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On a small Lancaster County farm last month, five of the eight King siblings sprawled on the living room floor, sucking on ice pops and listening to calming music, trying not to scratch their itchy skin.

The next county over, in Hershey, children were lying in hospital beds as their immune systems battled an infection damaging their organs.

They all had measles.

One of the most contagious diseases has made a resurgence in Pennsylvania and across the country as growing numbers of people are refusing the highly effective vaccine that prevents its spread.

Pennsylvania is now seeing its worst measles outbreak in 30 years, centered around rural counties just west of the Philadelphia metro area. Lancaster County has emerged as a particular hot spot, with 51 of the 89 total measles cases reported this year in the state.

Anti-vaccination sentiment is prevalent in Lancaster County, where vaccination rates among kindergarteners are some of the lowest in the state. Known for its agricultural bounty and the Amish and Mennonite communities that dot its rural landscapes, Lancaster is also home to the state’s eighth-largest city with an economy heavily supported by tourism and entertainment.

In Lancaster, doctors say many are flocking to local clinics and pop-up vaccination events as cases rise. But others, like the King family, remain resolute in their decision not to vaccinate, instead preparing to ride out what they hope will be an inconvenient summer interruption that builds character and family bonding.

The family isolated in their home for weeks in June while all eight unvaccinated children, who range in age from a 1 to 15, recovered from measles. Their 14-year-old son experienced the most severe symptoms, and went to the emergency department when coughing and nausea rendered him unable to keep down water or medicine.

“Measles isn’t fun, seeing your kids sick isn’t fun,” said Gina King, 41, who lives outside New Holland. But, she added, “I know this is going to be added to the King family core memories.”

The 89 cases Pennsylvania has recorded so far this year exceed by more than five times the cases recorded in 2025. Doctors say the official tally may be an undercount, with many cases going unreported.

The virus reached the Philadelphia region earlier this week, when Chester County reported two cases.

An Inquirer analysis found both the metropolis and state increasingly have become vulnerable to a major outbreak. In the 2024-2025 school year, kindergarten vaccination rates in 50 of Pennsylvania’s 67 counties were below the 95% vaccination rate scientists consider necessary to keep the virus from spreading. And even in counties with vaccination rates near so-called “herd immunity,” school-level vaccine data show that susceptible communities pockmark the region.

The majority of measles cases resolve in weeks with mild-to-moderate flulike symptoms, but the disease can take life-altering and even deadly turns, especially for young children.

Doctors and nurses who spoke to The Inquirer could not comment on the King family’s experience because they did not treat them.

But they cautioned that they have seen the harm measles can do to a child’s body: neurological damage, respiratory infections, and pneumonia, which can lead to death.

“Each one of those cases where a child suffers something really devastating — it only takes seeing one for it to really be something that hits home very hard,” said Evan Shirey, a pediatric infectious disease physician who has treated several children with measles at Penn State Health Golisano Children’s Hospital this year.

On the front lines of measles

As a medical student, Shirey never expected he would treat a measles case himself. By 2000, vaccination rates across the United States were so high that the disease was declared eliminated.

“I read the textbooks like they were history books,” Shirey said.

But as vaccination rates decreased, he and other providers began preparing in the last couple of years. He feared inevitably seeing cases like the several adults and children treated at Penn State hospitals this year.

He declined to share details on the cases, saying hospitalization numbers are low enough that doing so would risk compromising patients’ privacy.

Shirey said he’s also fielding “constant” phone calls from pediatricians all over the state as they prepare for — or deal with — emerging measles cases.

Intensive protection measures implemented at Penn State hospitals in Dauphin County, for example, include testing patients with respiratory symptoms, or who were potentially exposed to measles, and isolating them while they wait for test results.

The virus is so contagious, it can infect nine in 10 people who haven’t been vaccinated.

“Airborne diseases are a whole other world,” said Nancy Himmelberger, a critical care registered nurse at Golisano Children’s Hospital and the vice president of its nurses’ union, which is affiliated with SEIU.

Shirey tries to explain to parents why vaccination is the best defense against measles. “I do encounter a lot of parents who truly want the best for their child, and they’re afraid because of what they see on TV or social media.”

The Centers for Disease Control and Prevention recommends children receive two doses of the measles, mumps, rubella (MMR) vaccine at 1 year of age and before starting kindergarten, typically around age 5.

The vaccine is among those required for students to attend school, though Pennsylvania’s lax rules allow families to opt out for medical, religious, or philosophical reasons.

