The measles outbreak in Pennsylvania has already reached staggering proportions. Since it began in April, more than 970 cases across 39 counties have been confirmed. Nearly 200 people have been hospitalized. The state has reported five measles-associated deaths, including three unvaccinated adults and two infants.
As troubling as these numbers are, they don’t tell the whole story. To get a better sense of how the outbreak is unfolding for clinicians on the front lines, I spoke with Patrick Gavigan, a pediatric infectious diseases specialist at Penn State Health Golisano Children’s Hospital.
Gavigan’s hospital borders Lancaster County, where more than a third of the state’s cases have been confirmed. Before this outbreak, measles was so rare that he encountered it only once during his training. This year, his hospital has treated between 15 and 20 cases, most of them in the past month.
In addition to the volume, what stood out to him were the symptoms his patients exhibited. He had thought that most measles patients needing hospitalization would experience respiratory distress. About 1 in 20 children with measles develop pneumonia, and indeed, he is seeing patients with difficulty breathing who need oxygen support and, in some cases, machines to help them breathe.
Gavigan told me that his biggest surprise was how many severe cases he was seeing in previously healthy individuals, and how many involved non-respiratory symptoms. Some patients had vomiting and diarrhea and were found to have elevated liver enzymes and diagnosed with hepatitis. Some developed encephalitis, an inflammation of the brain that can result in seizures, paralysis and permanent brain damage. Some have been discharged to go home; others have faced a much slower recovery and may never regain the abilities they had before becoming ill.
What also worries him is how many people in the community are infected with measles but are not accounted for in official statistics. “Every pediatric patient that we’ve had at the hospital, when we talk to the family, everyone or nearly everyone at home has had a measles-like illness,” he said. When clinicians ask whether those family members were tested, the answer is no unless they, too, were sick enough to go to the hospital.
This means the reported case numbers are almost certainly far below the true number of infections, which is why this outbreak has been so hard to contain. Measles is caused by a virus that can linger in the air for up to two hours after an infected person leaves. Initial symptoms of fever, runny nose and congestion mimic other common viral illnesses. The characteristic rash does not appear until about four days after symptoms begin; during this time, the person could unknowingly spread the virus.
The best way to rein in measles is to track down exposed individuals and monitor them for symptoms during the incubation period, which can last up to 21 days. When people don’t realize they are infected and never get tested, contact tracing becomes much harder. Some reported cases have involved exposures affecting potentially thousands of people at a time, including at service stations along major highways, grocery stores, a courthouse and a soccer camp.
Gavigan told me all the patients requiring inpatient care at his hospital have been unvaccinated. This tracks with statewide data: Less than 1 percent of Pennsylvania cases have been in vaccinated individuals. Two doses of the measles, mumps and rubella vaccine are more than 97 percent effective against measles infection, making the kind of widespread societal disruption seen during the covid pandemic unlikely. But the resurgence has made life less safe for infants too young to be vaccinated and immunocompromised individuals, whose families must change how they interact with the public to protect them.
Despite the ballooning numbers, Gavigan sees signs of hope. He has seen people get vaccinated after watching family members fall ill. Some who were previously hesitant about the shot are now promoting them in their communities. His region has large populations of Amish and Mennonite families whom he believes are not necessarily opposed to vaccines but have been disengaged from the medical system.
“For so long, people hadn’t seen any measles,” he said. Now that it has become a real threat, there is more willingness to take preventive action.
The state health department is also reporting a surge of interest in the measles, mumps and rubella vaccine. In August, health care providers administered more than 49,000 doses, nearly double the number in a typical month. In the first three weeks of September, they administered more than 38,000, including many through pop-up vaccination clinics in affected communities.
How Pennsylvania handles this crisis will offer important lessons for other states. Over the past two years, major measles outbreaks have struck Texas, South Carolina and Utah. It’s only a matter of time before other states experience their next public health challenge from what remains a vaccine-preventable illness.
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