way to know what they were voting on. While the proposals were verbally read to the committee by vice chairman Robert Malone, they weren’t provided copies of the proposals’ text so they could assess and discuss the language.

The proposals, among other things, would recommend a birth dose of hepatitis B vaccine for babies born to women who test positive for the virus – a significant change from the current recommendation that all babies receive the vaccine. The proposals also contain language that would recommend delaying an initial dose of the vaccine until a child is 2 months old.

Text of the three proposals briefly read during Thursday’s meeting was not posted on the committee’s website.

Edward Tate, a spokesperson for the Hepatitis B Foundation, said Thursday’s meeting was concerning for many reasons.

“The meeting lacked transparency, with many of the presentations showing one-sided data, and several points made by committee members clearly showed that they have a very specific agenda,” he said.

“The committee members dismissed the extensive body of scientific data and real-life experience that prove the necessity, safety and value of the universal birth dose vaccination for hepatitis B,” Tate said.

The committee will resume its meeting at 8 a.m. Eastern on Friday. The meeting will be livestreamed at this link.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

What to watch for at this week’s CDC vaccine advisory committee meeting

2025-12-04T14:57:58+00:00

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The front line in the escalating political, cultural and scientific war over vaccination in the United States will return to a meeting room at the Centers for Disease Control and Prevention in Atlanta on Thursday and Friday.

That’s where an important CDC vaccine advisory committee – whose members were replaced with appointees of Health and Human Services Secretary Robert F. Kennedy Jr. – is scheduled to take another series of votes that could reshape longstanding recommendations to protect babies against the cancer-causing hepatitis B virus.

The two-day meeting of the CDC Advisory Committee on Immunization Practices is happening in the wake of Kennedy personally ordering changes to language on the CDC’s website that diminishes the agency’s longstanding statement that “vaccines do not cause autism” as not being an evidence-based claim – despite decades of research that has not found a link between vaccines and autism.

And it comes less than a week after a top U.S. Food and Drug Administration vaccine official asserted in a memo to agency staff – without providing data – that at least 10 children’s deaths are related to Covid-19 vaccination. The FDA has not released any information about the cases or how any links were made to vaccines.

With the advisory committee scheduled to start meeting at 8 a.m. Eastern Thursday, the CDC had not posted a final meeting agenda by Wednesday evening. The posted draft agenda – listed only broad topics of discussion, without details about the specific issues of concern, the data that will be presented, or the names of individuals who will be making presentations. Sometime overnight, a final agenda was posted that added a few lines of additional information but still few details.

Here’s what public health practitioners say they are watching for at this week’s ACIP meeting, which will be livestreamed on Thursday and Friday.

Votes that may delay or limit babies’ protection against hepatitis B

At issue: The meeting’s agenda shows that Thursday’s session will be focused on discussions and votes related to this vaccine. Overnight the committee posted draft language for two proposed recommendations.

The first vote is on language that would change current recommendations for universal vaccination of babies soon after birth. The proposed new ACIP recommendation would be for “individual-based decision-making, in consultation with a health care provider” on whether to give the hepatitis B vaccine to infants born to women who test negative for the virus or whose status is unknown.

This proposed recommendation also would leave it up to parents, in consultation with their health providers, to “decide when or if their child will begin the HBV series.”

The second vote involves draft language that would recommend that parents consult with health care providers about giving their children blood tests to check levels of immunity before receiving follow-up hepatitis B shots. The cost of these tests should be covered by insurance, the draft language says.

At the committee’s last meeting in September, the group postponed a vote on recommending a delay for when babies receive a first dose of hepatitis B vaccine.

Currently all babies are recommended to be vaccinated against this virus soon after birth. This is done to help prevent infection during the birth process if the mom’s infection hasn’t been detected during prenatal screenings, and also to protect them from exposure to caregivers and other contacts who may not know they are infected.

ACIP members have previously discussed the need for better hepatitis B screening of mothers during pregnancy. Other concerns have been raised about whether only babies deemed to be at high risk of virus infection should receive the shots.

RFK Jr. wants to delay the hepatitis B vaccine. Here’s what parents need to know.

Why it matters: Universal infant and childhood vaccination against hepatitis B has reduced by 99% the number of reported cases among U.S. children, adolescents, and young adults. The vaccine plays a significant role in preventing liver cancer caused by the virus.

“We have tried all of these methods that we’re now talking about potentially going back to and they did not work. So that is why universal vaccination is so important,” Michaela Jackson, the Hepatitis B Foundation’s program director for prevention policy, told Healthbeat before the final agenda was released.

“Prior to universal vaccination, only 50% of children who were being infected before the age of 10 were getting that from mother-to-child transmission,” she said. “The other 50% were getting it from places like day cares, from contact sports, from caregivers who didn’t know that they had hepatitis B. We’re talking about innocent interactions that you don’t really think about every day.”

The virus is highly infectious. It is transmitted through contact with blood and bodily fluids of infected people, who often have no symptoms or awareness they are living with the virus. While the virus can be spread through childbirth, sexual contact, and sharing contaminated needles, it also can be spread through contact with sharp items commonly shared in families: nail clippers, a toothbrush, even some kinds of jewelry.

Interest in changing the childhood and adolescent immunization schedule

At issue: It’s unclear what aspects of the schedule will be discussed. The posted draft agenda, which listed this as a discussion topic for Friday, didn’t say. The final agenda shows the presentation to the committee on this topic will be made by Aaron Siri, a lawyer and close adviser to Kennedy.

Critics of the current recommendations for when vaccines are given, including Kennedy, have questioned the number, timing, and spacing of shots.

The final agenda lists two sub-topics for Siri’s presentation: the evolution of the vaccination schedule and a comparison of the U.S. schedule to those in other countries.

Why it matters: “The childhood immunization schedule is an important framework that we use to protect children from harmful and potentially deadly childhood diseases,” Dr. Sean O’Leary, chair of the American Academy of Pediatrics committee on infectious diseases, said before the final agenda was posted.

“Every vaccine on that schedule and the recommended timing of it exists for a reason,” he said. “The timing of each dose of a vaccine for a child is critical, and it’s based on the age at which a child’s immune system can provide optimal protection after vaccination, and the earliest possible time for protection … There is no reason to delay or space out vaccines. Doing so just puts children at risk.”

Discussion of ‘adjuvants and contaminants’ in vaccines

At issue: The meeting’s draft agenda said there will be a discussion of adjuvants and contaminants on Friday afternoon. The final agenda describes the presentation as involving aluminum exposure from vaccines before the age of 24 months and persistent asthma at age 24 to 59 months.

Why it matters: “Just like the childhood vaccine schedule itself, every vaccine ingredient plays an important role in making sure the vaccine is safe and effective,” O’Leary said.

“I won’t be surprised if some on this committee refer to these ingredients as contaminants. This is simply false,” he said. “As with any medicine, the ingredients in vaccines are there for a reason. Aluminum, for example, they’ll talk a lot about aluminum. It’s one of the ingredients that vaccine skeptics like to go after.”

Aluminum salts, which are used in some vaccines – including diphtheria, tetanus and acellular pertussis, hepatitis A, and hepatitis B vaccines – boost the body’s immune response to the vaccine, O’Leary said.

“They’ve been safely used in vaccines for about 100 years and have been received by billions of people,” said Dr. Jesse Goodman, professor of medicine and infectious diseases at Georgetown University. “They strengthen our immune response and keep the antigens of the vaccine from disappearing too quickly.”

Wildcard issues, including alleged children’s deaths from Covid-19 shots

At issue: It’s been difficult for the public and public health stakeholders to provide focused input to the committee because information has not been shared in advance about the substance of the issues that will be discussed.

Why it matters: “There’s like zero transparency in this draft agenda,” said Rekha Lakshmanan, executive director of The Immunization Partnership, a Houston-based advocacy group. “We don’t know who’s going to be speaking. You know, it’s sort of like this rough outline that you put together in high school.”

With the ACIP meeting coming soon after last week’s internal FDA memo alleging 10 children’s deaths have been linked to Covid-19 vaccination, Lakshmanan, O’Leary and others said it’s possible the committee will raise the issue.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

Moms say ByHeart recall has shaken their trust in baby formula safety

2025-12-03T19:45:03+00:00

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For moms like Elisabeth Bates and Ashlee Johnson, the decision to feed their babies ByHeart infant formula was driven by necessity and influenced heavily by words like these on the products’ labels:

“Closest to Breast Milk”

“Made with Organic Grass-Fed Whole Milk”

“Certified Clean Ingredients”

“Purity Award”

Bates, a pediatric nurse practitioner in New York City, said she wanted something better for her son than your average baby formula.

Instead – like parents across the country – Bates has been on “high alert” scrutinizing 7-month-old Beau for signs of infant botulism and counting down the 30 days until he is safely beyond the period when any botulism bacteria spores he may have consumed before ByHeart’s recall could still germinate inside his body.

“Seeing that label, you as a parent, you just kind of automatically trust that some higher body gave them this kind of certification,” said Bates, who regrets stopping breastfeeding and giving her trust to the product. “There is a big feeling of guilt.”

So far, Beau remains healthy.

ByHeart’s recall of all of its formula products last month amid a growing nationwide outbreak of infant botulism has shaken the trust of moms and caregivers – not just in ByHeart’s formula, but also in formula made by other brands, moms from across the country told Healthbeat.

Nearly a month has passed since regulators and state health officials issued the first public warnings on Nov. 8 that ByHeart’s baby formula was suspected of fueling an increase in infant botulism hospitalizations across the country. Yet as the weeks have gone by, they’ve released little information about how botulism spores could have gotten into ByHeart’s formula – such as whether the source is likely inside a ByHeart manufacturing facility or in an ingredient used to make the companies’ formula.

This lack of information, the moms said, is not reassuring for families already on edge after making a hasty switch to different companies’ formulas in the wake of the ByHeart recall.

Johnson, who lives in Bremerton, Wash., said she worries about the potential for botulism contamination in the new formula she’s feeding her 5-month-old son, Elio.

“Even with the formula we’re using now, if he has an off day, I’m like: Is there something wrong with this one?” Johnson said. “It’s supposed to be top of the line, good stuff from a reputable company. And you are still worried about it. What if there’s another recall for this one?”

Bates said even her friends who never fed ByHeart formula are worried: “If this can happen to one formula, they’re also wondering: Could my formula be next?”

Few details released about how ByHeart formula became contaminated

At least 39 infants who were fed ByHeart formula have been hospitalized in 18 states with suspected or confirmed infant botulism, according to the Food and Drug Administration’s outbreak update on Wednesday. The dates these infants first started showing signs of illness ranged from Aug. 9 to Nov. 19.

ByHeart announced a small, initial recall of two batches of its formula on Nov. 8, then recalled all of its products on Nov. 11 after more babies were hospitalized.

ByHeart has all of its infant formula products amid a botulism outbreak affecting babies across the country.

Infant botulism is caused by babies ingesting spores of the bacterium Clostridium botulinum, which can colonize their large intestine. Once inside the body, it can take up to 30 days for the spores to activate and produce a paralyzing toxin in the child’s intestine, then start causing symptoms, such as constipation, difficulty feeding, and signs of muscle weakness, such as a floppy head.

The FDA and the Centers for Disease Control and Prevention have said little about their investigation into how botulism bacteria got into unopened containers of ByHeart infant formula. They have previously said they have not identified any other infant formula brands that pose a risk.

While ByHeart officials initially had emphasized “there is no historical precedent of infant formula causing infant botulism,” the company has since said that its own recent testing has detected botulism bacteria in five of 36 samples of unopened formula packages.

“Based on these results, we cannot rule out the risk that all ByHeart formula across all product lots may have been contaminated,” the company said late last month. “We continue to be focused on finding the root cause, through a rigorous audit of every step of our product development chain, from suppliers and raw ingredients, through to packaging and transportation.”

ByHeart did not answer questions from Healthbeat about what has been done to investigate each of those manufacturing steps and examine the component ingredients that were used to make the contaminated products.

Officials at the FDA and the CDC also did not answer questions from Healthbeat about what their investigation has found in the search for where and how botulism spores got into the product.

“FDA’s investigation, including onsite inspections, is ongoing to determine the point of contamination,” the agency said in an outbreak update last week that provided no details about what those recent inspections have found at ByHeart’s manufacturing plants or at any other companies that supplied the individual ingredients used to make ByHeart’s formula.

The FDA released redacted copies of inspection reports for three ByHeart manufacturing facilities from February and March 2025, and January 2024. The reports show manufacturing and contamination problems, some of which have been previously reported by Healthbeat and other news organizations.

But the FDA has released nothing about what its inspectors and investigators have found during the past month – in the wake of the infant botulism outbreak – as they have examined ByHeart’s manufacturing facilities, and potentially also the facilities of other companies supplying ingredients to ByHeart.

