Measles reported in Buncombe as public health officials worry about spread in the face of declining vaccination rates

Measles reported in Buncombe as public health officials worry about spread in the face of declining vaccination rates • Asheville Watchdog

A major outbreak of measles in South Carolina has spread to Buncombe County, with public health officials announcing three cases Tuesday and expressing concern that more will follow due to decreased vaccination rates and the highly contagious nature of the disease. The Buncombe cases are confined to three siblings whose family visited Spartanburg County, South […]

Asheville WatchdogDAN DeWITT

by DAN DeWITT January 6, 2026

A major outbreak of measles in South Carolina has spread to Buncombe County, with public health officials announcing three cases Tuesday and expressing concern that more will follow due to decreased vaccination rates and the highly contagious nature of the disease.

The Buncombe cases are confined to three siblings whose family visited Spartanburg County, South Carolina, one or two weeks before the children became sick, according to an announcement from the North Carolina Department of Health and Human Services. The agency said it is not providing any more information about the infections “to protect the family’s privacy.”

But the announcement also warns that “people who visited the Mission Hospital Emergency Department waiting room … between 2-6:30 a.m. on Jan. 4, 2026, might have been exposed.”

Asheville Watchdog reached out to Mission Hospital spokesperson Nancy Lindell for comment, but did not hear back before publication.

“If there are 10 people in a room who are not immune to measles, and one person with measles walks in that room, nine of those 10 people are going to get measles,” said Jennifer Mullendore, the county’s chief medical officer. “We definitely get worried if we get a case of measles in our community, where there are highly susceptible people, that this could spread just like it’s spreading in South Carolina.”

The spread of measles is part of a wave of illnesses preventable or containable by vaccines documented in a December news release by the Buncombe County Division of Public Health and backed by year-end statistics from state and county agencies and local healthcare providers.

The surge consists of two outbreaks of chickenpox, including four recent cases at Fairview Elementary School; an earlier flare-up of whooping cough at Charles D. Owen High School in Black Mountain; and an increase in flu cases that have killed 39 people in North Carolina, including one in Buncombe County, and led local hospitals to restrict visitations.

The South Carolina Department of Public Health had documented 188 cases of measles statewide as of the end of last week, most of them in Spartanburg County. The first sign of the illness’s advance into North Carolina came New Year’s Eve with the announcement of an apparent case in Polk County.

Partly because of the illness’s infectiousness, the NCDHHS tracks vaccination rates of incoming kindergarteners for measles, as well as for mumps and rubella, which are protected against by the MMR vaccine.

The rate of incoming county kindergarteners in Buncombe who had received the MMR shot dropped from 94.2 percent in 2020 to 89.2 percent in 2024, the last year of data available on the department’s vaccination dashboard.

“To keep a community safe,” the dashboard says, “at least 95% of people need to be vaccinated. If vaccination rates drop below that, outbreaks are more likely to happen.”

The proportion of county kindergartners inoculated has also slipped compared with statewide rates. It matched North Carolina’s percentage of inoculated kindergarteners in 2020 but had fallen 3.8 percent below this rate in 2024.

The dashboard shows that rates vary widely among schools, possibly leaving pockets of susceptibility where measles can take root, Mullendore said. At the I.C. Imagine Public Charter School in Asheville, for example, 55 percent of incoming kindergarteners were vaccinated in 2024, according to the dashboard. I.C. Imagine’s head of school, Jenn Townley, did not respond to a Watchdog email requesting comment.

Outbreaks of chickenpox, increase in flu cases

The incidence of chickenpox in Buncombe increased nearly eight-fold in 2025, with 109 cases compared with 14 in 2024, according to provisional data provided by county spokesperson Stacey Wood. The 126 cases of whooping cough (pertussis) reported in 2025 are up from 77 in 2024 and two as recently as 2022, Wood’s email said.

The state reported similar trends, Hannah Jones, a spokesperson for the NCDHHS, said in an email.

The 933 whooping cough cases in the department’s preliminary 2025 tally is up from 46 in 2022 while cases of chickenpox nearly doubled in 2025 compared to the year before, climbing from 155 to 298. 

The increase in cases has come in the face of increased skepticism about vaccinations, which played out dramatically Monday when the federal Centers for Disease Control and Prevention cut recommendations for the routine inoculation of children for flu and five other illnesses, sparking outrage from public health experts.

The new federal standards, which reduce the number of vaccinations from 17 to 11, do not apply to measles, chickenpox (varicella) or whooping cough, and the CDC websites continue to tout the benefits of vaccinations for these and a wide range of other illnesses.

This general message is echoed by the county’s Immunization Clinic website, which says, “What you do matters! Getting immunized throughout your lifetime protects you, the people you love, and our community against harmful diseases.”

A CDC webpage says about one in five unvaccinated people who contract measles require hospitalization and “nearly one to three of every 1,000 children who become infected with measles will die from respiratory and neurologic complications.”

Buncombe County Schools spokesman Ken Ulmer said that the district follows state vaccination guidelines, which note that state law requires public school children to be current on vaccinations for a variety of illnesses but allows religious and medical exemptions. The percentage of religious exemptions roughly doubled from 2020 through 2024, when the rate was about 3 percent of students statewide, according to NCDHHS.

The county’s December press release did not name the high school hit by whooping cough, but said it was linked to 17 cases. Ulmer provided a Nov. 15 notification sent to parents of Owen High warning about increased cases in the county and the school but could not provide information about the seriousness of the cases.

