Dealing with measles: Lessons from Pennsylvania

Lancaster County, Pennsylvania has become one of the nation’s largest measles outbreaks, with more than 200 reported cases, according to the state’s health department.

Across Pennsylvania, 460 cases have been identified, the department says.

We talked with two doctors who have been dealing with measles cases in and around Lancaster County: Dr. Pia Fenimore, chief of pediatrics for Penn Medicine Lancaster General Hospital and Dr. Patrick Gavigan, a pediatric infectious disease physician at Penn State Health Golisano Children’s Hospital.

They offered some insights that could be useful for other hospital systems that are seeing measles cases.

Communication

Penn Medicine has been talking regularly with other health systems in the region, including WellSpan, UPMC, and Penn State Health, Fenimore says. They’ve also been in regular touch with the Pennsylvania Department of Health, and she credited the agency with providing up-to-date information.

“If they're not operating together, then things can go wrong. And so, I think the communication piece is just huge,” Fenimore says.

Take a leadership role

Health systems must take an active leadership role in a public health crisis, and Fenimore says hospitals and healthcare organizations need to be delivering trusted information about the safety of vaccines.

“Never underestimate how much people trust their healthcare providers. And if they think that they shouldn't take a leadership role, they're wrong. So, both from a system standpoint, but also from a one-on-one, you know, primary care physician, such a huge importance that they take a leadership role to speak up,” she says.

Being proactive

Gavigan says health systems should be developing procedures, even if they aren’t seeing cases yet. Since the virus can survive for up to two hours after an infected individual leaves a room, it’s easy for measles to spread quickly.

“Be proactive in figuring out what you're going to do when you have measles cases and measles exposures, because it is significant how infectious this is,” he says.

Stocking up

Health systems should stock up on treatments to help those who have been exposed, including intramuscular immunoglobulin, to potentially prevent measles or the MMR vaccine.

He advocates “making sure that you have those readily available and then have enough of a supply in the event of a significant exposure.”

Giving clear recommendations

Fenimore stresses the importance of being respectful to patients and says doctors shouldn’t be combative or scold families wary of vaccines. But she also says doctors need to provide unambiguous recommendations about vaccines.

“You have to be non-judgmental,” Fenimore says. “You have to be open to talking about anything that they've heard or read about vaccines. But in the end, you need to say to them, The best thing you can do for your child is vaccinate them. And you need to say, by choosing not to, you are putting your child at risk for some very dangerous illnesses.”

Public education

The measles outbreak illustrates the importance of educating the public about the dangers with measles. Fenimore says she doesn’t advocate scare tactics, but she says too many people view the measles as a harmless malady.

“Most people recover from measles with no problem, but it is also true that those that don't, it can be very devastating,” she says. “And you cannot let your guard down on measles. If you've been infected with measles, you're at risk for years and years.”

Handling suspected cases

It’s one thing if patients show up with a cold or flu to an emergency room or urgent care, but health systems need to be sure patients who think they have measles don’t just appear in waiting rooms.

Gavigan talks about “telephone triages” to help guide patients who think they may have measles, and systems can direct patients to meet clinicians outside or in a designated space.

“Whatever sort of public messaging you can do outside of the hospital or system-wide is going to be helpful. Because if you can prevent those exposures, it's going to save a lot of resources,” Gavigan says.

Testing in-house

Penn State Health had sent measles tests to a lab, but the system recently began doing tests in-house, which has accelerated turnaround times. Now, the system can get tests for measles back in a couple of hours.

“That's also been helpful, and I think it's worth considering for hospital systems in this area,” he says.