Belleville, Pennsylvania
Main Street is bustling on a Wednesday afternoon in late September. Cars mix with horse-drawn carriages on the road, many coming and going from the weekly sale day – a market spanning 10 acres with livestock, fruits and vegetables, flowers and other produce available for purchase. Lively conversations in English and Pennsylvania Dutch fill the barn where a produce auction takes place until lunchtime; Bidding for a pint of bright red cherry tomatoes ranges from 90 cents to $1.30.
As dozens of people mingled throughout the afternoon – the Amish and other Plains peoples, so named for their simple way of dressing, as well as the “English,” as they referred to those outside their community – there was no direct indication that a measles epidemic was raging in the area. Only one woman wears a mask, which she says she wears every time she leaves the house since the start of the Covid-19 pandemic. A seller is closed for “unexpected family obligations” and a regular auction attendee is mourned after her recent sudden death after experiencing “flu-like symptoms.” The tourists come from Brooklyn.
But less than a mile away, at the Central Pennsylvania Clinic, measles is front and center.
An exit from Main Street quickly opens up into an idyllic rural valley, filled with lush farms against a backdrop of verdant mountains. An unpaved road crosses a babbling river to reveal a striking gray building on a hillside, a huge barn raised in the traditional style that uses only wooden stakes – no nails – to hold the structure together.
The front door is locked, with a photo and description of measles hanging in the window, along with a notice asking visitors to “ring the doorbell for service.” Dr. Katherine Mascia opens the door with a big smile and a quick question: “Any measles symptoms today?”
Behind the genuine smile hides real sorrow. A massive measles outbreak in the region – now the deadliest and nearly the largest the United States has seen in decades – is bringing considerable pain and suffering to the families it cares for.
“In the five years I’ve worked here, I don’t think we’ve had this many patients admitted to the hospital in the span of a few weeks,” Mascia said. “We can typically have maybe just one patient admitted for their complex care needs, but to have that many at the same time, it’s really unprecedented.
About 1,000 cases of measles have been reported by the Pennsylvania Department of Health since the outbreak began in April, nearly surpassing the record number recorded in South Carolina during an outbreak that began last year and became the largest in the United States since 1992. The clinic’s headquarters in Mifflin County is one of the hardest hit, near the epicenter in neighboring Lancaster County.
Patients served by Central Pennsylvania Clinic are particularly vulnerable to the serious effects of measles infection. The nonprofit organization cares for children and adults with genetic disorders that are particularly common within the Amish and broader Plain community, a group that also tends to have lower-than-average vaccination rates.
Plains people are known for their caution toward government and other non-religious authorities.
But as measles ravages many of their central Pennsylvania hometowns, the national debate has paradoxically become politically charged.
Federal and Pennsylvania government leaders have clashed over the response, with much of the debate centered on the five deaths that have occurred during this outbreak. Disputes over the definition of what constitutes a measles death and how news of deaths is shared with the public have disrupted public health response plans.
During this time, Central Pennsylvania Clinic staff are focused on how to best keep everyone safe and healthy. They build on the clinic’s well-established foundation of trust. It took persistence and patience – sometimes years – for the clinic to build these relationships, and the strength of that trust faced some of its greatest tests. over the last few months.
When Pennsylvania reported a measles-associated death in an 18-year-old in Mifflin County, Mascia said, the clinic started getting tons of calls — from patients they knew and others in the broader community — who just wanted to know what happened. They weren’t paying attention to government officials’ arguments on social media, she said. They wanted to clearly understand how the young man died.
“I’m very honored that they’re calling us and asking these questions. It helps me feel like they really trust us,” Mascia said. “But it also puts pressure on us.”
She said she contacted the county coroner directly to get an official statement on the cause of death, and she refers to that statement when patients have questions.
“We want to keep that line of communication open with the community, and it’s very important to provide accurate information and be consistent with the message,” she said.
Consistent communication and resilient response
Central Pennsylvania Clinic leaders have been thinking about and planning for a community measles outbreak since the West Texas outbreak began in January 2025, Mascia said. Their patients are vulnerable and their practices, while incredibly well equipped in many ways, are not designed to treat measles patients.
“We don’t have advanced ventilation systems or negative pressure rooms, so if a person infected with measles comes in, our entire building is compromised for two hours,” Mascia said.
Pennsylvania requires a throat swab, a blood sample and a urine sample to confirm a case of measles — arduous tasks both for sick patients, who often had to take a horse-drawn carriage and horseback ride to the clinic, and for clinic staff who must work within the constraints of their facility.
The rear entrance to the clinic building, which also houses a federally qualified health center, has become a makeshift triage center for people suspected of having measles. The rear parking lot is large enough for cars and strollers to stretch out, and clinic staff meet families at the door, where they can take the patient to a small storage barn to collect urine samples.
It was important to have a logistical plan to keep operations safe, Mascia said, but she makes it clear that the most important way to protect their patients is to increase vaccination rates.
The measles-mumps-rubella (MMR) vaccine is extremely effective. One dose is 93% effective against measles, and the recommended second dose increases this protection to 97% – and immunity lasts for life. Extensive research has also demonstrated the safety of the vaccine.
Childhood vaccination rates have fallen nationally, with a record share of parents opting to exempt their new kindergartners from required vaccines last school year.
Vaccination rates tend to be lower among Plains residents, but that’s not because of inherent opposition, experts say.
There are some shared values within the community, but there are also varied individual beliefs and opinions about vaccines, as there are in any large group of people, Mascia said. Consistency of clinic messages regarding vaccination has been key to increasing coverage rates.
If patients feel any form of coercion from doctors or if they feel pressured to make a decision about something like a vaccination, they will completely disengage from all healthcare – an outcome that would be particularly inconvenient for the vulnerable patients in their care.
“We share our strong recommendation that everyone be fully vaccinated,” Mascia said. “And if they’re not interested, we repeat our recommendation and say ‘we’re here to help you if and when you change your mind’.”
In the Amish community and the broader Plain community, a neighbor’s experience and a family member’s advice carry far more weight than the results of a study published in the most prestigious medical journal or the recommendations of the leading clinical society, said Dr. Helge Hartung, who joined the Central Pennsylvania Clinic last year.
The Central Pennsylvania Clinic has created a unique space to create this type of relationship, but it takes time.
Two hours are blocked off for new patient visits, and each subsequent visit is scheduled for one hour. The main exam room is very large, with space to accommodate the entire family (including an average of seven children) for conversations that touch every member. It’s time…
Gn Health