ByHeart told Healthbeat this week that “no observable links” have been found between the FDA’s facility inspection findings and the botulism bacteria that tests have detected in the company’s formula.

‘No signals’ other brands of infant formula are at risk, California officials say

The outbreak was initially identified by the California Department of Public Health, which noticed an increase in requests for a drug it makes to treat infant botulism. The drug, called BabyBIG, is the only FDA-approved treatment for infant botulism. California’s health department also serves as the nation’s infant botulism program.

The FDA has said it was alerted on Nov. 6 that California officials had identified a cluster of infant botulism cases linked to ByHeart’s formula.

CDPH told Healthbeat Tuesday evening that among the 118 infants nationwide treated for infant botulism with BabyBIG between Aug. 1 and Nov. 30, the only cases with a common source of exposure are those that have been linked to ByHeart’s formula.

FDA delays left recalled baby formula on store shelves, food safety expert says

“To date, there have been no signals that other infant formulas have been affected,” the department said in an email.

“It is usually difficult to pinpoint a root cause of any infant botulism case,” the department said. “Infant botulism is a very rare disease, and cases typically occur sporadically.”

CDPH noted that investigations and testing over many years indicate that most infant botulism patients become infected by simply swallowing microscopic dust particles containing spores. Honey is also a known and avoidable source of botulism bacteria spores.

The FDA and CDC did not respond to questions from Healthbeat about the potential for other products to be contributing to the recent rise in infant botulism cases.

Could contaminated milk or another ingredient be the source of botulism spores?

While ByHeart has said botulism bacteria has not been among the pathogens routinely tested for across the formula industry, formula maker Mead Johnson – whose brands include Enfamil – told Healthbeat it has tested its products for botulism contamination for years.

“Every lot of ingredients containing dairy undergoes testing for possible infant botulism contamination during the raw material phase because these bacteria can occur naturally in soil and farm environments, and we aim to mitigate risk right from the start,” Mead Johnson said in an email on Tuesday. “We also conduct routine clostridium and spore testing to ensure the quality and safety of our finished powdered products.”

The testing has not showed any evidence of infant botulism contamination, according to the company’s review of readily available testing records.

“To the best of our knowledge, there had never before been a confirmed case of botulism linked to infant formula. We are closely monitoring the recent competitor recall and look forward to understanding the circumstances behind it,” Mead Johnson said in its statement.

Formula maker Bobbie, which like ByHeart markets itself as a premium organic, whole milk formula, recently announced it is increasing testing of its facilities and products.

Recalled baby formula went to groups serving homeless and at-risk families

As of November, in the wake of ByHeart’s recall, Bobbie has added to its existing testing protocols a type of test that can identify potential spore-forming bacteria, including botulism bacteria. This kind of sulfite-reducing clostridia testing is a screening tool that can serve as an “early-warning system” that further testing is necessary if a positive result comes back, the company said.

It’s unclear what actions other formula makers are taking as a result of the ongoing ByHeart investigation.

Officials with the Infant Nutrition Council of America, an association of infant formula and toddler milk manufacturers, did not respond to repeated requests for comment since Nov. 20 about the potential implications of ByHeart’s botulism contamination for the wider formula industry. The council’s members include Abbott Nutrition, which makes Similac brand formula, and Perrigo Nutrition, which makes store-brand formulas and owns the rights to Nestlé’s Good Start brand.

Bill Marler, an attorney who has specialized in representing victims of foodborne illnesses for more than 30 years and who has filed four lawsuits against ByHeart on behalf of the families of sickened infants, told Healthbeat that manufacturing sanitation and ingredients are the primary suspects.

Marler said that ByHeart’s use of whole milk, not used by many formula makers, is a potential suspect ingredient. But the sanitation issues described in the FDA’s past inspections of ByHeart’s manufacturing plants are also concerning, he said.

“Hopefully they’re going to be able to figure out the number of kids that are sick and what likely lot they consumed from, and then start working their way back upstream,” said Marler, whose firm is based in Washington state.

David Clark, a dairy product industry consultant who specializes in infant formulas, said contaminated milking equipment is one of many potential sources of the contamination in ByHeart’s products.

Botulism bacteria can be found in the environment, stalls, and bedding on dairy farms, he said. The spores, he notes, are not killed by pasteurization. That’s why there are strict requirements for cleaning the cows’ udders and milking equipment, said Clark, whose firm Bovina Mountain Consulting is based in Englewood, Fla.

Officials with the U.S. Department of Agriculture, the federal agency responsible for animal health, did not respond to questions from Healthbeat about whether there have been any botulism outbreaks on dairy farms in the past year, whether there are any requirements for such outbreaks to be reported, and whether there are any regulations that require milk from infected cattle to be withheld from the food supply.

“Please direct these questions to the U.S. Food & Drug Administration,” the USDA press office replied in an email. The FDA also did not respond to the questions.

ByHeart formula carried ‘Purity Award’ certification from Clean Label Project

In addition to ByHeart’s manufacturing plants undergoing FDA inspections, the company’s cans and pouches were emblazoned with a certification that the formula had received a Clean Label Project “Purity Award.”

But the certification never involved any testing for pathogens like those that cause infant botulism, said Kate Stuard, a spokesperson for the Clean Label Project, a nonprofit group based in Colorado.

The project’s voluntary certification program, which manufacturers can apply to, tests a wide range of consumer products for industrial and environmental contaminants such as heavy metals, pesticides, and phthalates, Stuard said. The certification’s rules also require products be produced in facilities that maintain compliance with Good Manufacturing Practices.

The Clean Label Project recently removed ByHeart’s formulas from its list of certified products, a review of archived images of its website shows. The organization did not answer Healthbeat’s questions about when and why ByHeart’s listing was removed recently. The group also didn’t answer whether it took any actions against ByHeart’s purity certification in the wake of a previous recall in December 2022 for a different kind of bacterial contamination that prompted the FDA to issue a formal warning letter to ByHeart in August 2023.

The organization issued a general statement that “if a brand is subject to a recall, we suspend their certification pending the outcome of the investigation.” But it’s unclear what is done to alert consumers to any suspension.

ByHeart, which acknowledged the project’s practice of suspension during a recall investigation, told Healthbeat that the Clean Label Project “did not take action against ByHeart’s certification after a regulatory inspection or report. FDA inspections are a routine regulatory practice, and a core part of ByHeart’s continuous improvement program.”

Baby formula maker linked to botulism outbreak was warned previously about contamination issues

The Clean Label Project last month announced it has been selected to assist with Amazon’s Compliance Fast Track Program that will allow certified brands to have automatic compliance verification with the online retailer.

Health and Human Services Secretary Robert F. Kennedy Jr. last spring announced an initiative to improve the safety and nutrition of infant formulas. But so far the program, called Operation Stork Speed, has indicated a focus on nutrition reviews and testing for heavy metals and other contaminants.

Lack of answers about source of ByHeart contamination fuels concerns among moms

For now, the biggest question for many parents and caregivers remains: How did ByHeart’s botulism contamination happen – especially in a premium product that emphasized its purity to consumers.

“What if it happens at another facility?” asked Dezirae Davies, a medical assistant and mom in Canton, Ohio. “These are our prides and joys that we’re talking about. And some people don’t have the option of breastfeeding babies. So, it’s a really important thing to find out: How did this happen and why did this occur?”

Dezirae Davies holds her son, Koa, in June 2025. “I just wanted the best for my baby,” she said of her decision to feed him ByHeart formula, was recalled in November.

Davies said she chose ByHeart after a lot of research because she wasn’t producing enough milk after six months of breastfeeding her son, Koa. “We wanted something that was organic and more naturally made,” she said. “We wanted something that was comparable to my own breast milk.”

Koa did well on ByHeart’s formula for months until Davies got an alert on her phone last month about the recall. She remembers the horrible wave of panic as she realized that the recalled cans included one that Koa – who was by then 11 months old – had just finished.

“We talked to poison control for like an hour,” Davies said. As the family watched for infant botulism symptoms, Koa developed diarrhea from switching formulas. So they switched him to whole milk, based on his age and his doctor’s advice, and he’s now doing well, she said.

But dozens of families across the country have not been so fortunate.

Hanna Everett of Richmond, Kentucky, said her 4-month-old daughter, Piper, is among the dozens of infants who have been sickened with infant botulism after being fed ByHeart formula.

Piper, who Everett said had recently started drooling her formula out the sides of her mouth, became constipated the same weekend ByHeart announced its first recall. What hadn’t seemed anything serious, became terrifying warning signs in the wake of the recall announcement, prompting the family to rush Piper to the emergency room.

“They had to start numerous IVs, and they had to put a feeding tube in because of the muscle paralysis. They were worried she was going to aspirate,” Everett said.

“Watching them do the feeding tube and the IVs was just awful,” Everett said. “It’s hurting her. She’s screaming and crying.”

Once she started receiving the BabyBIG botulism treatment, which had to be shipped to the hospital, Piper clearly started feeling better, and she was able to return home within a few days, her mother said.

Doctors expect Piper to recover, Everett said, though she will need to receive feeding therapy to help improve her sucking and eating. “We caught hers very early,” Everett said. “We’re very thankful for that.”

Everett said picking out a new formula to feed Piper after ByHeart’s recall was incredibly stressful, but necessary because she has had difficulty producing enough breast milk.

“That was already a big decision the first time around, and I thought I made the right choice. Then it came back to hurt my daughter,” she said.

Everett’s message for the FDA and ByHeart: “They need to do better.”

“They were in trouble multiple times. I feel like the government agencies really let the ball slip on this,” said Everett, who has sued ByHeart in federal court. “It’s not something you should ever have to worry about when feeding your children.”

This article has been updated to include an update Wednesday from the FDA on the number of cases.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

FDA delays left recalled baby formula on store shelves, food safety expert says

2025-11-22T00:47:57+00:00

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Efforts to ensure recalled ByHeart infant formula is removed from store shelves have been hampered across the country because of bureaucratic delays by the U.S. Food and Drug Administration in sharing product distribution lists with state and local officials, according to the head of the Association of Food and Drug Officials.

“I’m not sure they recognize the sense of urgency,” Steven Mandernach, the association’s executive director, told Healthbeat on Friday, amid the nationwide outbreak of infant botulism cases linked to ByHeart’s baby formula. “You expect all hands on deck. This is infants.”

Mandernach said the FDA didn’t start fully sharing ByHeart’s product distribution lists with all state and local food safety officials until a teleconference held 6 p.m. Nov. 14 – nearly a week after the formula was linked to the outbreak and the company announced its initial recall on Nov. 8.

“We wasted almost a week,” Mandernach said. He said recall effectiveness inspections have been finding recalled ByHeart formula offered for sale at about 10% of stores that had been checked as of earlier this week.

On Wednesday and Thursday, the FDA warned the public that recalled ByHeart formula is still being found on the shelves of major retailers, including Walmart, Target and Kroger stores. The FDA did not immediately respond to Healthbeat’s questions Friday about why it took so long for the agency to share distribution lists with local food safety officials.

At least 31 infants who have been fed ByHeart Whole Nutrition infant formula have been hospitalized in 15 states with suspected or confirmed infant botulism as of this week. ByHeart has announced that its independent testing has found the bacteria that causes infant botulism in some of its formula.

Federal health officials have warned consumers worldwide to not feed any ByHeart infant formula to babies because of the potential for it to be contaminated with botulism bacteria spores. It can take up to 30 days between when a baby ingests botulism spores until they start showing signs of illness.

Disjointed sharing of ByHeart sales locations delays removal

Mandernach, in an interview with Healthbeat, described what he said were the FDA’s delayed, limited and disjointed sharing of critical information needed by local food safety officials about what stores and distributors received ByHeart’s formula.

Part of the issue has been bureaucratic, he said.

In recent years, he said, the FDA’s legal team has reinterpreted the agency’s authority. The FDA now considers a food manufacturer’s list of where it sent its recalled products to be confidential business information that cannot be shared with local food safety officials unless they have signed a privacy agreement.

The FDA can also go through an internal process to allow it to justify sharing the information with local departments, Mandernach said, which the agency ultimately completed on Nov. 14.

“No one expects the law to prohibit the agency from trying to share information in this type of event,” he said. “For it to take four days for them to figure out how to use that exemption, that’s just not normal.”

Mandernach said there has been a bipartisan effort in Congress for some time to address the bureaucratic hurdles to sharing distribution lists for recalled products with local officials, but the fix hasn’t happened.

While some states that had federal data-sharing agreements with the FDA received ByHeart distribution lists on Nov. 11 and 12, Mandernach said they were not allowed to share the lists with others. And not all of the departments who had agreements with the FDA were given the information at that time, he said.

“Finally, Friday night [Nov. 14] at 6 p.m., FDA holds a call with all the state partners and some of the large health department partners and says we’re officially able to share the list with you,” Mandernach said.

