Looking at the measles outbreak in Lancaster County, Pa.

Doctors in Lancaster County, Pennsylvania are facing something they have rarely seen, if ever.

Lancaster County is witnessing one of the largest measles outbreaks in the nation. This year, 210 measles cases have been reported in the county, according to the Pennsylvania Department of Health. Some of those patients have required hospital care, officials say.

Lancaster has nearly half of the state’s 460 reported measles cases, and the outbreak here has gained national attention. (Full disclosure: I live in Lancaster County).

Only one county, Spartanburg in South Carolina, has a higher number of measles cases, according to Johns Hopkins University. The outbreak in Lancaster County comes as measles cases nationwide have reached nearly 3,000 this year, a 35-year high, according to Johns Hopkins. CDC figures report just over 2,900 so far this year.

Dr. Pia Fenimore, chief of pediatrics for Penn Medicine Lancaster General Hospital, tells Chief Healthcare Executive® she saw one patient with measles when she was a resident, but hadn’t seen any measles cases until this year.

“It's jarring for several reasons,” Fenimore says. “It's in part just because I haven't had a lot of experience with caring for people with measles and we want to be obviously incredibly cognizant about how contagious it is. It's jarring just making sure that all the protocols are in place.”

Fenimore also says it’s frustrating that a disease that had once been essentially eradicated has now re-emerged.

“There are a lot of problems in the pediatric world that we can't prevent that we really need to be focusing on, and this steals that energy away,” Fenimore says. “So, I get angry at times. So it's jarring from that sense, because I'm not the kind of person to walk around feeling that.”

Dr. Patrick Gavigan, a pediatric infectious disease physician at Penn State Health Golisano Children’s Hospital, tells Chief Healthcare Executive® that before this year, he saw one patient with measles before the COVID-19 pandemic. The outbreak in the county now far surpasses any previous experience he has had with the disease.

“This is certainly the biggest that I've ever encountered, and we've ever encountered, at least since I've been here,” Gavigan says. “I think in this area it's been a little bit more unique than maybe some other areas, and that measles is sort of always in the back of your mind because we do have some pockets of under-vaccinated individuals, but we we've never seen anything to this scale since I've been been here.”

Roughly an hour from Philadelphia, Lancaster County is home to more than 560,000 residents, according to Census estimates. The county draws tourists who relish the rural scenery and Amish communities, with horses and buggies a frequent sight in some smaller towns. The city of Lancaster has also emerged as a destination with a flourishing dining scene and scores of arts and entertainment options.

While the Amish don’t engage health systems with the same frequency as most of their neighbors and doctors say they are less likely to be vaccinated, measles has rarely been seen in Lancaster County. There was only one reported case in the county in 2025, according to Johns Hopkins.

Fenimore says too many people view the measles as a childhood malady that’s harmless, but the disease can have lasting effects.

“It is true that most people recover from measles, but there's this encephalitis that can affect you for up to 10 to 15 years after a measles infection that is very life-threatening,” she says. “You might have someone who comes through measles infection just fine and then five years later be critically ill and have brain damage, because the virus can live in the nervous system.”

National attention

The measles outbreak gained national media coverage last week when the Pennsylvania Department of Health reported two measles-associated deaths.

Pennsylvania Gov. Josh Shapiro, a Democrat, delivered sharp criticism of U.S. Health & Human Services Secretary Robert F. Kennedy Jr. and the Trump administration.

Shapiro credited Kennedy for offering staff to assist Pennsylvania, but said state officials had sufficient resources. He also faulted Kennedy for misinformation, and public health groups have hammered Kennedy for undermining federal vaccine policies and raising questions about the safety of vaccines.

“I was very, very blunt with him, and I made very clear that his actions, and the rhetoric that’s coming from this administration, are having a negative impact on communities across America, particularly right here in Pennsylvania,” Shapiro said at a news conference last week. “There’s real-life consequences to spreading misinformation. There’s real-life consequences to scaring people and not relying on actual doctors and actual medical professionals to provide unbiased information to parents.”

