In mid-January, an unassuming man in khakis and a button-down shirt walked to a wooden lectern at a school board meeting in Spartanburg County, South Carolina. Most chairs in the audience were empty. The man, Tim Smith, was the only person signed up to speak during public comments. He had five minutes.

“I trust that each one of you had a good Christmas and New Year’s,” he began. “Unfortunately, I can’t say the same thing.”

His wife is an assistant teacher at a public elementary school in the county, epicenter of the state’s historic measles outbreak, and shortly before winter break she’d received a notice that a child in her classroom had measles. Given his wife is fully vaccinated, he wasn’t worried.

Then, she began to get sick. And sicker. She got a measles test and, to their shock, it came back positive. She was apparently among the very rare breakthrough infections.

Frightened, they took her to the hospital that night. “My wife was throwing up,” Smith said at the meeting. “She had diarrhea. She couldn’t breathe. All for what? This is — it’s absolute insanity.”

Dr. Leigh Bragg, a pediatrician working a county away, wasn’t even aware that anyone in South Carolina had been hospitalized with measles-related illnesses until a short time later when she logged on to Facebook and saw someone relay the distraught husband’s comments.

Part of the reason Bragg didn’t know is that South Carolina doesn’t require hospitals to report admissions for measles, potentially obscuring the disease’s severity. In the absence of mandatory reporting rules, she and other doctors are often left to rely on rumors, their grapevines of colleagues, and the fragments of information the state public health agency is able to gather and willing to share.