The adults who arrive at Penn State Lancaster Medical Center with measles have symptoms far more severe than the virus\u2019S hallmark cough, fever and rash.<\/p>\n
They are weak and disoriented with meningitis, sepsis or pneumonia. Some have bacterial infections in their blood, kidney failure or hepatitis.<\/p>\n
\u201cTo see that in otherwise young healthy patients is very unusual,\u201d said Fahmida McGann, an infectious disease physician at the hospital.<\/p>\n
Pennsylvania\u2019s measles outbreak is defying epidemiologists\u2019 expectations and historical trends: Adults account for about two-thirds of the 1,300 cases reported by the state in the largest outbreak the country has seen in decades.<\/p>\n
Until now, measles was rarely seen among adults. The virus is so contagious that virtually no one made it out of childhood without getting sick prior to the advent of a vaccine in the 1960s. Recent major outbreaks in Texas and South Carolina primarily affected children, with adults accounting for about a third of cases.<\/p>\n
Pennsylvania\u2019s outbreak is also sending people to the hospital at almost twice the rate seen in other recent outbreaks. Six people diagnosed with measles \u2014 four of them adults \u2014 have died, according to state health officials and local coroners. An infant, born with the disease after his mother was sick during pregnancy, was among the deaths.<\/p>\n
The toll showcases how adults over age 20 are among the groups at greatest risk for serious complications, given that they are more likely than children to have underlying medical conditions that make it harder to recover.<\/p>\n
Pennsylvania is seeing the highest hospitalization rate among children under 4 years old. They represent one in three of those admitted to the hospital, according to the state health department.<\/p>\n
Doctors say adults who waited to seek medical attention until they were too sick to carry out their home and work responsibilities could also be contributing to the high hospitalization rate.<\/p>\n
And just last week, health providers received a state-issued alert about congenital measles, which occurs when a pregnant woman passes on measles to her newborn infant. Cases are so rare that standard tracking is nonexistent, and little is known about its long-term implications.<\/p>\n
Pennsylvania\u2019s measles outbreak is a phenomenon decades in the making, experts say. The virus appears to be spreading widely in communities, such as Amish enclaves across the state, where some have skipped vaccines for a generation or more.<\/p>\n
\u201cYou have to have individuals who aren\u2019t getting vaccinated, but who also aren\u2019t being exposed to measles for decades,\u201d said William Moss, a professor of epidemiology and international health at the Johns Hopkins Bloomberg School of Public Health.<\/p>\n
A yearslong decline in vaccination rates amid rising politicization and misinformation has left any unvaccinated individual \u2014 infant, child or adult \u2014 vulnerable to the disease now ripping through the state.<\/p>\n
Children under 5 and people with compromised immune systems are also at high risk for severe illness.<\/p>\n
Measles among adults<\/p>\n
Adults between ages 25 and 49 have been hardest hit by Pennsylvania\u2019s measles outbreak, state data shows, followed by adults between the ages of 18 and 24. Combined, they represent about 60% of cases.<\/p>\n
About 20% of all measles patients in Pennsylvania require hospital treatment. Adults older than 50 are the second most likely to be hospitalized, representing more than one-fourth of hospitalizations.<\/p>\n
Both trends are unusual, medical experts say.<\/p>\n
The outbreak\u2019s path in Pennsylvania is nearly a mirror opposite of how measles has typically spread:<\/p>\n
\u2022 Last year in west Texas, adults accounted for about a third of cases in an outbreak that originated in a Mennonite community. Roughly 13% of all patients were hospitalized, and two people, both children, died.<\/p>\n
\u2022 In South Carolina, school-age children were at the center of an outbreak that sickened 997 this year and last. There were no deaths.<\/p>\n
\u2022 Between 1990 and 1991, more than 1,500 measles cases were reported in Philadelphia, amid a national resurgence of the disease. Here and nationally, children under 5 were more likely to get sick.<\/p>\n
So far this year in Pennsylvania, about 870 adults and 440 children have contracted measles. The state\u2019s tally is likely an undercount, since not all measles patients get tested or visit doctors. Adults with more serious cases may be more likely to get reported than mild cases among school-age children, experts say.<\/p>\n
Glen Wheeler, a primary care doctor working at the center of the statewide outbreak in Lancaster County, had never seen a measles case in his 56-year career until this year.<\/p>\n
At his clinic in Smoketown, he sees a lot of lacerations, eye injuries, burns and other problems that arise from the hard work of farm life. He knows his patients \u2014 mostly Amish and Mennonite families \u2014 typically seek care only when they are too sick to work.<\/p>\n
In recent weeks, between six and 10 adults are showing up daily, sleep deprived and dehydrated from trying to push through measles.<\/p>\n
\u201cThey\u2019re having diarrhea or vomiting, they can\u2019t keep liquids down, and they\u2019re coughing so hard they can\u2019t sleep or can\u2019t breathe,\u201d said Wheeler.<\/p>\n
Wheeler takes many to a private room cordoned off from the rest of the clinic and hooks them up to an IV with electrolytes, to help them hydrate. Some go through multiple IV bags before leaving.<\/p>\n
Treatments focus on minimizing symptoms, because there is no cure or specific therapy for measles. Some patients are so sick Wheeler refers them to the hospital.<\/p>\n
Many measles patients who arrive at Lancaster Medical Center can be treated in the emergency department and sent home to recover. But some must be admitted for more advanced care, said McGann, who treats adults at the hospital.<\/p>\n
Patients are generally \u201cnot coming in super early,\u201d but rather days after developing a rash, which typically appears three to five days after the first symptoms, McGann said.<\/p>\n