Kennedy has responded by saying state officials haven’t provided information about the measles-associated deaths to the CDC, and in a post on X, he accused Shapiro of “gaslighting” in his press conference.

It remains unclear if the two deaths in Lancaster County were caused by measles. Lancaster County Coroner Dr. Stephen Diamantoni says an infant who died tested positive for the measles, but he initially ruled the cause of death a laceration of the spleen, and not the measles, Lancaster Online reported. The infant is one of the two deaths associated with the measles, state officials have said.

State health officials said the two fatalities are the first deaths associated with measles since 1991.

There were three deaths tied to the measles nationwide in 2025, and they were the first deaths tied to the disease in the U.S. in a decade, federal officials have said.

Medical societies have opposed President Trump’s recent executive order to revamp the childhood vaccine schedule, saying it doesn’t reflect sound science and would put kids at risk.

More vaccine skepticism

Undeniably, Lancaster County is dealing with a measles outbreak that hasn’t been seen in generations. Local physicians say they aren’t sure if they have reached a peak.

In some ways, doctors say many may have believed that measles is a relic of the past.

“I used it as an example of the efficacy of vaccines and the importance of vaccines, and so now to be back here in an outbreak, yes, it's frustrating,” Fenimore says. “But it's yet another place where pediatric providers can step up and help the world, so I'm really looking at it like that.”

Gavigan also points to the previous success of measles vaccination for years, ironically, being a factor today.

“One of the reasons people don't think they need to get vaccinated is because they haven't seen measles,” Gavigan says. “Their friends haven't got measles. Their parents haven't gotten it. And so, when we start to see some of these vaccine-preventable infections, I think that's a great opportunity to readdress some of those patients and families who may have been more reluctant early on.”

Lancaster County has a low vaccination rate compared to other counties. Lancaster County kindergartners have an 87.6% vaccination rate for measles in the 2025-26 year, Lancaster Online reported. Nationwide, the 2025-26 vaccination rate for those in kindergarten was 92.4%, according to CDC data, and that’s below the 95% threshold public health officials say is needed.

Fenimore says she’s seen more families who have skepticism of vaccines.

“Vaccine hesitancy has definitely increased in the last five years, and I think there's a lot of things that contribute to that, but it makes me very nervous because we're losing our herd immunity, as we're proving with measles,” she says.

Penn Medicine has worked with the state health department to organize vaccine clinics in rural areas, including those with bigger Amish populations, and they have had some success, Fenimore says.

She cites a recent vaccination clinic at a volunteer fire department in southern Lancaster County, and she says some have taken place in the homes of members of the Plain communities.

“They've been very successful, and they have been widely supported by the Plain community,” Fenimore says. “And I think that's been a really great thing to meet them where they are and also to use the places where they feel comfortable and the people that they feel comfortable with.”

More than reported

Even as they work to bolster vaccination, local health systems and doctors face the difficulty of dealing with measles, which is easily spread.

The virus can linger in the air for up to two hours after an infected person has left an area, which poses challenges in contact tracing.

“Measles is a very, very feisty virus,” Fenimore says.

“Think about how many people come in and out of a Whole Foods in two hours,” she says. “So, that is the really challenging part about measles is how contagious it is.”

Even with more than 400 measles cases reported in Pennsylvania, Gavigan suggests that data is likely “a pretty significant underestimate.”

“We're only capturing obviously the people who are sick enough to get tested,” he says. “And most of the time, we're talking with those patients and families, they know several other people at home or around that have also likely had measles.”

Gary Price, president of The Physicians Foundation, tells Chief Healthcare Executive that he sees a direct correlation between rising misinformation and declining vaccination rates. Nearly two out of three doctors say misinformation is affecting their ability to provide care, according to a survey released by the foundation Monday.

Referring to the 35-year high in measles cases, Price says, “It's sad, number one, upsetting, number two, and frustrating, number three.”“I think we have to temper that frustration with understanding how this happened,” Price says. “And the only way individual physicians can deal with it is to deal with their patients in a one-on-one fashion, which is the way traditionally we've always done it.”