In response to rising cases, Pennsylvania earlier this year updated its guidelines to recommend babies be given their first dose as early as 6 months.

Once someone is infected with measles, Shirey stresses, no treatments are available that specifically target the virus.

Vitamin A may be given to children who have been hospitalized with severe measles symptoms, but it is not a cure and cannot prevent the disease. Excessive amounts of vitamin A can be dangerous.

“For measles, it is supportive care and trying to manage the complications that occur,” Shirey said.

Trying to change vaccine perspectives

When King and her husband, Shawn, began their family 15 years ago, they thought carefully about each vaccine recommended for their babies. They read package labels and looked up ingredients. For each shot, they considered whether they were more comfortable with the risk of side effects from the vaccine, or the risk of illness from skipping it.

When their pediatrician recommended a hepatitis shot before traveling to India, the Kings decided the risk of the disease was greater than any potential side effects.

But when it came to the measles, mumps, rubella (MMR) vaccine, they were uncomfortable that the rubella portion of the vaccine was developed using cells of an aborted fetus.

The approach used in some vaccines grows viruses in fetal cells. Scientists then extract proteins from the viruses to develop vaccines, according to the Children’s Hospital of Philadelphia’s Vaccine Education Center.

Vaccines themselves do not contain fetal material. And most major religions promote vaccination, even if they oppose abortion, reasoning that parents have a moral duty to protect their children and the health of the public.

Measles at home

The Kings weren’t aware their children had been exposed to measles, but knew cases were spreading locally. When their two oldest sons, aged 14 and 15, began showing symptoms, they locked down their home.

They appreciated how people can be contagious before and after they experience symptoms. They have relatives with cancer and Down syndrome, conditions that could put them at risk of severe illness if they contracted measles.

“If you made the choice to not vaccinate, you knew there was a risk of getting sick,” King wrote in a tip sheet she created to share with other families. “We should care about others enough to be willing to make some sacrifices to protect vulnerable people.”

Grandparents offered to help care for the children, but the Kings declined for fear of getting anyone else sick.

Instead, friends and family left treats for the kids on the front porch, picked up grocery orders, and checked in through video chat.

Days four, five, and six, were the thorniest, King said. She draped chilled washcloths over the foreheads of her usually independent teens, brought them tea, and read books to them.

She spent at least one night sitting beside the bed of her 14-year-old son, whose coughing and nausea were so bad he couldn’t eat or drink, and she worried he’d become dehydrated.

“I just wanted to be there and keep an eye on him,” she said.

A few days after the boys started feeling well enough to go outside, the five girls, who range in age from 4 to 12, were sick. The baby experienced the most mild symptoms among the siblings.

King, who is vaccinated, also got sick, though her husband, who is not vaccinated, has yet to develop symptoms. Vaccinated people, in rare instances, can contract measles, and infection is more likely in an outbreak.

After being inside all day, it became part of the family’s routine to tuck the kids into the back of their family ATV with blankets and more ice pops, and ride around their property to say goodnight to the sheep, cows, horses, and fruit trees.

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Community support

Elsewhere in Lancaster, church communities and friend groups are encouraging people who are sick to stay home, as well as those who are unvaccinated with a higher risk of severe illness.

Claudia Beiler, a Lancaster mother of five and a Christian wellness influencer, said she has dropped off vitamins, coffee, and dinner for friends and others in her community who were quarantining at home.

Beiler has posted frequently to her more than 110,000 Instagram followers about her decision not to vaccinate her children. She has also offered tips about how to weather measles cases at home.

Like the Kings, she says families who don’t vaccinate must avoid spreading the virus to vulnerable people.

“There’s a seriousness I’m proud of,” she said. “It feels like a lot of care and kindness.”

At Penn Medicine Lancaster General Hospital, physician Jeffrey Martin is heartened when he hears that residents have decided to isolate themselves when diagnosed with the virus. He sees it as a measure of the community spirit inherent to Lancaster County.

But isolating once symptoms emerge isn’t enough to protect the community, since the virus can spread days before the first sneeze or cough. The disease’s signature rash typically does not appear for several days.

“‘I can accept the risk’ doesn’t play well with infectious disease,” he said. “Creating space for people to think about that on another level is really important.”

Amid the latest outbreak, Martin said, clinics run by the state health department and Penn Medicine have seen high attendance, with unvaccinated patients choosing to get the shot.

Martin and his colleagues don’t ask many questions about why: “We’re just thankful that people are showing up,” he said.