“I never thought I would see this come back,” he says. His health system, like others, has had to adapt to a new normal as measles makes a comeback in the United States. As the country’s cases top 3,600, the highest yearly total since 1991, hospitals and health care providers are being forced to dust off decades-old protocols or develop new ones to deal with the highly contagious disease.

The University of Pittsburgh Medical Center’s community hospital in Lititz is in Lancaster County, the center of Pennsylvania’s current outbreak. It has evaluated around 50 patients with measles, with roughly 20 of those requiring hospitalization. Statewide, Pennsylvania has recorded 943 cases, including 176 hospitalizations and five measles-related deaths as of September 30.

Goldman says the Lititz hospital has rapidly ramped up measles screening, asking patients if they are experiencing symptoms such as fever, cough, sore throat, red eyes, and whether they are vaccinated. The classic measles rash does not appear until three to five days after these cold-like symptoms begin, or about one to two weeks after exposure to the virus.

The hospital is instructing physicians to call ahead before referring a patient with suspected measles to the emergency department. Patients must wear a mask and wait in the parking lot, where a staff member meets them and escorts them directly to a negative-pressure room, bypassing the waiting area. These special isolation spaces have lower air pressure than outside hallways, which traps airborne pathogens inside and prevents them from spreading within a hospital. Patients who don’t have serious symptoms are asked to stay at home.

“We are really trying to prevent people from coming to the hospital with measles, because once they’re in the hospital, it's very easy for them to expose other people,” Goldman says.

Jennifer Janco, chair of pediatrics for St. Luke’s University Health Network, which serves eastern Pennsylvania and New Jersey, says that with falling vaccination rates and increasing measles cases around the country, “it was only a matter of time before we started seeing cases.”St. Luke’s treated two unvaccinated siblings for measles in late July. One of the siblings was hospitalized in a different health network but released, and both were able to recover at home while pediatricians oversaw their care remotely. The health network has also tested other patients suspected of having measles.

To prepare for possible measles cases, Janco says the health system stocked up on the measles, mumps, and rubella (MMR) vaccine, as well as immune globulin, a mix of antibodies derived from healthy human blood plasma. The MMR vaccine can prevent infection or make the illness milder if given within 72 hours of initial measles exposure for people who haven’t been vaccinated, and immune globulin can be given up to six days after exposure to help ease symptoms.

Deploying those interventions requires quick, accurate testing. Because measles was rare for so long, most hospitals do not have the ability to test in-house for the disease. Instead, a nasal or throat swab is collected and sent to a commercial or state public health laboratory. The turnaround time for results is one to three days.

“There’s a narrow window of time to offer prevention for exposed, vulnerable people,” Janco says.

Janco says in cases where measles is highly likely—for example, if the patient is unvaccinated and had exposure to an infected person—the Pennsylvania Department of Health will send a representative to collect a patient sample at their home. In other instances, patients have been asked to wait in their car in the parking lot, where a health care provider meets them and collects a sample to avoid exposing others.

When measles cases began appearing in Spartanburg County, South Carolina, last fall, staff at Prisma Health in nearby Greenville started discussing how they would handle measles cases if the outbreak got bigger.

“Since Covid, we haven't really had to think a lot about how we flow patients through a system, or the special things that we need to have in place to really protect not only the health care givers but also the other patients who are susceptible,” says Robin LaCroix, a pediatric infectious disease physician at Prisma Health.

But the planning proved prescient: A total of 997 cases from October 2025 through March 2026 were tied to an outbreak centered around Spartanburg County and the upstate region in South Carolina.

Newborns are among the most susceptible to measles, since babies don’t usually receive their first dose of the MMR vaccine until 12 months of age. To protect them, the health system asked parents with newborns to call their pediatrician’s office when they arrived for an appointment and enter through a separate door so they didn’t have to sit in a waiting room.

In addition to newborns, immunocompromised and pregnant people are also at higher risk of serious complications from measles. To prevent potential exposures in doctors’ offices, providers started screening patients for measles over the phone when scheduling appointments and in person upon arrival.

Prisma’s Greenville Memorial Hospital, which tested 400 patients for measles during the outbreak and cared for 13 hospitalized patients, didn’t have enough negative-pressure rooms to handle suspected and confirmed cases, so staff had to retrofit regular rooms. That involved bringing in portable air scrubbers and high-efficiency particulate air filters, and at times moving measles patients to a room that didn’t share a common air-handling unit with rooms where non-measles patients were staying. This required the health network’s engineering department to assess ventilation systems and measure airflow to figure out where staff could safely relocate patients. In urgent care clinics and doctors’ offices without negative pressure capability, a potential measles exposure could be very disruptive to patient care, LaCroix says.

Since measles can remain airborne in a space for two hours after an infected person leaves, a room that a suspected measles patient had been in needed to be closed and vacated for that amount of time before it was usable again, causing longer wait times for other patients. Prisma also tried to keep infected patients out of health care settings if they had milder infections.

At the height of South Carolina’s outbreak, the health system relied heavily on telemedicine visits. Some pediatricians were seeing patients twice a day to check in on their status and determine whether they needed to come into the hospital.

Collectively, the measures needed to protect patients from exposure and the changes in workflow were difficult for both patients and staff, LaCroix says.

For many hospitals, measles’ return means heightened vigilance to keep the most vulnerable safe. Geisinger Medical Center in Danville, Pennsylvania, had to update visitation rules to its neonatal intensive care unit in August following a potential measles exposure from a hospital visitor. Now, only a baby’s parents or legal guardians are permitted to visit the NICU, and only if they do not have signs or symptoms associated with measles. Geisinger has since implemented screening of parents and legal guardians for measles symptoms upon entering its Danville facility, and it expanded the protocols to its children’s hospital in early September.

“It is a resource strain,” Janco says. “There are so many pieces that have to fall into place to make sure that we're doing everything we can to contain this.”