U.S. Healthcare Systems Race to Adapt as Measles Makes Its Worst Resurgence in 3 Decades
John Goldman, an infectious disease specialist at the University of Pittsburgh Medical Center (UPMC) based in central Pennsylvania, had not encountered a single measles case across 30 years of his career. That all shifted starting last April, when he began treating dozens of patients sickened by the once nearly eradicated viral illness. “I never thought I would see this disease come back,” he recalls.
His health system is far from alone in grappling with a new operational normal, as measles has reemerged as a widespread public health threat across the United States. With national case counts now topping 3,600 — the highest annual total recorded since 1991 — hospitals and frontline care providers are rushing to revive long-forgotten decades-old response protocols, or build entirely new frameworks to contain this exceptionally contagious pathogen.
UPMC’s community hospital in Lititz, situated in Pennsylvania’s Lancaster County, the epicenter of the state’s ongoing measles outbreak, has evaluated roughly 50 measles patients to date, nearly 20 of whom required inpatient admission. Statewide, as of September 30, Pennsylvania has logged 943 total cases, 176 hospitalizations, and five confirmed deaths linked to measles complications.
Goldman notes that the Lititz facility rapidly rolled out system-wide measles screening at all entry points, asking every incoming patient to disclose both any relevant symptoms (fever, persistent cough, sore throat, red watery eyes) and their measles vaccination status. The signature splotchy measles rash, he explains, only develops 3 to 5 days after these initial cold-like symptoms set in, or 1 to 2 weeks after a person is first exposed to the virus.
To avoid spreading the virus in shared clinical spaces, the hospital has rolled out a strict pre-referral rule: all providers must call ahead before sending a patient with suspected measles to the emergency department. Upon arrival, the patient is given a surgical mask, instructed to wait in their car in the parking lot, and met by a designated staff member who escorts them directly to a negative-pressure isolation room, skipping the public waiting area entirely. These specialized rooms maintain lower air pressure than adjacent hallways, trapping airborne viral particles inside the space to stop the pathogen from drifting through shared ventilation systems to infect other patients and staff. Anyone presenting with only mild, non-severe symptoms is instructed to isolate and recover at home. “We are prioritizing keeping measles patients out of our physical facilities as much as possible,” Goldman explains. “Because once someone with the virus is inside a hospital, it is shockingly easy for them to expose dozens of other vulnerable people unintentionally.”
Dr. Jennifer Janco, chair of pediatrics at St. Luke’s University Health Network that serves communities across eastern Pennsylvania and New Jersey, notes that the steady drop in childhood vaccination rates paired with rising national measles case counts made a local outbreak all but inevitable. “It was only a matter of time before we started seeing cases pop up in our service area,” she says. St. Luke’s treated two unvaccinated young siblings for measles in late July: one of the two had been admitted to a different health network for inpatient care before being discharged, and both completed their full recovery at home under remote monitoring from their pediatric care team.
In preparation for a potential surge in local cases, Janco’s team pre-emptively stockpiled supplies of both the measles-mumps-rubella (MMR) vaccine and immune globulin, a concentrated formulation of antibodies sourced from healthy human donor plasma. For unvaccinated people who have been recently exposed to measles, the MMR shot can either fully prevent infection or drastically reduce symptom severity if administered within 72 hours of exposure, while immune globulin can be given up to 6 days post-exposure to further ease complications.
Deploying these time-sensitive interventions, however, depends on fast, accurate diagnostic testing. After decades of near-zero local measles transmission, most U.S. hospitals no longer maintain in-house testing capacity for the virus. Instead, clinicians collect nasal or throat swabs from suspected cases and ship them to either commercial labs or state public health facilities, with a 1 to 3 day turnaround time for results. “The window to offer these protective interventions to exposed, high-risk people is extremely narrow,” Janco points out.