By that late hour, it meant that many local and state food safety programs were not able to start visiting stores and other locations on the lists until Monday. “Wow. We waited from Tuesday to Friday night at 6,” he said.

In its outbreak updates to the public this week, the FDA emphasized that all ByHeart infant formula products, including cans and single-serve “anywhere pack” sticks have been recalled, and they should not be available for sale in stores or online.

“FDA has received reports that recalled formula is still being found on store shelves in multiple states, including at multiple Walmart, Target, and Kroger locations, and at one or more Sprouts Organic Market, Safeway, Jewel-Osco, Shaw’s, and Star Market locations,” the agency said in an announcement on Thursday. “FDA is working with state partners and retailers to ensure an effective recall and immediate removal of these products from store shelves across the country.”

Walmart said in a statement on Friday it has removed ByHeart formula from its stores and clubs as well as online sites. The retailer also said it has a “sales restriction” in place on ByHeart products, which electronically stops the products’ barcode from being scanned and sold to a customer when they check out.

Sprouts, which said it took “immediate action” to remove ByHeart products from its shelves, told Healthbeat the stores have also taken “additional measures” with vendors to ensure no remaining product is available for sale.

Recalled products have been left on store shelves during previous outbreaks

Food safety advocates said Friday it’s not surprising that ByHeart infant formula continues to be found on store shelves in multiple states, nearly two weeks into a recall and amid a nationwide nationwide outbreak of infant botulism

“This is part of a pattern we’ve seen in recalls, where products are often left on store shelves well after the recall announcement,” said Sarah Sorscher, director of regulatory affairs for the Center for Science in the Public Interest, a food and health watchdog organization based in Washington, D.C.

“It’s just a lot of dysfunction in how recalls are managed in this country,” she said.

The delays in FDA sharing ByHeart’s distribution lists with state officials is an example of this, Sorscher said.

“That slows the recall check because states can’t go out and check on the effectiveness of the recall unless they have that list,” she said. “FDA has repeatedly asked Congress to give it the authority to share more freely with states.”

During 2023 and 2024, after nationwide recalls of certain brands of cinnamon applesauce pouches that were linked to elevated lead levels in children, the FDA continued to find the product being sold on the shelves of Dollar Tree stores.

The FDA issued a formal warning letter to Dollar Tree in June 2024.

“In the weeks and months that followed the manufacturer’s voluntary recall of apple cinnamon fruit puree pouches, public health officials across many states reported continuing to see recalled WanaBana apple cinnamon fruit puree pouches on Dollar Tree store shelves,” the FDA said at the time it issued the warning letter.

“When a food is recalled, retailers play a crucial role in carrying out the recall by ensuring that recalled products are not available to consumers at their stores,” the FDA said at the end of the recall.

Still, it’s not uncommon for products to remain on store shelves, said Barbara Kowalcyk, director of the Institute for Food Safety and Nutrition Security at George Washington University.

The current issues with ByHeart formula remaining on store shelves deserves further scrutiny, she said.

“It’s not surprising to me, but it’s saddening. We know recall effectiveness is not as good as it should be,” Kowalcyk said. But this particular product involved such a vulnerable population – infants who often rely on formula as their only source of nutrition. “I think there needs to be an assessment of why that happened,” she said.

ByHeart officials on Friday said they have been working “with urgency” to recall their formula. The company told Healthbeat it has notified all of its retail customers to remove all ByHeart formula from shelves.

“Since November 9, ByHeart has notified retailer partners four times, and they have confirmed communication has been sent to stores. The FDA has also shared notifications with retailers,” the company said.

ByHeart also said it has taken action to notify members of its OpenHearted formula donation program of the recall. “All OpenHearted partner organizations have been notified, and ByHeart has helped aid recall implementation with them. We have shared all necessary information on our donation programs with the FDA and other regulatory bodies, as needed,” the company said.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

As botulism outbreak grows, major stores still selling recalled ByHeart baby formula

2025-11-20T22:43:47+00:00

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As the nationwide outbreak of infant botulism continues to grow, and new test results show botulism bacteria in some samples of ByHeart infant formula, the source of the potentially deadly contamination remains unknown.

ByHeart Inc., in an announcement on its website Wednesday night, said that testing the company commissioned has identified Clostridium botulinum, the bacteria that cause botulism, in some samples of its baby formula.

“We do not yet know the root cause, but we are committed to finding the answers,” the company said.

At least 31 infants in 15 states who have been fed ByHeart Whole Nutrition infant formula have been hospitalized with suspected or confirmed infant botulism as of Wednesday, according to the U.S. Food and Drug Administration.

That’s eight more infants since Friday’s outbreak update. It can take up to 30 days between when a baby ingests botulism spores until they start showing signs of illness.

Meanwhile, despite the outbreak and nationwide recall of all ByHeart products, FDA officials on Thursday warned that the company’s products are still being sold in multiple states. The FDA said the formula has been reported at “multiple Walmart, Target, and Kroger locations, and at one or more Sprouts Organic Market, Safeway, Jewel-Osco, Shaw’s, and Star Market locations.”

Here’s what to know about the latest developments in the outbreak investigation,

How did ByHeart formula become contaminated with botulism spores?

Federal investigators have said little about how they suspect ByHeart’s infant formula became contaminated, and they have released few details about what their investigation of ingredients and manufacturing processes have found.

“The contaminant is the spores, Clostridium botulinum spores,” said David Clark, a dairy product industry consultant whose practice specializes in infant formulas. “It’s very important to find out where the spores are coming from, because it’s difficult to eliminate them, to kill them, to prevent them from germinating into active bacteria.”

Pasteurization of milk does not occur at a high enough temperature to kill botulinum spores, which is why it’s important to prevent them from getting into milk, he said.

Infant botulism is caused by babies ingesting these inactive spores. But once the spores are in the body, they germinate and colonize the infant’s intestine, where they produce a neurotoxin. The infant may not have any symptoms until weeks after exposure, then begin to show signs of constipation, loss of head control, and difficulty sucking and feeding.

As federal investigators and ByHeart continue to look for how bacteria spores got into the formula, Clark said there are a wide range of ingredients and manufacturing processes that are likely being scrutinized.

Clark, whose firm Bovina Mountain Consulting is based in Englewood, Fla., told Healthbeat it’s important to keep an open mind about where the spores might be coming from, because the bacteria that causes botulism is found widely in the environment.

“As dairy ingredients are key in formula, they must look through those and how those ingredients are handled,” he said.

Dairy cows have the potential to become infected with botulism through contaminated feed and other sources in the environment. Scientists in Germany have reported detecting Clostridium botulinum bacteria and toxin in milk from dairy cattle that appeared to be infected with the bacteria. But other researchers have not found bacteria in the milk produced by a small number of experimentally infected dairy cattle.

“The most likely source of contamination is not actually in the milk coming out of the teat in the [cow’s] udder, it’s more likely to be contamination on the milking equipment,” Clark said.

Botulinum bacteria have the potential to grow in the environment where dairy cattle are kept, including in their bedding, where there is fecal material.

“That’s why there are very thorough requirements, operating procedures about cleansing the udder and the equipment” before milking cows, he said.

But Clark said there are many other potential sources of how the infant formula could have become contaminated. He noted there are other ingredients in formula beyond dairy, including oils, fiber, and minerals.

“It could come from any of the ingredients,” he said. It also could come from contamination of manufacturing or packing equipment or products. “So it’s going to be difficult to track it down,” he said.

Recalled ByHeart infant formula continues to be sold

The FDA this week raised concerns that the recall of all ByHeart infant formula products, which was announced on Nov. 11, has not been effective in protecting consumers.

“FDA has received reports that recalled formula is still being found on store shelves in multiple states,” the agency said. “All ByHeart infant formula products have been recalled, and these products should not be available for sale in stores or online. This includes all formula cans and single-serve ‘anywhere pack’ sticks.”

The FDA said it is working with state agencies and retailers “to ensure an effective recall.”

The agency also warned on Wednesday and Thursday that customers worldwide should not use ByHeart products, which were sold through online marketplaces and shipped to customers. Customer information provided to the FDA by Amazon shows ByHeart formula was distributed to about 20 countries, including Argentina, Canada, Egypt, Israel, Peru, South Africa, and Thailand.

Healthbeat reported last week that in addition to commercial sales, ByHeart had a formula donation program that gave away its product to food banks and organizations helping homeless and in-need families.

It remains unclear what actions are being taken to notify families who received donated formula. The FDA’s outbreak update Wednesday did not mention that ByHeart products have been supplied to food banks and social service agencies. The agency did not respond to questions about this sent by Healthbeat on Wednesday.

“I’m getting very concerned,” Donald Whitehead, executive director of the National Coalition for the Homeless, said Thursday. Whitehead said he’s tried to reach officials at the Centers for Disease Control and Prevention, an agency that has been helpful to his organization in the past.

“I’ve not heard anything back,” he said.

ByHeart’s statements evolve from skepticism to finding bacteria

News of potential issues with ByHeart’s infant formula first became public on Nov. 8. That’s when the company announced it was voluntarily recalling just two batches of its formula.

ByHeart’s announcement emphasized “there is no historical precedent of infant formula causing infant botulism,” that the FDA had not found a “direct link” to the company’s product, and said the recall was being done “out of an abundance of caution.”

At that time, health officials had identified 13 infants hospitalized with infant botulism who had consumed ByHeart formula.

Three days later, on Nov. 11, the company announced it was recalling all of its products after two more hospitalized infants that consumed ByHeart formula were identified the previous day.

The 31 infants whose illnesses are so far linked to the outbreak range in age from 16 days to about 6 months old. And they have fallen ill on different dates over the past three months. The dates that each of their illnesses started range from Aug. 9 to Nov. 13, the FDA said.

But most of these infants have fallen ill in recent weeks, according to the CDC’s timeline of infants’ illnesses. Of the 27 outbreak cases in the CDC’s data, 21 had a first date of illness on or after Oct. 19.

There can be a significant delay between when a child ingests botulism bacteria spores and when they start experiencing any symptoms of illness. Health officials say babies that drank ByHeart formula should be watched closely for 30 days after they last had any of the product.

While the California Department of Public Health announced on Nov. 8 that preliminary tests on an open can of ByHeart formula suggested the presence of Clostridium botulinum bacteria, ByHeart officials emphasized the need to test unopened cans.

“Opened product can be exposed to environmental factors – soil, dust, vegetables – that can contain C. botulinum, which is why it is important to test unopened samples to establish causation,” the company told Healthbeat on Nov. 10.

Now, the company’s own testing has identified the bacteria in “some samples” of its formula. ByHeart said the tests were done by IEH Laboratories & Consulting Group.

“We have been working in cooperation with the FDA, and we are investigating every facet of our process – from ingredient-sourcing to our manufacturing process and facilities, packaging, transportation, everything,” the company’s announcement of the test results said.

ByHeart did not answer questions from Healthbeat on Thursday about how many samples were tested by its lab contractor or how many tested positive for contamination. It’s unclear what regulators have found in their testing of ByHeart’s formula. The FDA said that its investigators have collected and are analyzing unopened ByHeart products.

“Additional testing is underway, and results are expected in the coming weeks,” the FDA said this week. “Detection of Clostridium botulinum in infant formula is difficult, and a negative test result does not rule out the presence of the bacteria in the product.”

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

Recalled baby formula went to groups serving homeless and at-risk families

2025-11-14T20:17:49+00:00

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Baby formula linked to a nationwide outbreak of infant botulism was distributed to programs serving homeless mothers and other struggling families in multiple states, but it’s unclear what actions are being taken to alert those families to the recall.

Formula maker ByHeart Inc., operates a formula donation program in partnership with Baby2Baby, a Los Angeles-based nonprofit that counts high-profile celebrities among its supporters. ByHeart’s Open Hearted Initiative has donated nearly 24,000 cans of formula to at-risk families since June 2022, according to ByHeart’s website.

Neither ByHeart nor Baby2Baby answered questions sent by Healthbeat on Wednesday and Thursday about what actions are being taken to ensure people who received donated formula are aware they shouldn’t feed it to their babies.

Donald Whitehead Jr., executive director of the National Coalition for the Homeless, said Thursday he was unaware ByHeart’s recall involved formula that included cans that were donated to groups that help feed homeless people. Special outreach efforts are needed to ensure they are aware of the danger, he said.

“We have no clear indication that people have access to news stories or if they’re listening at a given time to the radio,” Whitehead said, emphasizing press releases are not enough.

Whitehead said his organization has not received any alert from the Centers for Disease Control and Prevention about the recall impacting homeless people. He said the CDC typically alerts the coalition of such health risks.

“Until you just alerted me, I did not know this issue existed,” Whitehead told Healthbeat. “I personally will reach out to the CDC.” He also said he will be sending an alert to his organization’s network.