The vast majority of measles cases involve mild-to-moderate flulike symptoms that improve within two weeks, and don\u2019t require hospital care. McGann suspects that some of the patients arriving with advanced illness assumed they, too, would be able to recover at home.<\/p>\n
\u201cIt\u2019s not a benign disease,\u201d McGann said.<\/p>\n
Congenital measles emerges<\/p>\n
In an outbreak spreading among adults, unvaccinated pregnant women are particularly vulnerable, because they cannot receive the measles, mumps and rubella vaccine, which contains a live, weakened version of the virus.<\/p>\n
The state has reported 64 measles cases among pregnant people. A measles infection raises the risk of premature delivery and complications for the infant after birth.<\/p>\n
\u201cWhen there\u2019s a widespread outbreak in a community, it\u2019s next to impossible for an (unvaccinated pregnant woman) to not be exposed,\u201d said John Goldman, an infectious disease specialist at the University of Pittsburgh Medical Center.<\/p>\n
The state is working with the Centers for Disease Control and Prevention to develop tools to track cases of infants with congenital measles. In the past, there was little need: Most women had already acquired measles or were immunized by childbearing age and were unlikely to pass it to their newborn.<\/p>\n
The death of an infant in Lancaster County drew wide attention to the risks of measles during pregnancy.<\/p>\n
The mother contracted measles shortly before she gave birth prematurely to a baby who also tested positive for measles. After his death, Lancaster County\u2019s coroner told reporters that he did not believe the child died from measles, but of a lacerated spleen. Other physicians have questioned this conclusion, noting that measles can weaken the spleen, making it more likely to rupture.<\/p>\n
State officials have maintained the infant\u2019s death was associated with measles.<\/p>\n
Last week, state health officials issued a health alert for physicians with advice on how to treat measles during pregnancy and after birth.<\/p>\n
Women who have measles around the time they give birth can pass on the virus to their newborn, putting them at risk for potentially fatal complications, such as brain swelling and a rare complication called subacute sclerosing panencephalitis, a brain disorder that develops years after a child recovers from the disease.<\/p>\n
Goldman said he\u2019s aware of \u201ca couple\u201d cases of congenital measles treated in his health system, mostly at UPMC Lititz in Lancaster County, but could not provide an exact number.<\/p>\n
As in adults, treating congenital measles involves working to ease symptoms. Exposed pregnant women and babies can receive immune globulin, an antibody treatment that can offer some protection against measles and other illnesses, or at least prevent severe disease, Goldman said.<\/p>\n
\u201cWe can do our best to predict what these babies may struggle with, but we just don\u2019t have a whole lot of experience to pull from,\u201d said Alexandra Medoro, the medical director of CHOP\u2019s congenital and perinatal infections program.<\/p>\n
Shifting public health response<\/p>\n
In smaller measles outbreaks in recent years in Pennsylvania and nationally, tried-and-true messaging targeted parents with vulnerable children.<\/p>\n
The mantra of public health leaders: Get your children vaccinated. Pediatric offices, urgent care centers and hospitals were advised that flulike symptoms could be the early signs of measles that appear before the telltale red rash. They also were given photos of the rash on the arms, backs and faces of children.<\/p>\n
But as Pennsylvania\u2019s outbreak logs more adult patients, public health leaders and hospitals are revising the playbook.<\/p>\n
Another local hospital at the outbreak\u2019s epicenter, Penn Medicine Lancaster General Hospital, has updated its electronic medical record to prompt intake staff to ask all patients if they have had flulike symptoms and if they are vaccinated against measles, said Nitin Patel, an infectious disease doctor at the hospital.<\/p>\n
Pennsylvania\u2019s Department of Health has scheduled dozens of pop-up clinics in rural communities, where some entire families come to get vaccinated. The measles vaccine is 93% effective after the first of two recommended doses.<\/p>\n
Nurses employed by Chester County, which has the third-highest number of cases in Pennsylvania, make house calls to Amish and Mennonite families who don\u2019t use cars.<\/p>\n
Messaging has emphasized that anyone can get measles, said Jeanne Franklin, Chester County\u2019s health director.<\/p>\n
\u201cThe disease doesn\u2019t know how old you are,\u201d Franklin said. \u201cThis is not a childhood disease \u2014 you can get it at any point in your life if you\u2019re unvaccinated.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"The adults who arrive at Penn State Lancaster Medical Center with measles have symptoms far more severe than…\n","protected":false},"author":2,"featured_media":318860,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[13],"tags":[1057,182,139,28,29,147,149,148,150],"class_list":["post-318859","post","type-post","status-publish","format-standard","has-post-thumbnail","category-upper-darby","tag-health","tag-local-news","tag-news","tag-pennsylvania","tag-pennsylvania-news","tag-upper-darby","tag-upper-darby-headlines","tag-upper-darby-news","tag-upper-darby-township"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/us-pa\/wp-json\/wp\/v2\/posts\/318859","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/us-pa\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/us-pa\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-pa\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-pa\/wp-json\/wp\/v2\/comments?post=318859"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/us-pa\/wp-json\/wp\/v2\/posts\/318859\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-pa\/wp-json\/wp\/v2\/media\/318860"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/us-pa\/wp-json\/wp\/v2\/media?parent=318859"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-pa\/wp-json\/wp\/v2\/categories?post=318859"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-pa\/wp-json\/wp\/v2\/tags?post=318859"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}