To cut down on unnecessary transmission risk while waiting for test results, the Pennsylvania Department of Health deploys field staff to collect samples directly at a patient’s home in high-probability measles cases, such as an unvaccinated patient with a confirmed known exposure to a measles case. For other lower-risk suspected cases, patients are instructed to wait in their personal vehicles in clinic parking lots, where a care team member meets them to collect their sample to avoid any contact with other patients in waiting rooms.
When the first measles cases started appearing in South Carolina’s Spartanburg County last fall, care teams at nearby Prisma Health in Greenville immediately launched planning sessions to map out their response if the local outbreak grew larger. “Since the height of the Covid pandemic, we haven’t had to put much thought into adjusting patient flow through our facilities, or putting in place special safeguards to protect both our frontline staff and other high-risk, susceptible patients,” notes Dr. Robin LaCroix, a pediatric infectious disease physician at Prisma Health.
Their proactive planning proved critical: between October 2025 and March 2026, South Carolina’s Spartanburg County and broader upstate region reported a total of 997 linked measles cases, a far larger outbreak than many local public health teams initially projected.
Infants under 12 months old rank among the population groups at highest risk for severe measles complications, since the first routine MMR vaccine dose is not scheduled until a child turns 1 year old. To shield this vulnerable group, Prisma’s health system asked all parents bringing newborns to appointments to call the pediatric clinic ahead of their arrival, then enter through a dedicated separate entryway so they never had to spend time in a shared waiting room. Along with infants, immunocompromised people and pregnant people also face drastically elevated odds of life-threatening measles complications, prompting the network to roll out two layers of pre-appointment screening: staff screen all patients for measles symptoms over the phone when they book their visit, and conduct a second quick screening in person when the patient arrives at the facility.
Prisma’s Greenville Memorial Hospital tested more than 400 patients for measles over the course of the outbreak, and cared for 13 admitted measles patients — but the facility did not have nearly enough negative-pressure isolation rooms to accommodate both suspected and confirmed cases. Care teams had to quickly retrofit standard patient rooms for safety, bringing in portable air scrubbers and high-efficiency particulate air (HEPA) filters, and in many cases reassigning measles patients to rooms that were not connected to shared air handling units serving areas where non-measles patients were staying. The network’s facilities engineering department had to conduct full assessments of all ventilation systems and measure precise airflow patterns to identify which rooms could be safely repurposed for measles patient care.
LaCroix notes that the lack of negative-pressure rooms at smaller urgent care centers and private pediatric offices made even a single suspected measles case extremely disruptive for normal operations. Because live measles virus can remain suspended in the air in an enclosed space for up to two full hours after an infected person leaves, any room used by a suspected measles patient had to be fully emptied and sealed off for that entire two-hour window before it could be sanitized and reused for other patients, leading to major delays and long wait times for other people seeking care. To avoid these disruptions entirely, Prisma prioritized keeping all mild measles cases out of in-person care settings, leaning heavily on telehealth visits at the peak of the outbreak: some pediatricians checked in on their measles patients twice per day remotely to monitor symptoms and confirm if any patient needed to come in for emergency in-person care.
All of these new workflow changes and patient protection measures placed significant strain on both patients and clinical staff, LaCroix says.
For hospitals across the U.S., the return of widespread measles transmission has required a dramatic, sustained increase in vigilance to keep the highest risk patients safe. In August, Geisinger Medical Center in Danville, Pennsylvania, was forced to update its neonatal intensive care unit (NICU) visitation rules immediately after a hospital visitor was found to have potentially exposed the unit to measles. The new rules restrict NICU access exclusively to a newborn’s parents or legal guardians, none of whom are allowed to enter if they present any symptoms consistent with measles. Geisinger then rolled out mandatory measles symptom screening for all parents and legal guardians entering its main Danville facility, and expanded the same protocol to its affiliated children’s hospital in early September.
“This takes a huge amount of resources to sustain,” Janco notes. “There are so many moving pieces that all have to line up perfectly to make sure we are doing everything in our power to contain this outbreak.”