The CDC did not immediately respond to questions from Healthbeat.

Bobby Watts, CEO of the National Health Care for the Homeless Council, also said he was not aware that the recalled formula was part of a distribution program to homeless people and food banks. “I’m glad you raised this to our attention,” he said.

Watts said the infant formula recall is occurring at a time when families are relying even more on donated products because of recent cuts to food aid under the federal Supplemental Nutrition Assistance Program.

The FDA announced Friday that the number of confirmed or suspected infant botulism cases in the outbreak has risen from 15 infants to 23 infants. All of these infants have needed to be hospitalized and all had confirmed exposures to various lots of ByHeart Whole Nutrition infant formula. The cases are spread across 13 states.

Symptoms of the dangerous infection – which include constipation, difficulty suckling or swallowing, loss of head control and progressive paralysis – are caused by infants ingesting bacteria spores.

ByHeart on Saturday announced a limited recall of its powdered formula, which it expanded to include all of its products on Tuesday as the number of infant botulism cases identified by federal and state health officials continued to grow.

According to ByHeart’s website, the company has been donating its infant formula as part of a goal of ending food insecurity for babies by 2028. “Whenever you purchase ByHeart, you’re supporting our OpenHearted Initiative, which helps provide infant formula, nutrition education, and essential support to families who need it most,” the company’s website says.

ByHeart said it partners with Baby2Baby to distribute formula to families. The program lists 23 organizations across the country as participants in the ByHeart formula donation program. They include WIN (Women In Need) in New York City, which provides services to homeless women and children and describes itself on its website as the city’s “largest provider of family shelter and supportive housing.”

In the metro Atlanta area, Helping Mamas in Norcross, Ga., is listed as another participant in the formula donation program.

Nobody from WIN or Helping Mamas responded to questions from Healthbeat about how much recalled formula they received and what is being done to ensure the people who were given the formula are aware it shouldn’t be used.

In Portland, Oregon, PDX Diaper Bank received 400 cans of the recalled ByHeart infant formula, of which 312 cans were recently distributed, said Rachel Alston, the group’s executive director.

But PDX Diaper bank wasn’t able to say what’s being done to alert the individual families who received the formula cans.

“PDX Diaper Bank does not provide direct services to families, so [we] are calling on our partner agencies to provide recall information to families directly impacted,” Alston said in an email to Healthbeat. Her organization disposed of the 88 formula cans remaining in its warehouse.

“We are prepared to support our partner agencies in regard to communications to families, if needed.”

Alston said PDX Diaper Bank, which was notified about the recall by Baby2Baby, has followed up by email and phone with the six organizations where it sent the formula to make sure they are aware of the recall. She did not name the six organizations.

Some of the other groups listed on ByHeart’s website as participating in the formula donation program include: El Nido Family Centers on Manchester Avenue in Los Angeles; Miami Diaper Bank in Hialeah, Florida.; Detroit Diaper Bank in Detroit; The Baby Bureau in Westminster, Pennsylvania; Mary’s Shelter in Reading, Pennsylvania; Family Network in Springdale, Arkansas; Power in Changing in Columbia, South Carolina; Northern Kentucky Community Action Commission in Covington, Kentucky; SheRises in Bowie, Maryland; and the Center for Children and Families in Norman, Oklahoma.

Healthbeat received no reply to messages left with these organizations asking how they are alerting people who received recalled formula.

A complete list of organizations that ByHeart’s website says are participating in the formula donation program is available at this link.

This story has been updated to reflect an increase in reported cases from the FDA.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

Baby formula maker linked to botulism outbreak was warned previously about contamination issues

2025-11-11T17:35:29+00:00

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The baby formula company linked to an infant botulism outbreak that has hospitalized children in at least 12 states, was previously cited by federal regulators for contamination issues involving a different type of dangerous bacteria.

ByHeart Inc. on Tuesday morning expanded its infant formula recall to all batches of ByHeart Whole Nutrition Infant Formula cans and Anywhere Pack amid new warnings from federal health officials that parents and caregivers should immediately stop using any of the company’s products.

“The decision to broaden our recall to all ByHeart products comes after a call with the FDA late last night, informing us that they found two more cases of infant botulism in babies that had also consumed ByHeart at some point,” the company said in a note to customers posted on its website.

ByHeart was involved in another formula recall in December 2022. The company received a formal warning letter in August 2023 from the Food and Drug Administration for failing to have manufacturing processes that ensured its products didn’t become contaminated with microorganisms.

In these earlier safety issues, records show FDA investigators found that ByHeart had failed for months to adequately look into warning signs that infant formula made at its Pennsylvania facility was at risk of contamination with Cronobacter sakazakii, bacteria that can cause life-threatening infections in infants. No illnesses were noted in the 2022 recall.

The current recall of ByHeart Whole Nutrition Infant Formula that began over the weekend involves a different type of bacterium – Clostridium botulinum – that causes infant botulism. And this time the recalled formula was made at ByHeart manufacturing facilities in Portland, Ore., and Allerton, Iowa, the company said in an email to Healthbeat.

The FDA most recently inspected ByHeart’s Oregon facility in March and classified it as “No Action Indicated.” The Iowa facility, however, was cited for issues related to good manufacturing practices on its February inspection, and it was classified as “Voluntary Action Indicated,” the FDA said.

No additional information about these inspections was available Monday. ByHeart officials did not answer Healthbeat’s questions about what the FDA found during the facilities’ inspections. The company said that no products other than infant formula are made at the facilities.

“We adhere to rigorous safety and quality standards and have the utmost confidence in our product, our safety systems, and the people behind them,” Dr. Devon Kuehn, ByHeart’s chief medical officer and chief scientific officer, said in emailed responses to Healthbeat’s questions on Monday night.

Preliminary tests indicate botulism bacteria in one opened formula can

Infant botulism is caused by a baby swallowing spores of Clostridium botulinum bacteria. Once inside the body, the spores activate, then infect the child’s large intestine and produce botulinum toxin. The toxin blocks nerve signals and causes weakness and loss of muscle tone.

Symptoms can take weeks to develop and may include constipation, difficulty suckling or swallowing, loss of head control and decreased facial expression. Without treatment, symptoms will worsen and can lead to breathing difficulties.

The California Department of Public Health, which runs the national infant botulism monitoring program that distributes the only FDA-approved drug to treat children who are sickened by the toxin, noticed an increase in medication requests, then alerted federal officials to the cases involving infants who drank ByHeart powdered infant formula.

“At this time, CDPH is urging families to stop using ByHeart formula immediately, and to report any signs or symptoms of infant botulism to their health care provider or local health department immediately,” the department said in an email to Healthbeat on Monday evening.

ByHeart infant formula is sold online by the company and through major retail stores including Amazon, Kroger, Walmart, Whole Foods, and Target.

As of Tuesday morning, the FDA said the infant botulism outbreak linked to ByHeart’s products involved 15 infants hospitalized in 12 states: Arizona, California, Illinois, Kentucky, Minnesota, North Carolina, New Jersey, Oregon, Pennsylvania, Rhode Island, Texas and Washington state.

The earliest known case linked to ByHeart formula became ill in August, and the most recent case became ill Monday, the FDA said.

The FDA said that among 84 infants treated nationwide for infant botulism since August, those who were fed powdered baby formula disproportionately consumed ByHeart formula. ”Investigations remain ongoing but have not identified any other infant formula brands or shared exposures that pose a risk to infants,” the FDA said.

Nine of the cases linked to ByHeart formula have been confirmed as toxin type A botulism; the others’ tests are still pending, CDPH has previously said.

California health officials on Saturday announced that their preliminary tests on a can of ByHeart powdered infant formula that was fed to one of the hospitalized infants “suggest the presence of the bacteria that produce botulinum toxin.”

ByHeart officials said the company is working with state and federal investigators.

“We are conducting a comprehensive investigation and have offered the FDA and CDC and CA Dept of Public Health full access to our facilities and unopened cans, without restriction,” Kuehn said.

He said that the bacteria that cause infant botulism are found naturally in soil, dust, and some vegetables. “International food safety authorities have concluded that C. botulinum is not a risk in powdered infant formula, and no U.S. or imported formula is currently required to be tested for C. botulinum.”

ByHeart says it launched recall within 24 hours of notification

The FDA was first made aware of a cluster of illnesses on Thursday afternoon. ByHeart officials say they were notified of concerns about their formula on Friday. Then on Saturday, the company announced its voluntary recall and public warnings were put out by state and federal health officials.

ByHeart officials say they were told by the FDA that the infant botulism cases linked to their formula are part of a larger spike in infant botulism cases involving about 83 infant botulism cases since August.

ByHeart’s recall announcement posted on the FDA website Saturday said, “No ByHeart product has tested positive for any contaminants,” even though California health officials in their same-day announcement noted their preliminary tests of ByHeart formula in one opened can indicated the presence of the bacteria that causes botulism.

When asked about the conflicting information, Kuehn told Healthbeat: “We became aware of the CDPH test result on Sunday, November 9 and are treating it with the utmost seriousness.”

But because opened cans could have become contaminated from the environment while they are being used, Kuehn emphasized the importance of testing unopened cans of formula.

“We are working closely with the FDA, as well as a third-party independent testing facility, to test unopened product from the voluntarily recalled lots to conclusively determine causation,” he said.

The Centers for Disease Control and Prevention on its outbreak web page said that officials in several states have collected leftover infant formula for testing. Results “are expected in the coming weeks,” it says. The CDC did not respond to questions on Monday about the outbreak and its role in investigating its source.

The company told Healthbeat on Monday night that there had been no government recommendation to recall any product lots beyond two batches of formula made on April 23 and May 6, which were recommended by the FDA. These batches were distributed primarily in July and August, the company said.

Then Tuesday morning, the company announced it was voluntarily expanding its recall to include all batches of ByHeart Whole Nutrition Infant Formula cans and Anywhere Pack “despite the fact that no unopened ByHeart product has tested positive for Clostridium botulinum spores or toxin.”

The recalled cans have UPC code 85004496800, and Anywhere Packs are marked with UPC code 85004496802.

“The safety and well‑being of every infant who uses our formula is, and always will be, our highest priority,” Mia Funt, ByHeart co‑founder and president, said in the company’s announcement.

The FDA on Tuesday warned parents and caregivers to immediately stop using ByHeart formula and to seek immediate medical attention if their child has consumed the company’s products and is experiencing any symptoms.

Children who are not showing any symptoms should be monitored for signs of infant botulism, the FDA said, which can take weeks to appear. The FDA advises that people who have any leftover ByHeart formula take a photo or record the information on the bottom of the package, then store the product in a safe place after marking it as “DO NOT USE.”

“If your child develops symptoms, your state health department might want to collect your formula container for testing,” the FDA said. “If your child does not develop symptoms after 30 days, throw your containers out.”

This story has been updated with ByHeart voluntarily expanding the recall.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

5 From the Field: Q&A with NACCHO CEO Lori Freeman

2025-11-11T12:00:00+00:00

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As CEO of the National Association of County and City Health Officials, Lori Freeman spends much of her time on the road talking with the people on the front lines of public health.

It’s been a challenging year for local health departments.

The federal government in March announced it was pulling back $11.4 billion in funding allocated across the nation for pandemic response and infrastructure, an action that’s now being debated in the courts. More cuts are expected amid a dramatic reorganization of the Centers for Disease Control and Prevention, which has traditionally sent about 80% of its domestic budget to states, localities, tribal organizations, and other public health partners.

Meanwhile, swaths of the American public have grown increasingly distrustful of scientific and public health institutions.

We spoke with Freeman to get her insights on five questions about some of the current challenges facing local health departments. This 5 From the Field interview has been edited for clarity and length.

What public health concept do you wish the public better understood?

It’s this concept that from the youngest age possible, that public health is around them, keeping them safe.

They don’t see it, but they need to know that for all of their lives, that we will be there on the ground, in their community, helping to make sure that there’s safe water to drink, safe air to breathe, safe places to play and walk, safe restaurants to eat at, safe pools to swim in.

We need to make it real for them, because we just haven’t done that.

You recently co-authored a journal article titled, ‘Where Do We Go From Here? The Way Forward for State and Local Public Health.’ The article notes that the future of public health depends on rebuilding trust with the community. What are some ways to do that?

We talk about this a lot. There is a lot of distrust right now in our federal government, and we have to not automatically extend that distrust further down to the community, because that simply isn’t the case.

Broadly speaking, our local health departments still are very well trusted in their communities. Not as much as the No. 1 primary care physician, but close up there.

For me, this is about how we retain trust, not regain trust. We had some missteps during the pandemic, but they weren’t all of our fault at local public health. But we had to take the brunt of the punishment because we’re the closest to the ground.

We’re past that now. We want to talk about how we assure anybody coming into a local health department that they can have an honest conversation about their concerns and what they need.

