How Are Hospitals Changing Protocols to Handle Measles Cases?

Hospitals in Pennsylvania and other states are rewriting infection-control routines for a disease many clinicians had never treated: measles. The changes include parking-lot triage, dedicated isolation rooms, and new stockpiles of vaccine and antibody treatment, according to physicians interviewed by Wired.

What triggered the protocol changes?

U.S. measles cases have topped 3,600 this year, the highest annual total since 1991, Wired reported. John Goldman, an infectious disease specialist with the University of Pittsburgh Medical Center (UPMC) in central Pennsylvania, told the outlet he had not seen a measles case in 30 years before this year. Since April, he said, he has treated dozens of patients. "I never thought I would see this come back," Goldman said.

Pennsylvania's Lancaster County is the center of the state's current outbreak. UPMC's community hospital in Lititz, which sits in the county, has evaluated roughly 50 measles patients, about 20 of whom required hospitalization, according to Goldman. Statewide, Pennsylvania had recorded 943 cases, 176 hospitalizations, and five measles-related deaths as of September 30, Wired reported.

How do hospitals screen patients before they arrive?

The Lititz hospital now instructs physicians to call ahead before referring a patient with suspected measles to the emergency department, Goldman told Wired. Screening questions focus on fever, cough, sore throat, red eyes, and vaccination status — the cold-like symptoms that typically precede the measles rash by three to five days, or one to two weeks after exposure to the virus.

Patients who arrive with suspected measles are told to wear a mask and wait in the parking lot rather than the emergency department waiting room. A staff member then meets them outside and escorts them directly to an isolation room, bypassing other patients. "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 said.

What happens inside the hospital once a patient is isolated?

Suspected measles patients are placed in negative-pressure rooms, which maintain lower air pressure than surrounding hallways so airborne pathogens stay contained rather than spreading through ventilation systems, according to Goldman's description to Wired. Patients without serious symptoms are asked to recover at home instead of being admitted, reducing the number of people who pass through hospital isolation infrastructure at any one time.

At St. Luke's University Health Network, which serves eastern Pennsylvania and New Jersey, two unvaccinated siblings were treated for measles in late July, said Jennifer Janco, the network's chair of pediatrics. One sibling was hospitalized at a different health network before being released; both recovered at home while pediatricians monitored their care remotely, Janco told Wired.

What treatments and supplies are hospitals stocking?

Janco said St. Luke's built up supplies of the measles, mumps, and rubella (MMR) vaccine and immune globulin, a mixture of antibodies drawn from healthy human blood plasma, in anticipation of more cases. The MMR vaccine can prevent infection or reduce severity if given within 72 hours of exposure to an unvaccinated person, according to Wired's reporting. Immune globulin can be administered up to six days after exposure to ease symptoms in people who were not previously vaccinated.

Janco said the rise in cases was foreseeable given falling vaccination rates nationally. "It was only a matter of time before we started seeing cases," she told Wired.

Why is Pennsylvania seeing so many hospitalizations?

The Lititz hospital's hospitalization rate — about 20 of 50 evaluated patients — reflects a pattern playing out statewide, where Pennsylvania's 176 hospitalizations represent roughly 19 percent of its 943 recorded cases as of September 30, per the figures Wired cited. Measles spreads through respiratory droplets and can remain airborne in a room for up to two hours after an infected person leaves, which is why hospitals have prioritized rerouting patients away from shared waiting areas rather than relying solely on in-hospital isolation once a patient has already been admitted.

What should someone with suspected measles symptoms do?

Based on the protocols described by Goldman and Janco, patients experiencing fever, cough, sore throat, or red eyes who suspect measles exposure should call their hospital or physician before arriving in person, wear a mask if they do go to a facility, and avoid emergency department waiting rooms. Those without severe symptoms are generally advised to isolate and recover at home under remote medical supervision, a step both UPMC and St. Luke's have built into their updated procedures to limit transmission inside health care facilities.

Read the original reporting at Wired.