It’s been a little over a year since a major measles outbreak was first detected in west Texas. By the end of 2025, there were 49 outbreaks and 2,267 confirmed cases of measles1 throughout the United States, marking the worst year for measles in the U.S. since 1991. Measles is continuing to spread in 2026, with two new outbreaks and 588 confirmed cases reported by the end of January.
In North Carolina, 15 confirmed cases of measles were reported between late December 2025 and January 30, 2026.2 The Epidemiology Section of the North Carolina Division of Public Health (NCDPH) is monitoring cases in the state and maintains a measles dashboard that is updated twice weekly.
The U.S. Centers for Disease Control and Prevention (CDC) recommends vaccination of all children against measles and North Carolina law requires it. Immunization requirements are a preventive measure, intended to stop vaccine-preventable diseases such as measles from occurring in the first place. When a case or outbreak happens, different public health laws provide for communicable disease control measures such as isolation or quarantine.
This is the first of two blog posts on measles and North Carolina public health law. This post focuses on the laws that establish North Carolina’s childhood immunization requirements. A subsequent post will address North Carolina’s communicable disease control laws and how they apply to measles.
Does North Carolina law require children to be immunized against measles?
Yes, measles is one of 12 diseases for which immunization is required in North Carolina.
A state statute requires “[e]very child present in this state” to be immunized against certain diseases, including “red measles (rubeola).” G.S. 130A-152. Red measles is an outdated term that was used to distinguish rubeola from another illness that was sometimes referred to as “German measles,” or rubella. Today rubeola is simply called measles and it is the disease at the center of the current outbreaks.
The same statute also authorizes the North Carolina Commission for Public Health, an appointed rulemaking body, to adopt the state’s childhood immunization schedule. The immunization schedule specifies how many doses of each required vaccine a child should receive and at which age(s) the doses should be administered. 10A N.C.A.C. 41A. 0401. For measles, two doses are required to be administered at least 28 days apart: one at age 12 months to 16 months, and a second before the child enters school for the first time—typically on or around the age of five.
When there is a measles outbreak, the first dose may be given as early as 6 months of age. The North Carolina Department of Health & Human Services (NCDHHS) recommends that measles immunization be considered for 6 to 11 month old infants who live or spend time in counties where measles transmission is occurring. Early immunization is a recommendation, not a requirement under North Carolina law. At the time of this writing, the recommendation applies only to Buncombe County.
Are any children exempt from the measles immunization requirement?
Yes, some children are exempt from the requirement for either medical or religious reasons.
Medical exemption
A child is exempt from the requirement to be immunized against measles if a physician who is licensed to practice in North Carolina certifies in writing that the child has a medical contraindication to the measles vaccine. G.S. 130A-156. The statute directs the Commission for Public Health to adopt a rule specifying the medical contraindications. Under the Commission’s rule, in most cases the medical contraindication must be one that is recognized in the recommendations of the federal Advisory Committee on Immunization Practices (ACIP). 10A N.C.A.C. 41A .0404. ACIP’s most recent recommendations for contraindications to the measles, mumps, and rubella vaccine are reprinted on North Carolina’s medical exemption form.
A contraindication is a medical condition that increases the risk of a severe adverse reaction to an immunization. According to the CDC, most contraindications are temporary and allow for the immunization to be administered at a later date. North Carolina’s medical exemption form requires the physician to specify how long the exemption for a medical contraindication will be in effect.
ACIP recommendations also recognize “precautions,” such as an acute illness on the date the vaccine was scheduled to be administered. The presence of a precaution does not preclude vaccination, but makes it prudent to administer the vaccine at another time. A child with a precaution ordinarily does not qualify for a medical exemption to the measles vaccine requirement.
If a child’s physician believes a child should be exempt from the measles immunization requirement for a contraindication that is not recognized by ACIP, the physician may submit a written request to the State Health Director, who decides whether to grant the exemption.
Religious exemption
A child qualifies for a religious exemption if the child’s parent or guardian has bona fide religious beliefs that are contrary to the immunization requirements. G.S. 130A-157. A child whose parent or guardian’s objection to the immunization requirements is for reasons that are not religious in nature does not qualify for this exemption. 10A N.C.A.C. 41A .0403.
The parent or guardian of a child with a religious exemption must provide a written statement of the parent or guardian’s religious objection to immunizations to any North Carolina school or child care facility that the child attends. North Carolina does not provide a form or template for documenting religious exemptions.
Is proof of measles vaccination required to attend school or day care?
Yes, a child’s parent or guardian must provide either a certificate of immunization or documentation of an exemption before the child may attend school or child care.
School principals and child care facility operators must exclude a child if the child’s parent or guardian does not provide proof that the child is in compliance with the state’s immunization laws. G.S. 130A-155. A parent or guardian provides proof by presenting the child’s immunization certificate or documentation that the child is exempt from the requirements (either the medical exemption form or the religious objection statement described previously).
The proof should be provided by the first day of school or child care. However, the law provides for a grace period of 30 calendar days before the child must actually be denied permission to attend. Additional time may be allowed if a physician certifies that the child has begun a series of required immunizations but needs more time to complete the series.
A similar law requires students attending colleges or universities in North Carolina to provide proof of compliance with the state’s immunization laws. The requirement applies to all students who reside on campus as well as non-residential students who enroll for more than four traditional credit hours. To prove immunization, the student may provide either a certificate of immunization or a record of immunization from a North Carolina high school. If the proof is not provided by the date the student first registers for classes, a 30-day grace period is allowed for the student to obtain required immunizations (or begin the series). G.S. 130A-155.1.
Conclusion
The measles outbreaks that have been ongoing in the United States since early 2025 have now reached North Carolina. By January 30, 2026, 15 cases had been confirmed in the state. (See North Carolina’s measles dashboard for updated information.)
Public health officials are responding to measles by urging people to get vaccinated. In some areas, free walk-in vaccination clinics are available.
Measles is a vaccine-preventable disease and one of 12 diseases that children in North Carolina must be immunized against. Children who are unvaccinated against measles are not allowed to attend school or child care unless they have a documented exemption from the state’s immunization requirements.