If you have a young mom coming in nervous about getting a Covid vaccine, what we have to do is say: This is the information about the vaccine. And this is the information if you want to find further information about some of the side effects, or what can happen if you have certain conditions. This is what you need to know, and this is how you can research that, and how can I help you?

More open conversation about choices is where we’re headed here. It allows our health departments to stay in a neutral space, because we are completely bipartisan. We treat everybody the same.

Really focusing on honest conversation where we can. And it’s not always easy to do that. But we have to listen, and we have to understand where people aren’t meeting us in terms of understanding what public health needs are and how they can contribute.

If we don’t listen and understand that, we’re not going to address the misunderstanding that is still out there, and the mistrust.

This has been a year of significant change and disruption in public health. What are you most concerned about in the year ahead?

There’s a lot of things. One is our ability to actively respond to public health emergencies and threats. Not only are the resources changing and shrinking, but the administration that’s in place now clearly believes in a smaller federal government footprint, impact, and influence.

The partnership between federal, state, and local agencies is never more important than it is in a national public health emergency. Without an active federal component, or even a lessened federal component, the state and locals will be left to manage this more directly on their own. And I don’t know that they have the capacity to do that.

Imagine a year ago when the hurricane [Hurricane Helene] came up through multiple states, and we saw a tremendous impact in the South, in mountain areas, and across multiple jurisdictions. States and locals can’t provide that level of coordination themselves. It’s impossible.

How have the job losses at the CDC impacted local health departments?

It’s a lot of chaos right now with the workforce at the CDC. We had broad-scale layoffs. We had recissions. I can tell you right now, nobody I talk to anywhere at the CDC or elsewhere knows where we stand.

Local health departments, they function along until they need help. Those instances are usually when there is an outbreak, a novel disease shows up in the community, [or they need] advanced testing and diagnostics. We’re seeing some instances where the CDC has been unable to respond or provide assistance.

We recognize the CDC is a huge bureaucracy with a lot of people, and maybe not all of them are needed. But we can point to real expertise that has been lost that we miss.

The CDC represents some of the most world-renowned expertise in disease. We don’t have that capacity locally. We’re not set up that way.

The level of expertise we’re losing from the CDC is alarming. This CDC that we are seeing right now is a fully burned-down version of what we were experiencing a year ago.

Your recent journal article focused on ways public health departments can move forward in the current climate. What are some of the key suggestions?

Look at your core mission. Look at who you are serving, and make sure that you are really targeting what you need to do in the community.

If we continue down this road of federal back-out of supporting public health, health departments really have to look at what are the core things that we have to worry about to keep our community safe. Drinking water, environment, clean air, safe places to eat, keeping communities free of disease – and really honing in on those and letting the rest of the things fall away for now or get diminished. It’s going to be painful.

Some of those core services in local public health are supported by regulatory funding. They’re able to get funding for licensing and inspections. We can still do things at a basic level.

That’s one way to look forward. It’s not an ideal way.

We have to keep returning to our own visionary model of public health. We are the public health strategist for the community, convening and organizing our partners in a way that blends funding support resources across the community.

Some of our communities have already moved here. You have some states and locals who have disengaged and disentangled themselves from federal funding to the extent that they feel far less pain. A lot of these are conservative, red states. They have a story to tell and one that is important for us to learn from. How did they do it, and are they successful at it?

Our partners have to be different and expanded. We have never attempted, as far as I can tell, to try to tie ourselves more closely to the spectrum of health.

Public health is just the pre-health care part of it: Everything that we do [in public health] that you don’t always see that is keeping you from going to the doctor and that is keeping you from having to seek health care, and that is keeping our communities healthy as a whole.

Healthbeat’s “5 from the Field” series highlights insights from public health leaders and practitioners. To suggest someone for a future interview, email Alison Young, Healthbeat’s senior national reporter, at ayoung@healthbeat.org. You can also reach her through the messaging app Signal at alisonyoungreports.48

Monkey escape is latest safety breach involving Tulane research facility

2025-10-31T17:45:51+00:00

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The crash of a truckload of research monkeys this week in Mississippi is the latest safety breach involving a national primate research center run by Tulane University.

The Tulane National Biomedical Research Center in Covington, La., drew national media attention in 2015 when a deadly foreign-strain of bacteria – that poses a significant public health threat in other countries – escaped one of the center’s high-containment laboratories.

That incident, which I reported on at the time for USA Today and further investigated for a recent book on the risks posed by lab accidents, is one of several biosafety lapses that have occurred over the years at the research facility. Until it was renamed this month, the center was called the Tulane National Primate Research Center.

A Tulane spokesperson said the center’s safety history has nothing to do with Tuesday’s truck crash that resulted in the escape of some of the 21 rhesus macaques that were being transported from the university’s facility to an undisclosed destination.

“This incident is completely unrelated to the other issues you mention,” Tulane spokesman Mike Strecker said Friday in a text message to Healthbeat, noting the animals were not owned or transported by the center. “The primates in this week’s tragic accident were not carrying any diseases and had received recent checkups confirming that they were pathogen-free.”

Here are four things to know about some of the Tulane research center’s past biosafety breaches, which are detailed in a full chapter about the facility in my book, “Pandora’s Gamble: Lab Leaks, Pandemics, and a World at Risk.”

Deadly bacteria escaped Tulane center’s lab in 2014

In late 2014, two rhesus macaques – part of the Tulane center’s massive monkey breeding operation that involved about 4,000 animals kept in outdoor cages – became ill. Tests ultimately revealed they were infected with a lab-strain of a dangerous bacterium called Burkholderia pseudomallei.

The monkeys, as breeding stock, had never been used in any experiments. Their outdoor cages were on the other side of the center’s 500-acre compound, far from the secure and federally regulated biosafety level 3 lab where scientists had been using this specific strain of bacteria.

The strain, called 1026b, was not one that could be found naturally in the United States. It had been isolated from a rice farmer in Thailand who became infected in 1993.

Burkholderia pseudomallei causes a disease called melioidosis that can be fatal in people and animals. The disease, which is spread through contact with bacteria-contaminated water or soil, as well as by breathing contaminated dust or water droplets, is difficult to diagnose. The bacteria is often studied because of its potential to be used as a biological weapon and the need to develop treatments against the disease.

The bacterium is rarely found in the United States, but poses a significant public health risk in parts of the world with tropical climates where it is common, especially Southeast Asia and northern Australia.

The bacteria’s release from the center’s secure lab worried local, state, and federal officials because Burkholderia pseudomallei bacteria, which can cause fatal infections in people, lives and grows in warm, moist soil.

These conditions were present in the dirt and grass floored cages where the sick monkeys had been living – raising concerns about the potential for contamination of the wider environment in that part of Louisiana.

CDC investigators blamed sloppy lab practices for bacteria release

Lab regulators from the Centers for Disease Control and Prevention announced in March 2015 that the federal investigation concluded the most likely cause of the bacteria getting out of Tulane’s secure lab involved the organism hitching a ride to the monkeys on contaminated worker clothing.

Federal inspectors determined that workers routinely entered the secure lab without wearing appropriate personal protective gear, increasing the risk of unknowingly carrying bacteria out of the lab or becoming infected. The monkeys, the CDC said, may have become infected either in their outdoor cages or in an on-site veterinary clinic where they went for routine care and treatments.

“CDC has found no evidence to date to suggest the organism was released into the surrounding environment, and therefore it’s unlikely there is any threat to the general population,” the agency told the public.

USDA investigators privately warned of risk to Louisiana’s environment

Investigators for another federal agency, however, saw the situation differently.

According to a copy of a 58-page risk assessment, obtained for “Pandora’s Gamble” through public records requests, investigators from the U.S. Department of Agriculture saw several plausible ways the bacteria could have escaped the facility’s labs.

They concluded, however, that contaminated laboratory wastewater was the most likely way the bacteria escaped the lab and infected monkeys in the outdoor breeding colony. The USDA report found evidence that Tulane was lax in its decontamination of potentially infectious wastewater going back years – a particularly significant issue for a bacteria that lives in water and soil.

The serious biosafety breaches cited in the USDA risk assessment included the way lab workers at the Tulane center failed to decontaminate – with bleach or heat – the blood and body fluids from animals used in experiments with Burkholderia pseudomallei.

Instead, the report said, infected monkeys were “exsanguinated” – draining the blood from their bodies – “directly into the sink during the course of euthanasia and that fluids were not retained for any contact period with disinfectant before entering the drain.”

These fluids from infected monkeys then flowed into the primate center’s on-site wastewater settling ponds, the report said, noting the ponds were near the outdoor breeding colony. The USDA team noted that the nearby Bogue Falaya River, where the center’s wastewater was discharged, “is within the optimal temperature range for B. pseudomallei April through October.”

CDC inspectors privately also had concerns about the facility’s workers not properly disinfecting blood and tissue waste from infected monkeys before sending the potentially infectious materials down the drain.

“This observation raises serious concerns regarding environmental contamination due to improper decontamination of infectious fluids,” they wrote in a March 2015 inspection report marked “Sensitive But Unclassified” that I obtained for the book under the Freedom of Information Act.

In the wake of the monkey infections and regulatory concerns, Tulane officials have said that hundreds of tests have been done of the environment, wildlife, monkeys, and lab workers and that none have detected the presence of Burkholderia pseudomallei.

In response to the 2015 monkey infection incident, Tulane told me for the book that the center had “improved our biosafety program which is widely regarded as a model program for other institutions throughout the country.”

More lab wastewater safety lapses occurred in 2017

Records show that in October 2017, the USDA notified the Tulane center it could face up to $600,000 in fines for multiple violations of the Agricultural Bioterrorism Protection Act of 2002 for issues related to its release of Burkholderia pseudomallei.

The department eventually let Tulane settle the violations by paying about $39,000.

Despite safety concerns about the potential of the facility’s wastewater to release pathogens into the environment, records show that in November 2017 built-up sewage sludge was pulled out of the facility’s wastewater treatment plant that serves laboratories, then spread across the ground in an area on the primate center’s property where the debris from monkey cages was routinely dumped.

Tulane’s safety officials didn’t learn about the sludge spreading until a month after it happened, and they didn’t notify state environmental regulators until October 2018, records show.

During that gap, Tulane hired an outside expert to test soil at the dump site for the presence of Burkholderia pseudomallei and also the bacteria that cause anthrax. Both had been studied in the center’s labs, and both had the potential to contaminate the environment if they were present.

The tests did not detect the presence of these pathogens, and in correspondence with Louisiana environmental regulators, Tulane officials said they “believe that the land application of the sludge did not have an adverse effect on the environment, did not pose a threat to public health, and did not cause an emergency condition.”

In 2021, Tulane officials sought funding from the National Institutes of Health to improve systems at the research facility, including installing a system to sterilize biohazardous liquid lab waste.

“Effluent decontamination capabilities are desperately needed and will be realized through installation of the proposed effluent decontamination system,” Tulane wrote in its application, which was funded.

A spokesperson for the university told me for the book that the request involved equipment needed for future growth into new research areas and that the center’s existing programs were in compliance with waste treatment rules.

Questions remain about monkeys that escaped in Mississippi this week

In the wake of Tuesday’s truck crash on Interstate 59 in Mississippi, which resulted in some monkeys escaping and others being killed, Tulane officials have released little information about why the animals were being moved or where they were going.

The Jasper County, Mississippi, sheriff’s department initially announced on Facebook that the monkeys were aggressive, carried “hepatitis C, herpes, and COVID,” and that handling them required the use of personal protective equipment, based on what the department said the truck’s driver told local law enforcement.

The sheriff’s department later posted a short statement from Tulane, which said that the research center provides primates to other research organizations, and the monkeys involved in the crash “belong to another entity and are not infectious.” But that organization was not identified.

In text messages to Healthbeat on Friday, Tulane spokesman Strecker said it is the university’s understanding that 13 of the monkeys recovered from the crash site remain in the possession of their owner and have arrived at their original destination.

Local law enforcement has acknowledged that some of the 21 rhesus macaques monkeys that were being transported were killed by officers after the crash. Three monkeys were still on the loose as of midday Friday, according to the Mississippi Department of Wildlife, Fisheries, and Parks, whose officers are involved in the search.

Strecker said that the transport of research animals is common and usually involves contracts that prevent the disclosure of information “both for the safety of the animals and to protect the parties’ proprietary information.”

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

Health alert shows growing concerns about type of mpox spreading in Europe and California

2025-10-28T15:55:59+00:00

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European health officials are warning that they have identified a concerning type of mpox virus spreading locally in four countries. The announcement follows the discovery of similar mpox cases spreading locally in California.

The European Centre for Disease Prevention and Control (ECDC), in a public alert issued Friday, said that locally acquired cases of a type of clade I mpox virus have been identified in Spain, Italy, Portugal, and the Netherlands.

