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LEWISTOWN - The room can be empty and still not be safe.
A person with measles can cough, walk out and leave microscopic viral particles floating in the air for up to two hours. Someone can enter an hour later, never see the infected person, and still contract the virus.
At Geisinger-Lewistown Hospital, doctors are now confronting this threat.
Dr. Stanley Martin, director of infectious diseases for Geisinger, said the hospital is treating "a handful" of suspected measles cases.
The Pennsylvania Department of Health must confirm the cases through testing, a process that can take several days. Martin said doctors remained confident the patients had measles.
Martin said the patients were unvaccinated. He didn't identify them or associate the cases with a specific community.
The suspected cases come amid a statewide outbreak that has spread beyond its earlier concentration in Lancaster and Lebanon counties.
Pennsylvania had reported 142 measles cases by July 27, including 31 during the previous seven days, according to the state Department of Health.
State health officials also reported a confirmed case in nearby Snyder County. A resident who tested positive may have exposed people at the Lowe's store in Selinsgrove on July 14.
The Centers for Disease Control and Prevention had reported 2,371 confirmed cases nationwide as of July 30. That surpassed the 2,289 cases reported during all of 2025.
The numbers alone don't capture how easily measles spreads.
Measles travels through respiratory particles released when an infected person breathes, talks, coughs, or sneezes. The particles are too small to see and can linger after the person leaves.
Martin described measles as "one of, if not the most contagious viruses that we know of."
In a population with little or no immunity, one infected person may spread the virus to as many as 18 others within several days, Martin said.
A shared room can be enough.
After exposure, a person may have no symptoms for one to two weeks. The first signs are usually fever and respiratory problems. A cough may begin. The nose may run. Both eyes can become red and inflamed.
The rash usually follows, beginning on the head or neck before spreading to other parts of the body.
That delay gives the virus time to spread. A person can go through an ordinary week without knowing an infection has begun. By the time the rash arrives, the virus may have already reached others.
People who know they've been exposed and aren't immune should contact a health care provider immediately. The measles, mumps, and rubella vaccine, if given within 72 hours of exposure, may provide protection or make the illness milder.
People at greater risk of severe illness may receive immune globulin within six days of exposure.
For everyone else, vaccination remains the strongest protection against measles. Two doses of the MMR vaccine are about 97% effective at preventing the illness.
For years, vaccination worked so well that many Americans knew measles only through medical textbooks and warnings from another era.
The United States declared measles eliminated in 2000, meaning the virus was no longer spreading continuously within the country.
Martin graduated from medical school that same year. He remembers professors teaching measles while telling students they probably would never encounter a case during their careers.
"And here we are in 2026, trying to help people with this entirely preventable problem," he said.
Gaps in vaccination gave measles room to return.
Public health officials seek MMR vaccination rates of at least 95% within a community to prevent widespread transmission. Local rates can vary, leaving pockets of unvaccinated people vulnerable even in states with high overall coverage.
Nearly 93% of Pennsylvania kindergarten students had received both required MMR doses during the 2024-25 school year, according to the Department of Health. That remained below the level public health officials seek for strong community protection.
"When you're talking about a virus that's this contagious, actually that makes all the difference," Martin said.
Measles may begin with fever, coughing, and a rash, but its complications can become far more serious.
The illness can cause pneumonia and make breathing difficult. In some patients, it can cause encephalitis, an inflammation of the brain that may produce confusion, severe headaches, lethargy, or personality changes.
Martin said anyone who has trouble breathing, develops confusion or severe headaches, or becomes too sick to care for themselves should seek medical attention.
Anyone who believes they may have measles should call before visiting a medical office or hospital emergency department.
The advance call gives medical workers time to keep a potentially contagious patient away from others. It also helps health officials identify people who may have been exposed and arrange testing. Some of those people may qualify for vaccination or immune globulin.
Martin said decades of successful prevention allowed people to forget how dangerous measles can be.
"We're the victims of our own success," he said.
People stopped seeing the disease because vaccination had prevented it for decades. That success made some people less involved in prevention and less aware of the damage measles can cause.
Vaccination can restore that protection, but Martin's warning was direct.
Measles can cause permanent neurological damage in children. It can kill. There is no specific treatment that removes the virus once a person is sick. Doctors manage symptoms and complications while the infection runs its course.
A person can leave a room while the virus remains behind. The strongest defense against it has been available for decades.
"This problem that we're having is one which is entirely preventable," Martin said.