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LEWISTOWN -- Mifflin County's measles outbreak has climbed to 43 confirmed cases as students return to classrooms, while a Geisinger infectious disease specialist warns Pennsylvania's outbreak could continue growing for months.
The county had 29 cases on Aug. 24, meaning 14 additional cases have been reported in about a week. Pennsylvania has now confirmed 497 measles cases in 34 counties, according to the state Department of Health.
The state's measles dashboard shows 100 new cases during the past seven days. Pennsylvania had reported 393 total cases as of Aug. 24.
Hospitalizations have also increased, rising from 70 to 87. The state has recorded two measles-associated deaths this year.
The increase comes as children across the region return to school, putting students back into classrooms, cafeterias, buses and other settings where an infectious disease can spread.
Dr. Stanley Martin, director of infectious diseases at Geisinger, said last week he doesn't believe Pennsylvania has reached the end of the outbreak.
"I don’t think we see an end to the cases just yet by any means," Martin said. "And I don’t think any of us would be surprised if they continue to spike upwards over the next couple of months."
Martin didn't say schools are causing the increase. But measles spreads easily among people who aren't immune, and bringing large numbers of children together creates more opportunities for exposure if an infected person enters a school.
The virus spreads when an infected person breathes, coughs or sneezes. It can remain infectious in the air and on surfaces for up to two hours after the infected person leaves an area, according to the Department of Health.
Symptoms can begin seven to 21 days after exposure. Early symptoms include fever, cough, runny nose and red, watery eyes. A rash follows, beginning on the head and spreading downward.
Martin said schools can prepare by making sure staff members know how to recognize possible symptoms and by helping parents understand the value and safety of vaccination.
Vaccination remains the main protection against the disease. The measles, mumps and rubella vaccine is given in two doses and provides about 97% protection against measles, according to the Department of Health.
"At least in the Commonwealth of Pennsylvania so far with our measles outbreak this year, none of the cases that we know of have occurred in anybody who’s been fully vaccinated," Martin said.
He stressed that risk isn't limited to any particular community.
"Anybody, though, who’s going to be unvaccinated is unfortunately going to be at risk and potentially wind up on our doorstep," Martin said.
That risk takes on added importance with schools reopening because some students may be too young to have completed the vaccine series, may have medical reasons they can't receive the vaccine, or may be unvaccinated for other reasons.
For an unvaccinated person who learns of an exposure, timing can matter.
"If you’ve been exposed to measles and you’re not immune, if you get vaccinated within 72 hours, that will generally protect you from going on to develop the measles," Martin said.
People who can't find their vaccination records can talk with their doctor about a blood test to determine whether they have immunity. Martin said people who have completed the two-dose MMR series don't need routine booster shots.
Geisinger has also been conducting vaccination clinics and education efforts in communities considered at risk.
"We’ve had vaccine clinics," Martin said. "We’ve been doing vaccine clinics out in the community to try to increase uptake of the vaccine for those who have not been fully vaccinated."
He said Geisinger continues to work with the Pennsylvania Department of Health as the outbreak develops.
"We are working with the DOH on a daily basis to try to help combat this as best we can," Martin said.
Mifflin County continues to carry the largest case count in the immediate region. Centre County has reported 15 cases, Perry County four, and Huntingdon County one. Juniata County has reported no confirmed cases.
State health officials urge anyone who believes they were exposed to measles and develops symptoms to contact a health care provider before arriving for treatment. That allows the provider to take precautions and reduce the chance of exposing other patients.
The Department of Health's hotline is 877-PA-HEALTH, or 877-724-3258.