It is the first time this type of mpox has been detected spreading within the European Union and European Economic area, the health agency said. Previously, cases of this form of the virus were associated with international travel outside the region.

Will new type of mpox virus spread beyond California? Many at-risk people aren’t vaccinated.

Outbreaks of clade I mpox have been ongoing in parts of Central and Eastern Africa.

There are two types of mpox, clade I and clade II, and both are spread through close, intimate and sexual contact and cause potentially painful rashes. During 2022-23, outbreaks across the United States involved the milder clade II type of the virus, which continues to circulate here at low levels.

The clade I type of the virus has the potential to cause more severe disease, health officials have said.

While an mpox vaccine provides protection against both the clade I and clade II virus, Healthbeat reported last week that federal data show in most U.S. states, more than half of people at highest risk of mpox infections were not vaccinated in the wake of the 2022-23 outbreaks.

Here are four takeaways from the ECDC’s new alert.

Clade I mpox has been detected spreading locally in Europe

The ECDC says cases of mpox clade I have been spreading locally in European countries, rather than just being brought in by travelers.

Spain reported its first locally acquired clade I case on Oct. 10. The Netherlands reported a case on Oct. 17. Since then, two cases were reported in Italy and one in Portugal. The patients started showing symptoms between Sept. 16 and Oct. 7.

Among these five patients, all men, none had any history of travel to countries with known transmission of clade I mpox. Of the four patients whose vaccination status was known, only one was vaccinated against mpox.

“These new cases have been reported among men, some of whom identify themselves as men who have sex with men, with no recent travel history to mpox-endemic areas,” the ECDC said. “This indicates that transmission may be ongoing in sexual networks among men who have sex with men in European countries.”

In its alert, the ECDC noted that local transmission of clade Ib cases has also been detected in California among gay, bisexual, and other men who have sex with men and their social networks.

European risk assessment says more cases are likely to be identified

An mpox threat assessment, also released Friday by the ECDC, said the overall risk of mpox clade I infection in Europe is “moderate for men who have sex with men and low for the general population.”

But the agency noted there is “substantial uncertainty” about the extent of transmission within sexual networks. “In general, the likelihood of exposure is higher with a higher number of casual sexual partners, which is supported by historical data from the mpox outbreak in 2022/23,” the assessment said.

The assessment said it is likely there are additional mpox clade I cases that have not yet been detected.

The severity of locally spread clade I mpox is unclear

While the three recent clade I cases identified in California all required hospitalization, the ECDC said the five European cases all had mild symptoms.

Clade I mpox is divided into two subtypes: clade Ia and clade Ib. The recently identified European and California cases are all clade Ib mpox, the ECDC said.

According to the U.S. Centers for Disease Control and Prevention, infections with clade 1a mpox, especially among children younger than 15, have occurred in Central Africa through contact with infected dead or live animals and through household transmission or patient care.

Clade Ib was more recently identified as spreading through intimate and adult sexual contact.

The ECDC, in its health alert Friday, said: “Some uncertainties remain regarding the transmissibility and clinical severity of clade Ib” compared to the clade II virus that has circulated since the 2022-23 outbreaks.

Before the recent locally transmitted clade I cases were identified, there had been 29 travel-related clade I cases reported to the ECDC, with seven of them needing hospitalization. But the agency said it is difficult to estimate the severity of disease based on such small numbers.

The ECDC said the severity of clade I infections may be worse among those living with HIV, especially if they are receiving inadequate treatment. People with other underlying health conditions, including suppressed immune systems, and people over the age of 65, may also be at increased risk for severe disease.

Awareness, vaccination can protect against mpox

Both the clade I and clade II types of mpox cause a rash that may look like pimples or blisters. The rash, which may involve a few lesions or many, can appear on any part of the body, including the hands, face, mouth, chest, or near genitals.

Mpox may also cause flu-like symptoms. The virus is usually spread through close contact, such as skin-to-skin contact and during sex, health officials say.

“If an unusual rash develops, they should seek medical help by contacting a health care professional for testing and advice. It is also important to avoid close physical or sexual contact with others until they are symptom-free,” the ECDC said.

Vaccination is the best protection against both clade I and clade II, health officials in Europe and the United States said.

The mpox vaccine in the United States, called JYNNEOS, is available through retail pharmacies, usually with advance appointments, as well as through clinics, health care providers, and public health departments. Locations that may offer the vaccine can be found at: www.EmpoweredAgainstMpox.com.

The ECDC has called for European countries to ensure lab testing is easily accessible, especially in locations that serve men who have sex with men, and that those at higher risk are advised to get vaccinated.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

Disease sleuths piece together clues in unusual malaria case in Washington state

2025-10-27T11:00:00+00:00

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When public health investigators received a report this summer about a woman hospitalized with malaria who lived east of Tacoma, Wash., the case didn’t seem unusual.

Even though malaria was officially eliminated from the United States decades ago, every year about 2,000 people travel to places where the disease is common and bring it back with them.

All it takes is a bite from an infected mosquito to inject the malaria parasites into the skin.

So when the Tacoma-Pierce County Health Department received an official notifiable disease report on Aug. 4 about the woman’s malaria diagnosis, it triggered a routine investigation.

In the beginning it was just another of the 20-70 malaria cases reported in Washington state each year, and among the thousands of reports for a wide array of other diseases and conditions that health departments across the state track and investigate.

“The vast majority of people who are diagnosed with malaria in the United States have traveled to a malaria endemic setting,” Dr. James Miller, the department’s health officer, told Healthbeat. “By the time they’re diagnosed, they’re back in the U.S.”

It usually takes seven to 30 days from the time the person is infected until they start getting sick with fever, chills, sweating and other flu-like symptoms. Without quick treatment, the infection can become life-threatening.

Dr. James Miller, health officer for the Tacoma-Pierce County Health department, says he was initially skeptical a local mosquito bite could have caused a woman's malaria infection.

Each person whose malaria case is reported to the department gets interviewed by public health staff.

The department’s health investigators expected to learn that the woman had traveled to one of more than 80 countries where malaria infections routinely occur. Worldwide, there were about 263 million new malaria cases in 2013, according to the World Health Organization, and about two-thirds of them occurred in about a dozen African countries.

Yet the woman in Washington state hadn’t traveled anywhere she could have become infected.

“That’s what made this case unusual,” Miller said.

Reports of locally acquired malaria are rare in the U.S.

It raised the question: Could the Pierce County woman have somehow become infected with malaria in the local community?

That seemed implausible. There had never been a case of locally acquired malaria documented in Washington state, he said.

While rare, there had been sporadic reports of local infections in other parts of the United States over the years.

In 2023, health departments in Florida, Maryland, Texas, and Arkansas identified 10 people whose malaria infections were attributed to mosquito bites in those four states. Before this unusual series of small malaria outbreaks, it had been 20 years since a locally acquired malaria case had been identified in the United States.

So Miller was skeptical that a local mosquito bite was how the woman in Pierce County, Wash., had been infected.

“Initially I thought we’ll probably find some other explanation here,” he said.

New research raises concerns about local malaria infections in U.S.

Before joining the local health department, Miller had been a regional medical officer for the state’s health department, and he had also served as an epidemic intelligence officer – a disease detective – for the Centers for Disease Control and Prevention.

Often in public health investigations, he said, additional interviews and other probing will result in an explanation that makes sense. “So I think that was my first thought, that we would find another explanation,” he said.

After consulting with zoonotic disease specialists at the Washington State Department of Health and additional experts in the CDC’s malaria branch, Miller and his team started digging deeper.

“The first step was to do a more detailed Interview with the patient and their family,” he said. “Not just recent international travel, but exploring their lifetime international travel history, also looking at recent domestic travel, looking at things like outdoor activities, as well as any other potential sources of infection.”

There can be rare scenarios where people can become infected with malaria without a mosquito being involved, Miller said.

Could the woman have been infected with malaria through a transfusion, despite precautions blood banks take to prevent that from happening? Or could she have been exposed to malaria-contaminated blood through unsterilized medical equipment or perhaps by getting a tattoo in unsterile conditions?

“Again, very rare, but obviously local transmission of malaria is also rare. So we explore all the possibilities,” Miller said.

“There are rare cases where someone can have traveled to a malaria-endemic setting years prior and then not develop malaria until later,” he said. “But in this case, we didn’t identify any relevant travel for the patient, even in the more distant past.”

Investigators also didn’t identify any medical procedures or other potential blood exposures that could explain her infection.

Miller said his skepticism about a local mosquito causing the infection faded after the team’s in-depth interview with the patient and her family.

“Even though it seems very unlikely, we have to really be thinking that this could be transmission within Washington,” Miller said.

Investigators went from skeptical to warning the public

On Aug. 6, the department put out a press release alerting the public that they were investigating a possible locally acquired case of malaria.

The most likely cause of the woman’s infection, the release said, was a local mosquito biting someone who was infected with a travel-associated case of malaria, then spreading the infection to the Pierce County woman.

Malaria is caused by a parasite that is transmitted by a specific type of mosquito, called the Anopheles. To spread the disease, mosquitoes must first bite a person who already has a malaria infection, then go on to bite other people.

The department emphasized that the risk to the public was “very low,” that malaria does not spread directly from person to person, and that the best way to protect against malaria was to prevent mosquito bites and to talk with a health care provider about taking anti-malaria medications if traveling to countries where the disease is more common.

An alert also was sent to the area’s health care providers to be on the lookout for malaria infections, even in people who had not traveled abroad. “Without a relevant travel history, people wouldn’t be suspecting malaria in a place like Washington,” Miller said.

Meanwhile, the Tacoma-Pierce County public health team worked with the state health department and CDC to examine recent emergency department data. The records were analyzed looking for people with possible malaria symptoms who may not have been diagnosed with the disease in the recent past and going forward. No additional malaria cases were identified, Miller said.

Mosquitoes were trapped at the patient’s house and at other nearby locations.

Investigators wanted to determine whether the specific type of mosquito that’s capable of spreading malaria – the Anopheles mosquito – was present in the area. Some Anopheles mosquitoes were captured, but testing showed none of these individual mosquitoes was infected with the malaria parasite, Miller said.

The local health investigators went back and reviewed the cases of other people in the county who had been diagnosed recently with travel-related malaria infections, just to see if there was anything that was overlooked in those earlier investigations, Miller said.

They also went back to the Pierce County woman’s family and took a closer look at their travel and illness histories, in case one of them had been an initial malaria case.

But neither of these efforts produced additional clues, Miller said.

In labs at the CDC, scientists did molecular testing on samples of the malaria parasites that infected the Pierce County woman, then compared the findings with the genetic makeup of the parasites involved in the county’s other recent travel-related malaria cases.

These lab results indicated parasites in the county’s recent malaria cases weren’t similar enough to suggest any connection, Miller said.

“So where that leaves us is that in the absence of any other explanation, we think the most likely scenario is that this person did acquire a mosquito bite either here in Pierce County or potentially in a neighboring county,” Miller said.

The investigation’s findings suggest that this Pierce County woman is the state’s first known locally acquired malaria infection.

But there is no way to know exactly how her infection occurred.

One possibility, Miller said, is that a mosquito with malaria could have somehow been brought into the United States, perhaps on a plane.

The CDC’s testing of the malaria parasites that infected the woman indicate that they are most likely from sub-Saharan Africa, Miller said.

Another possibility, he said, is that there may have been a person in the area who had malaria, but their infection didn’t receive medical attention, and therefore wasn’t reported to public health officials. Miller noted that people who have lived in areas where malaria infections are common can have some level of immunity and may have a less severe case of the disease.

“And then a mosquito would have had to bite that person and then bite the person with locally acquired malaria,” Miller said.

But there is no way to know for sure. “We don’t have any confirmation or ability to say for sure about any of those scenarios,” he said.

Miller said the rapid investigation of this malaria case highlights the way the nation’s public health system should work, with local, state and federal agencies, sharing resources and expertise.

“In this situation, fortunately, the patient recovered. We didn’t identify any other cases. But of course, you don’t know that at the beginning of an investigation,” Miller said. “So it’s important to have a public health system that’s ready to ramp up quickly and to work together effectively to do an investigation.”

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

Will new type of mpox virus spread beyond California? Many at-risk people aren’t vaccinated.

2025-10-22T17:45:27+00:00

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As California health officials investigate an outbreak of a more severe type of mpox virus, federal data indicate that across the country most of the people at highest risk of exposure haven’t been vaccinated against the disease.

In most states – including Georgia, Florida, Texas, Michigan, and New Jersey – more than half of at-risk people remained unvaccinated in the wake of the 2022-23 U.S. outbreak of a milder form of the virus that infected more than 30,000 people, according to Centers for Disease Control and Prevention estimates last updated in January 2024.