The notification recommended that “older children and adults should get at least one dose of the pertussis booster vaccine,” which is typically administered as part of the TDaP shot, which also protects against tetanus and diphtheria, according to the CDC. 

A similar notification sent to parents at Fairview Elementary School on Dec. 30 said three cases of chickenpox had been documented at the school since early December. A fourth was confirmed Tuesday, Ulmer said.

“Please be aware that your child could get chickenpox if they have not been immunized against chickenpox or have not had chickenpox before,” the notice said, adding that “if your child has symptoms of chickenpox, keep them at home and call your child’s healthcare provider.”

The December news release also said an unidentified private school in western Buncombe was hit by a “large varicella outbreak … due to a high number of unvaccinated individuals.”

“A significant number of students at the school who lacked proof of immunity to varicella were excluded from attending … for several weeks,” the release said. All the students had returned by Dec. 10.

Chickenpox, like measles, is considered “vaccine-preventable” because the shot is highly effective, said Mullendore, the Buncombe chief medical officer, who added that the infected residents are “predominantly unvaccinated.”

“Pertussis is a little harder” than chickenpox to link to lower vaccination rates, said Mullendore, a physician, because the vaccination does not provide complete protection and its impact wanes over time.

In the 1990s, the United States was one of several countries that switched from a “whole cell” vaccine to one made of parts of the pertussis bacteria. The newer formulation results in fewer acute short-term reactions, including high fever and uncontrolled crying, than the earlier version, according to the CDC website.

But the current vaccine does usually protect against severe cases, the agency says, noting adolescents and adults who contract the illness after receiving the vaccine “may be asymptomatic” or suffer only from a mild cough.

A ‘100-day cough’

Pertussis vaccines for older children and adults also play a crucial role in protecting infants, the group most susceptible to infection and severe outcomes, said both the CDC and Mullendore.

“A lot of the focus is on making sure pregnant people get vaccinated in their third trimester of pregnancy and that anyone who’s going to be around an infant is up to date on their pertussis vaccine to sort of cocoon that baby, to insulate that baby, while their immune system is not fully protective,” she said.

The illness can be severe and long-lasting, Mullendore said.

“The 100-day cough is its old-time name,” she said. “When you think of babies coughing and breathing – or not breathing – that’s very scary.”

And though pertussis is not typically fatal, she said, Kentucky recorded three whooping cough deaths in the 12 months before Nov. 24, the first in the state since 2018, according to a statement from the state’s Cabinet for Health and Family Services.

Chickenpox is typically less dangerous than whooping cough, Mullendore said, but occasionally requires hospitalization. Childhood infections also leave adults susceptible to shingles, which is sometimes “very devastating,” she said.

“I think that there’s a significantly lower risk of shingles among people who have been vaccinated” for chickenpox, she said. “I don’t think it’s zero, but it’s significantly lower.”

Elderly hit hardest by flu

Flu is especially dangerous for older people, according to the NCDHHS’s respiratory virus surveillance dashboard.

Of the 39 people who had died of the disease in North Carolina from the start of the annual flu season in October to the end of December, 27 were aged 65 or older, while two, in the 5-17 age group, were classified as pediatric deaths.

The dashboard also shows that 24 of the 39 deaths had come in the weeks before the last report in December. Mullendore said Tuesday that the death in Buncombe also occurred recently.

Overall, “influenza-like illnesses” accounted for 16.5 percent of hospital emergency room visits in the state compared to 13.4 percent at the peak of the previous flu season in February of last year. 

Though Jones did not supply county-level information about flu cases, the dashboard shows the recent rate of hospital admissions due to flu-like symptoms in western North Carolina is considerably lower than the statewide rate – 10.8 percent.

But the rate was high enough for Mission Health to announce Dec. 31 that it was imposing a limit of two visitors per patient and that all visitors  must be older than 13. The restrictions apply, with rare exceptions, to its hospitals throughout the region, Mission said, and will remain in place “until reported influenza-like activity decreases.”

Two days earlier, AdventHealth announced similar restrictions at all its facilities in the state citing flu and other respiratory illnesses, including COVID-19, though the state dashboard shows hospital admissions due to “COVID-like” illness are slightly lower than this time last year.

Lindell, the Mission spokesperson, did not respond to a request for information about admissions due to chickenpox and whooping cough, though Amy Waters, a nurse at Mission’s pediatric intensive care unit said it hadn’t had a whooping cough case in several months.

“It’s really just a lot of pediatric flu cases … (and) the usual winter viruses,” she wrote in a text last week. “I am worried about measles.”

Though U.S. Health Secretary Robert F. Kennedy Jr. has repeatedly voiced skepticism about the effectiveness of vaccines and raised widely debunked concerns about their safety, CDC websites continue to strongly recommend inoculations for a variety of illnesses, including flu.

While, questions have been raised about the effectiveness of the current inoculation as cases rise nationally, the CDC site says vaccinations are highly effective in preventing serious and fatal cases.

“Flu vaccines help reduce the burden of flu illnesses, hospitalizations and deaths on the health care system each year,” said the site, which recommends “everyone six months and older should get a flu vaccine every season.”

The county’s Dec. 22 release also said “community members are urged to help prevent the spread by making sure they are up to date on their measles, pertussis, varicella, flu and other vaccines.”

Rose Goldfarb, a parent of an 11th grader at Owen who received the county’s notification in November, said her family keeps up with vaccinations out of concern for themselves and the people they come in contact with.

“I’m all about protecting our neighbors, not just our family,” said Goldfarb. “I also feel like I don’t have time to get sick. So I would prefer not to even get a cold if I can afford it.”

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