Pennsylvania’s measles outbreak is worse than the numbers suggest
Washington Post reports:
By Leana S.Wen
BLUF: What doctors on the front lines are seeing should serve as a warning to other states.
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.
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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.
AI Generated summary of 112 readers’ comments regarding this article:
The conversation explores the escalating measles crisis and the role of misinformation in exacerbating the situation.
Participants express strong opinions about the influence of anti-vaccine figures like RFK Jr. and former President Trump, blaming them for spreading falsehoods that have led to decreased vaccination rates and subsequent outbreaks.
Many comments highlight the preventable nature of the crisis, emphasizing the importance of vaccination and criticizing those who reject it.
There is also a focus on the political implications, with some urging voters to consider these issues in upcoming elections.
The discussion reflects frustration with the spread of misinformation and the perceived negligence of leaders who have contributed to the public health crisis.
About Dr. Wen:
Dr. Wen is a practicing Emergency Medicine Physician and a Professor of Medicine at George Washington University School of Medicine and frequent contributor on medical topics.
My comments:
Robert F. Kennedy, Jr played a key role in propagating anti-vaccination misinformation that fueled the deadly 2019 - 2020 Samoa measles epidemic but also included cases in Tonga, the Philippines, Fiji, and New Zealand. Only Samoa experienced deaths due to their low vaccination rate.
The 2019 Samoa measles outbreak began in September 2019 and by 6 January 2020, over 5,700 cases of measles and 83 deaths had been reported, out of a population of 200,874, an infection rate of more than 2.5%. The cause of the outbreak was decreased vaccination rates among newborns, from 74% in 2017 to 31–34% in 2018. Nearby islands had rates near 99%.
Samoan anti-vaccination activist Edwin Tamasese was arrested and charged with "incitement against a government order.” RFK, Jr never faced any legal consequences for the key role he played in the deadly outbreak; nor did he ever acknowledge his own responsibility for the outbreak.
Certainly, had Donald Trump properly vetted Kennedy, it would be obvious that he was unqualified to lead HHS.
Kennedy has mismanaged measles outbreaks in multiple states since his appointment in early 2025. The drop in vaccination rates nationwide makes it inevitable that outbreaks of measles and other vaccine preventable diseases will not only continue, but will increase.
The changes Trump and Kennedy recently made to the “Recommended Vaccine Schedule” for children will only add more fuel to this fire.
It is time to force the resignation of Robert F. Kennedy, Jr.
By Leana S.Wen
BLUF: What doctors on the front lines are seeing should serve as a warning to other states.
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.
What will happen in the 2026 midterms? Sign up for Margin of Victory
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.
AI Generated summary of 112 readers’ comments regarding this article:
The conversation explores the escalating measles crisis and the role of misinformation in exacerbating the situation.
Participants express strong opinions about the influence of anti-vaccine figures like RFK Jr. and former President Trump, blaming them for spreading falsehoods that have led to decreased vaccination rates and subsequent outbreaks.
Many comments highlight the preventable nature of the crisis, emphasizing the importance of vaccination and criticizing those who reject it.
There is also a focus on the political implications, with some urging voters to consider these issues in upcoming elections.
The discussion reflects frustration with the spread of misinformation and the perceived negligence of leaders who have contributed to the public health crisis.
About Dr. Wen:
Dr. Wen is a practicing Emergency Medicine Physician and a Professor of Medicine at George Washington University School of Medicine and frequent contributor on medical topics.
My comments:
Robert F. Kennedy, Jr played a key role in propagating anti-vaccination misinformation that fueled the deadly 2019 - 2020 Samoa measles epidemic but also included cases in Tonga, the Philippines, Fiji, and New Zealand. Only Samoa experienced deaths due to their low vaccination rate.
The 2019 Samoa measles outbreak began in September 2019 and by 6 January 2020, over 5,700 cases of measles and 83 deaths had been reported, out of a population of 200,874, an infection rate of more than 2.5%. The cause of the outbreak was decreased vaccination rates among newborns, from 74% in 2017 to 31–34% in 2018. Nearby islands had rates near 99%.
Samoan anti-vaccination activist Edwin Tamasese was arrested and charged with "incitement against a government order.” RFK, Jr never faced any legal consequences for the key role he played in the deadly outbreak; nor did he ever acknowledge his own responsibility for the outbreak.
Certainly, had Donald Trump properly vetted Kennedy, it would be obvious that he was unqualified to lead HHS.
Kennedy has mismanaged measles outbreaks in multiple states since his appointment in early 2025. The drop in vaccination rates nationwide makes it inevitable that outbreaks of measles and other vaccine preventable diseases will not only continue, but will increase.
The changes Trump and Kennedy recently made to the “Recommended Vaccine Schedule” for children will only add more fuel to this fire.
It is time to force the resignation of Robert F. Kennedy, Jr.