Mpox, which causes a rash and sores that can be painful, is spread mostly through close, intimate, and sexual contact.

Fewer than one-quarter of at-risk people in most states were fully vaccinated with two doses of the mpox vaccine, the CDC data show. Even in the jurisdictions with the highest levels of people fully vaccinated against mpox – the District of Columbia, at 68%, New York City, at 47%, and California at 43% – many at-risk people were not fully vaccinated.

It’s likely that mpox immunization rates are even lower today, as the earlier mpox outbreak has faded from the headlines and is “out of sight, out of mind,” said Dr. Peter Chin-Hong, an infectious disease specialist at the University of California, San Francisco.

“It’s a wake-up call for at-risk populations to be up-to-date on their vaccines, because a lot of people are not,” Chin-Hong said. “They might have gotten the first shot back in 2022 when everyone was afraid, and people knew a lot of people who had it.”

None of the three Southern California residents hospitalized in the new outbreak were vaccinated against mpox, the California Department of Public Health said in an email to Healthbeat.

California cases of clade I are first in the U.S. without international travel

California public health officials last week began warning that a more virulent type of mpox that has primarily caused disease in African countries, called clade I, now appears to be spreading from person to person in their state.

The three California cases identified with clade I infections didn’t have any recent history of international travel, local, county and state health officials have said. They also didn’t have any connection to each other. Two lived in Los Angeles County, one in Long Beach. All are recovering from their infections, officials said.

They are the first reported clade I infections in the United States that don’t involve international travel, the California Department of Public Health said. These cases indicate that clade I is spreading in the community, “primarily impacting communities of gay and bisexual men, and other men who have sex with men, as well as their social networks,” the department said.

New research raises concerns about local malaria infections in U.S.

The clade I form of the virus can cause more severe disease than clade II type, which was involved in the 2022-23 outbreak. Vaccination and public health education campaigns caused a sharp drop in those clade II cases, but that form of the virus continues to circulate at low levels across the country.

Both forms of mpox, formerly called monkeypox, cause rashes that can initially look like pimples or blisters that may appear on the hands, face, mouth, chest, or near genitals. Mpox also can cause flu-like symptoms. The risk of severe disease is highest among people with weakened immune systems.

The two-dose mpox vaccine, called JYNNEOS, provides protection against both clade I and clade II mpox, health officials said. For those who have already received two doses, a third booster shot is not recommended.

At-risk people encouraged to get mpox vaccine

While California health officials said the risk to the public is low, they are encouraging people at increased risk of mpox exposure to get vaccinated, including people who are gay, bisexual, and men who have sex with men, transgender, and non-binary people, and people who have been exposed to someone with mpox.

The virus primarily spreads through close contact with an infected person, such as through intimate physical contact during massages, cuddling, or sex, or sharing a living space or personal items with someone who has mpox. Casual contact, such as interactions in an airplane, office, or store, are unlikely to spread the virus, California’s state health department said.

There is no indication so far that the clade I outbreak in California is spreading to other states.

“We have to be vigilant, but not scared,” Chin-Hong said. “If it gets into the right place at the right time, like what happened in 2022, it could potentially take off again.”

While California has only identified three cases of clade I mpox, Chin-Hong said there are probably more people who haven’t sought treatment or been diagnosed, despite painful sores and other symptoms that can take three weeks to run their course.

Chin-Hong said he found it interesting that all three of the identified cases were hospitalized.

“Either it’s something about clade I, or it could be that the people who were identified happened to have more serious cases,” he said, “and people who had milder cases just didn’t bother to come to see anybody about it.”

The mpox vaccine is available across the United States through a mix of public health departments, community clinics, and retail pharmacies, said Mark Clarke, a spokesperson for Bavarian Nordic, which makes the JYNNEOS vaccine.

The vaccine, which is given as two injections four weeks apart, is generally covered by health insurance, Clarke said, and those without coverage may find free or reduced-cost vaccine from local health departments and LGBTQ+ focused clinics. The company’s locator tool www.EmpoweredAgainstMpox.com – provides locations that may offer the vaccine.

Spokespeople for CVS and Walgreens told Healthbeat that in most cases, people seeking mpox vaccination will need to make an advance appointment because it can take a few days to ship the vaccine to their local pharmacy.

Chin-Hong said the emergence of what appear to be locally spread clade I cases in California illustrate the broader importance of public health activities in the United States and around the world.

By the United States helping other countries combat infectious diseases, he said, it helps protect against the spread of diseases spreading here.

“We need to continue to invest in public health. That’s what keeps us safe,” he said. He noted that the California cases have been identified as clade I in the middle of a federal shutdown that has impacted the CDC. “You need to invest in people and surveillance, diagnostics and prevention with vaccines to keep everyone safe.”

The CDC has been doing genomic testing to learn more about the virus that infected each of the clade I cases in California, the Los Angeles County Department of Public Health has said.

The CDC did not respond to questions from Healthbeat about mpox vaccination rates across the country and the potential for clade I spreading beyond California. A spokesperson for the U.S. Department of Health and Human Services told Healthbeat to seek information about the new California outbreak from state health officials and the CDC webpage about the disease.

When asked about the impact of the federal shutdown on the mpox outbreak response, the California Department of Public Health told Healthbeat by email that the department continues to work with available staff at CDC, “but the recent federal government shutdown and other actions at the federal level have added a layer of uncertainty to the current work environment.”

Alison Young is Healthbeat’s senior national reporter. You can reach her atayoung@healthbeat.orgor through the messaging appSignalat alisonyoungreports.48

New research raises concerns about local malaria infections in U.S.

2025-10-17T15:52:26+00:00

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An unusual series of small U.S. malaria outbreaks – attributed to mosquito bites occurring in Florida, Maryland, Texas, and Arkansas in 2023 – illustrates what may be an increasing risk of the disease transmitting locally in the future, according to new research from local and federal public health investigators.

Their paper, published this month in the journal JAMA Network Open, comes as health officials in New Jersey and Washington state are investigating the potential that two people may have been infected with malaria this summer in those states. Neither had traveled to international destinations recently.

Malaria was largely eliminated in the United States more than 70 years ago and health officials say the risk of contracting the disease in this country remains low.

The greatest risk involves international travel to countries where the disease is widespread. Such travel is the source of most of the 2,000 malaria cases in the United States each year, according to the Centers for Disease Control and Prevention.

Yet the local U.S. malaria outbreaks in 2023 and sporadic locally transmitted cases over the decades illustrate the potential for malaria infections to occur from mosquito exposures across the United States.

That’s because when malaria-infected travelers return to or arrive in the United States and are bitten by local mosquitoes, the disease can spread in U.S. communities. More than a dozen states – including Georgia and New York – are where most of these imported malaria cases have been identified.

Here’s what you need to know.

What is malaria?

Malaria is a serious, but treatable, disease caused by a parasite that is transmitted by a specific type of mosquito, called the Anopheles. To spread the disease, mosquitoes must first bite a person who already has a malaria infection, then go on to bite other people. The disease does not spread from person to person like the cold or flu.

Initial symptoms – which typically occur seven to 30 days after infection – can include fever, chills, headache, muscle aches, and fatigue. If not quickly treated, the disease can become fatal, causing kidney failure, seizures, and coma, according to the CDC.

How often do malaria cases occur in the U.S.?

Local transmission of malaria in the United States was largely eliminated by 1951 because of intensive public health efforts dating back to 1914 that included drainage projects and the spraying of mosquito-killing pesticides.

The Centers for Disease Control and Prevention, which began in 1946 as the Communicable Disease Center, traces its history to an earlier World War II malaria-control agency that worked to protect troops at military training bases in Southern states as well as U.S. territories. The historic challenges eliminating malaria in the Southeast is a big part of why the CDC is based in Atlanta.

Captured in 1954, this historic image depicts a view of what was the Centers for Disease Control and Prevention, formerly known as the Communicable Disease Center, Newton Field Station, located on the Ichauway Plantation in Newton, Georgia. This wooden structure was known as the Mossy Pond tower, used to trap insects.

Malaria was considered eliminated from the United States by the early 1950s and the World Health Organization certified the United States as malaria-free in 1970.

These days, malaria cases in the United States are usually the result of infections that occurred during international travel. Each year there are about 2,000 travel-related malaria cases reported to the CDC, and on average during 2007-22 there were nearly seven deaths per year.

On occasion, however, the public health teams that investigate each U.S. malaria case cannot find any connection to international travel, raising the possibility that the infection occurred here in the United States.

For example, in August 2002, when two teenagers in northern Virginia became infected locally, public health investigators concluded the source of their infections was “probably the bite of an infective mosquito that had acquired the parasite by biting a malaria-infected person in the general vicinity.” The teens lived about a half mile apart from each other, but the 19-year-old who became infected had made numerous visits to friends who lived across the street from the 15-year-old who became infected.

How unusual were the domestic outbreaks of malaria in 2023?

Over the past 50 years, the CDC says that malaria that has been transmitted locally in the United States has resulted in more than 150 cases and more than 60 limited outbreaks.

Yet after 2003, no U.S.-acquired malaria infections from local mosquito bites were detected for 20 years. That ended in 2023, according to an examination of the 2023 cases by local, state and federal health officials published this month in JAMA Network Open.

From May through September 2023, 10 people across four states were sickened with fevers and other malaria symptoms, nine of them seeking treatment from emergency departments, and one from primary care.

After a 20-year absence of documented local malaria infections, it was “unexpected” to have so many cases spread across multiple states in one summer, the researchers wrote.

Seven of the people lived in Sarasota County, Florida, and the other three lived in Cameron County, Texas; Saline County, Ark; and the National Capital Region of Maryland. All were treated with antimalarial medications and recovered.

None had recent international travel that could explain their malaria exposures, the team found, and none had risk factors for blood-borne transmission, such as transfusions, tattoos, or needle-sharing practices.

The public health investigators found that in the weeks before these people became ill, all had a history of spending time outdoors at night – the time when Anopheles mosquitoes pose the greatest risk. Two of the infected people had worked outdoors overnight, three reported being homeless, and the rest said they had been involved in other types of outdoor nighttime activities.

Genetic and other testing determined that the cases in Florida, Arkansas, and Texas involved malaria strains associated with Central or South American parasites, the paper says. The Florida cases appeared to share a common source, the testing indicated.

But the Arkansas and Texas cases were not genetically related to each other nor were they related to the Florida cases. The infection in the Maryland case had a genetic signature consistent with African malaria parasites.

Hundreds of mosquitoes were collected and tested in the four states in the areas near where the infected patients lived. Three Anopheles mosquitoes captured over three nights in May 2023 from the same swamp in Sarasota County, Florida indicated a recent blood meal from a person infected with malaria. Evidence of malaria was not detected in any of the other mosquitoes collected as part of the investigation.

A spokesperson for the Florida Department of Health in Sarasota County said no one was available to discuss the 2023 cases.

What caused these outbreaks?

The research team noted that there were likely many factors that contributed to the U.S. malaria outbreaks in 2023. It’s suspected that the risk of local transmission of malaria has increased along with the increase in the number of malaria cases being imported to the United States through international travel.

After the Covid-19 pandemic, as “as international travel rebounded, preliminary 2023 data suggested a record high of 2,205 imported malaria cases,” the researchers said.

While most U.S. states report at least one travel-related case of malaria each year, 75% of these infected travelers in 2022 were located in 13 states. Three of the four states involved in the 2023 outbreaks were among the top states with imported cases of malaria.

Other top states for imported malaria cases in 2022 included Georgia, New York, Pennsylvania, Ohio, Virginia, Minnesota, and Virginia.

Prior to the 2023 locally acquired malaria cases, the new paper notes that the last outbreak of locally transmitted malaria occurred in 2003 in Palm Beach County, Florida, that involved eight cases.

What lessons can we take from the 2023 malaria outbreaks?

While the research team said sustained malaria transmission within the United States is unlikely, they warned that a variety of factors may increase the risk of future cases that are locally acquired in U.S. communities.

Those factors include continued increases in international travel and migration, and that rising temperatures increase the potential for mosquito exposures.

The researchers noted that there were several challenges to identifying these locally transmitted malaria outbreaks because doctors may not consider malaria as a possible diagnosis when people haven’t had recent international travel.

“Although all patients were eventually diagnosed and treated appropriately, several experienced delayed diagnosis and health care access barriers,” the paper notes.

In addition, they said, more research is needed about the prevalence and patterns of Anopheles mosquitoes in the United States. Other species are prioritized because they more commonly spread disease in this country.

“There is no national surveillance system for Anopheles species,” they wrote. And they noted that local capabilities to perform resource-intensive mosquito control efforts vary by jurisdiction.

