BELLEVILLE, Pa. — In the parking lot of the Central Pennsylvania Clinic, horse-drawn buggies are hitched to posts. On the front door, a taped-up sign tells anyone with measles symptoms to return to their car and call the office. Many people here don’t have a car or a cellphone. For them, the sign has a different request: put on a mask, ring the bell and step back from the door.

The clinic serves many Amish families in and around Belleville. The area, along with Lancaster County, is at the heart of a measles outbreak spreading through largely unvaccinated Amish communities that are especially vulnerable to one of the most contagious viruses.

Doctors here are scrambling to stop the spread, and they are worried the outbreak will strain hospitals as flu season approaches. All of it is playing out against a political fight in Washington, where the Trump administration has cast doubt on the measles vaccine and the Centers for Disease Control and Prevention has yet to fully recognize the deaths Pennsylvania has linked to the virus.

“I fear that it is very widespread in our area, and I’m seeing so much suffering from our community,” Dr. Katherine Mascia, a pediatric geneticist at the clinic, told MS NOW. “Many of our patients, by the time they present to us, they’re already so sick that they require hospitalization or even ICU stays.”

For doctors on the frontlines of the measles outbreak, watching the once-eradicated illness surge back has been devastating.

Dr. Stanley Martin, an infectious-disease specialist at Geisinger Medical Center in Danville, said that he has seen “well over 90 cases” of measles this year. Complications can include pneumonia, secondary bacterial infections and encephalitis, a swelling of the brain that can cause permanent neurological damage.

Over the past month, the Pennsylvania Department of Health has reported four measles-associated deaths. The CDC initially declined to count them. On Wednesday, the CDC updated its measles outbreak page to show one measles-related death nationwide. The page did not say where the death occurred or whether it was one of Pennsylvania’s. A note beside the figure said it is “subject to change,” and that the agency would “update its reporting as additional information becomes available and relevant reviews are completed.”

The CDC did not respond to a request for comment for this article.

As of Wednesday, the CDC had reported 3,471 confirmed measles cases in the United States this year. More than 300 of those patients were hospitalized.

The CDC’s earlier refusal to count Pennsylvania’s deaths sparked a public feud between Health and Human Services Secretary Robert F. Kennedy Jr. and Pennsylvania Gov. Josh Shapiro.

“Just a few years ago, Secretary Kennedy was in Lancaster downplaying the severity of measles and saying that the cure was ‘chicken soup and vitamin A,’” Shapiro wrote on X. “Secretary Kennedy has stoked confusion amongst parents and others — and the result has been less protection from measles and more cases.”

Kennedy has maintained that the Trump administration’s response is working.

“Mexico has 11 times the amount of measles cases as we do,” he said during an August news conference. “I’ve sent the CDC in to cooperate with the state health agencies, and we’ve brought it to an end overnight.”

Earlier this summer, President Donald Trump signed an order limiting the vaccines recommended for children and splitting the combined measles, mumps and rubella vaccine into separate doses. In August, Trump was asked what evidence he had that the MMR vaccine is “lethal.” The president said he had heard it and that “some people” say so. The vaccines are safe when given individually, he said, but “when you put them together, they can be explosive.”

Medical experts say there is no need to split the MMR shot, nor any evidence that the combined shot is dangerous or that splitting it offers any benefit. Vaccines remain the most effective way to protect against the measles.

Asked whether they felt supported by the federal government, both doctors said they have relied on their colleagues and on Pennsylvania’s Department of Health.

Both doctors say they are worried the outbreak is stretching hospitals so thin that treating other patients this fall could get harder. Measles patients must be kept in negative-pressure rooms, which prevent airborne viruses from escaping, and those rooms are scarce.

“Our hospitals have limited rooms, limited negative pressure rooms, and when those rooms are being used by these very very sick measles patients, then that impairs our ability to care for other illnesses,” Mascia said.

For Martin, watching the return of a disease the U.S. declared eliminated in 2000 has been hard to absorb.

“It’s a real bitter pill,” he said. For families, “it changes everything for them overnight. But for the healthcare personnel, it’s also very difficult to wrap your head around. These are people that should have been living full, normal lives.”

MS NOW senior medical analyst Dr. Vin Gupta contributed to this report.

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From MS Now.