“This case underscores common challenges in malaria diagnosis, including differentiation from babesiosis and other diseases, and potential for sporadic locally acquired malaria cases in the United States,” said Amanda Hils, a spokesperson for the Maryland Department of Health, whose investigators were co-authors of the paper. “It also highlights the need for coordinated efforts among public health officials, clinicians, laboratories, and the public to prevent, detect, investigate, and respond to such cases.”

What’s known so far about this summer’s New Jersey and Washington malaria cases?

In New Jersey, state health officials announced in August that they were working with the CDC to investigate a possible locally acquired malaria infection in a resident of Morris County, which is about 30 miles northwest of New York City.

The infected resident had no history of international travel, state health officials said. They noted the possibility the person became infected in New Jersey and said they were working to reduce potential public risks through local mosquito control activities.

If the New Jersey case is confirmed as being a locally acquired infection, it would be the first in the state since 1998, officials there said.

“The investigation to determine a potential source of the case is ongoing and is awaiting investigational testing at CDC,” Dalya Ewais, communications director for the New Jersey Department of Health, told Healthbeat on Thursday. “This testing takes time and may or may not provide definitive information.”

Ewais said the department’s trapping and testing of mosquitoes did not identify any that carried malaria parasites. The department also is not aware of any additional cases of suspected locally acquired malaria in the state, beyond the one in Morris County, she said.

“Risk of non-travel-related malaria to the general public in New Jersey remains low,” she said.

In Washington, the Tacoma-Pierce County Health Department announced earlier this summer that a woman in East Pierce County, who had not traveled recently, was diagnosed with malaria on Aug. 2.

The county health department, which has been working with the Washington State Department of Health and the CDC to investigate how the woman became infected, said it did not have an update to provide about the investigation at this time. The department as previously noted it’s “possible she was recently infected with malaria in Washington.”

If confirmed, the department said it would be the first known locally acquired case of malaria in Washington.

The CDC, which is part of the ongoing federal government shutdown, did not respond to a request for information about the New Jersey and Washington malaria cases.

What can U.S. residents do to reduce their risk of malaria?

Because mosquitoes can spread a variety of diseases besides malaria – including the viruses that cause West Nile virus, dengue and Zika – the CDC recommends protecting against mosquito bites. Some tips for doing this include using proven insect repellants that are registered with the U.S. Environmental Protection Agency, wearing loose-fitting clothing with long sleeves and pants, using screens on windows and doors, and eliminating or treating standing water outdoors where mosquitoes breed.

The biggest risk of being infected with malaria comes with international travel. Most of the approximately 2,000 cases of malaria diagnosed in the United States each year involve people returning home after trips to countries where malaria is common.

For U.S. cases where the country of infection was known in 2019, the CDC says 93% acquired malaria in Africa; 4% in Asia; 2% in the Caribbean, South America and Central America; and less than 1% in Oceania and the Middle East. When these infections occurred among U.S. civilians, 76% were traveling to visit friends or relatives.

Before going to countries where malaria is endemic, the CDC advises travelers to consult with health care providers about their risk factors and whether they should be taking an anti-malaria medication to prevent infection during their trip. The CDC maintains a list of health risks by international destination and guidance for health care providers who advise and treat travelers.

CDC officials note that even people who may have once had some immunity to malaria because they previously lived in a country where the disease is widespread can quickly lose that immunity. They are also urged to take preventative actions to avoid infection.

Preventing malaria infections during international travel reduces the risk of bringing the parasites back to the United States, where mosquito bites on returning home have the potential to spread the disease in this country.

Where in the world does malaria pose the greatest risk?

Worldwide there were an estimated 263 million malaria cases and 597,000 deaths in 83 countries during 2023, according to the WHO.

About two-thirds of these malaria cases and deaths occurred in 11 African countries: Burkina Faso, Cameroon, Democratic Republic of the Congo, Ghana, Mali, Mozambique, Niger, Nigeria, Sudan, United Republic of Tanzania and Uganda. And the African region as a whole accounted for an estimated 94% of malaria cases, according to the WHO.

But malaria endemic countries are found around the world. Outside of Africa they include Bolivia, Brazil, Colombia, Haiti, Indonesia, Iran, Myanmar, Pakistan, Panama, Papua New Guinea, and Peru.

The United States is among 44 countries and one territory that have been certified as malaria-free by the WHO.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

The U.S. is facing an obesity epidemic. New report details the best and worst states.

2025-10-16T04:01:00+00:00

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The number of U.S. states where 35% or more of adults were obese dropped slightly in 2024, according to a report released Thursday analyzing federal health data.

Nineteen states had these particularly high rates of adult obesity, down from 23 states a year earlier.

“That’s actually the first time that there’s been a decrease in the number of states that are at or above that 35% level since this dataset began in 2011,” said Dr. J. Nadine Gracia, president and CEO of the Trust for America’s Health, the nonpartisan public health research and policy organization that released its annual “State of Obesity” report.

The states where obesity declined below this threshold were Alaska, Illinois, Missouri, and New Mexico.

Yet what may be progress in some parts of the country is set against a backdrop of a continuing national obesity epidemic, the data show. Across the country, 4 in 10 U.S. adults have obesity, which is defined as a body mass index of 30 or above.

“The rates of obesity in the nation remain alarmingly high,” Gracia told Healthbeat. “The data show that over more than two decades, obesity rates have increased by 32% among adults and 52% among children and adolescents.”

Each year the organization analyzes data from the Centers for Disease Control and Prevention to track U.S. obesity rates and offer policy solutions. This year’s recommendations include reversing cuts to federal nutrition programs and urging the U.S. Food and Drug Administration to require nutrition labels on the front of packages.

Key takeaways from this year’s 140-page report:

Worst states had obesity rates near or above 40%

West Virginia at 41.4%; Mississippi at 40.4%; and Louisiana at 39.2% had the highest adult obesity rates, according to the group’s analysis of 2024 data from the CDC’s Behavioral Risk Factor Surveillance System.

Georgia had an adult obesity rate of 35.4%, ranking No. 19 in the nation.

Best states had obesity rates of about 25%

Colorado at 25%; Washington, D.C., at 25.5%; and Hawaii and Massachusetts both at 27% had the nation’s lowest adult obesity rates.

New York had an adult obesity rate of 29.5%, ranking No. 43 in the nation.

Obesity data continue to show disparities

Obesity rates varied by race, ethnicity, education, and where people lived.

Black adults had the highest rate of obesity at 49.9%, followed by adults who were Hispanic (45.6%), white (41.4%), and Asian (16.1%).

There tended to be more obesity among people living in rural areas than in metro areas. People with college degrees and higher incomes also tended to have lower obesity rates, the report notes.

“We know factors like poverty, like food insecurity, having access to healthy and nutritious foods, housing instability, and access to health care, all of these influence increased risk of chronic diseases, including obesity,” Gracia said.

Politics provide opportunities and challenges

Chronic disease has been highlighted as a priority issue by the Trump administration, which has created the Make America Healthy Again Commission. Yet the report notes the administration has laid off federal health workers and restricted funding of programs that address obesity, chronic disease, and nutrition.

A key example cited in the report is the “near total elimination” in the president’s fiscal year 2026 budget request of the CDC’s National Center for Chronic Disease Prevention and Health Promotion, which leads and funds “cornerstone” obesity and chronic disease programs at the local, state, and national levels. The report recommends keeping and strengthening this CDC center.

Ultra-processed foods draw attention from policymakers

The report says that while there are currently no federal statutes or regulations that specifically define or regulate ultra-processed foods in the United States, there is mounting evidence connecting such foods with obesity and other negative health effects.

In July, federal health agencies sought public input on how to develop a uniform definition of ultra-processed foods. The report notes that while state legislators have introduced a number of bills related to ultra-processed foods, there has been limited movement. However earlier this month, California became the first state to prohibit certain ultra-processed foods in public school meals, a policy that will be phased-in over 10 years.

Alison Young is Healthbeat’s senior national reporter. Contact Alison at ayoung@healthbeat.org.

Meet Alison Young, Healthbeat’s new senior national reporter

2025-10-09T14:21:02+00:00

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My introduction to covering public health came during an earlier time of turmoil and leadership exodus at the Centers for Disease Control and Prevention.

In the wake of the 9/11 terror attacks, which were quickly followed by deadly anthrax-laced letters sent through the U.S. mail, then-CDC Director Julie Gerberding in 2003 launched what was called the agency’s Futures Initiative.

The initiative, which went on for years, involved a massive reorganization of the CDC. Gerberding said the goal was to make the agency more nimble and effective in responding to the urgent and emerging threats of the modern world, such as bioterrorism and pandemics.

Yet prominent scientists and staff within the agency accused Gerberding, who was appointed during the administration of President George W. Bush, of creating a controlling, top-down management structure that added bureaucratic layers, stifled science, and put at risk the CDC’s ability to respond to a public health crisis.

As the full-time CDC beat reporter for The Atlanta Journal-Constitution back then, I reported extensively on the wave of high-profile CDC leaders and scientists who were departing the agency, including the directors of six of the CDC’s then eight primary scientific centers, the agency’s pandemic influenza coordinator, and top experts in vaccines and several diseases.

The continuing departure of high-profile scientists and plummeting morale within the agency prompted five former CDC directors to privately send a rare joint letter to Gerberding in December 2005 expressing their “great concern.” The letter only became public because of my AJC reporting.

“We have all gone through periods of change and recognize the difficulties attendant to change. However, we are concerned about the previous and impending losses of highly qualified and motivated staff,” wrote former CDC directors Dr. William Foege, Dr. James Mason, Dr. David Satcher, Dr. Jeffrey Koplan and Dr. David Sencer, who led the agency during Republican and Democratic administrations going back to 1966.

“We are concerned that so many of the staff have come to us to express their concerns about the low morale in the agency. We are concerned about the inability of many of the partners to understand the direction in which CDC is headed,” they wrote.

Fast-forward to today and the seismic changes that are underway at the CDC and across every corner of the nation’s public health safety net.

The circumstances now are far different.

Federal health workers have been hit with mass layoffs; an important CDC vaccine advisory panel had all of its expert members replaced; a gunman opened fire on the CDC headquarters in Atlanta, killing a police officer; the most recent CDC director, Susan Monarez, was fired just a few weeks into the job; and other top CDC officials have resigned in protest over the way Health and Human Services Secretary Robert F. Kennedy Jr. is remaking the CDC.

These days former directors and acting directors of the CDC are warning very publicly that the nation is being put at risk by wide-ranging directives from Washington that are “unlike anything we had ever seen at the agency and unlike anything our country had ever experienced.”

It’s against this backdrop that I’m excited to join the team at Healthbeat as senior national reporter and return to covering public health full time during this critical period in our nation’s history.

I will be writing about a wide range of public health issues – from outbreaks and infectious diseases to vaccines, food safety, health disparities, chronic diseases, the Make America Healthy Again movement and more – and I will be helping explain how they impact all of us.

My reporting will shine a light on federal public health policy and agencies, as well as examine the risks, benefits, and scientific evidence for public health interventions.

I will be showcasing the people behind the work of public health, sharing their challenges and victories. I also will tell the stories of regular people across the country as they seek to keep themselves and their families healthy. And I look forward to highlighting public health solutions and providing independent and contextualized consumer resources to help readers make their own informed decisions.

I have spent most of my career reporting on health, science, and environmental issues at local and national news organizations that include USA Today, Knight Ridder’s Washington Bureau, the Detroit Free Press, and The Arizona Republic, in addition to the AJC.

At USA Today, my reporting revealed how substandard hospital care fuels childbirth deaths and injuries, the health risks posed by tainted dietary supplements, and the spotty enforcement of drinking water regulations. For a project called Ghost Factories, I was part of a team that traveled the country testing soil to show dangerous lead contamination in neighborhoods near the forgotten sites of smelters that had closed decades earlier.

At other news organizations, I’ve reported on the outbreak risks of low vaccination rates at individual schools, the failure of drinking water utilities to identify lead pipes in their systems, the dangers of unprotected hazardous chemical pipelines, and problems in the nation’s food recall system.

For more than a decade before the Covid-19 pandemic emerged near a major coronavirus research center in Wuhan, China, my reporting for USA Today and the AJC had been revealing serious safety breaches at prestigious U.S. labs, as well as the lax approach to biosafety oversight and regulation here and abroad that risked a future pandemic. This reporting is the underpinning of my recent book, “Pandora’s Gamble: Lab Leaks, Pandemics, and a World at Risk,” which was named to Kirkus Reviews’ Best Books of 2023.

As I get started here at Healthbeat, I’m asking for your help. Please let me know the issues and topics you want me to cover. How are public health policies and approaches impacting you, your family, your organization, or your community? What’s working? What’s not working? What do you have questions about?

If you happen to have any documents or emails you think I should see, please send those, too.

You can reach me at ayoung@healthbeat.org or contact me on the messaging app Signal at alisonyoungreports.48

I look forward to beginning a conversation with you.