Hospitals are fighting this virus.He saw very few doctors.

With nearly 1,000 cases in the Carolinas, health care workers who have never seen this vaccine-preventable disease are in for a surprise.

Hospitals battling this virus are facing a challenge that few doctors have seen

ASHEVILLE, N.C.- Around 2 a.m., 7-year-old twin brothers arrived at Missionary Hospital in Asheville.Both had fever, cough, rash, pink eyes and cold symptoms.

The men were in one waiting room and then another.Two hours and 20 minutes passed before the two were separated, according to Centers for Medicare & Medicaid Services records obtained by KFF Health News.Then another two hours passed.

When the sun came up, the emergency room doctor called the state epidemiologist and described the symptoms.The public health official told him to keep the children in the hospital and quarantine them.Shortly after that conversation, the patients received the diagnosis.

It was measles.

Hospital staff sent the father home with instructions on how to quarantine the family.

Federal investigators determined that the virus exposed at least 26 other people at the hospital that January.CMS health inspectors investigated measles infections and other treatment failures and concluded that the twins' symptoms should have triggered an isolation procedure that Mission Hospital staff had been trained to do seven months earlier.CMS placed the task at "urgent risk" for disclosure and other related issues, one of the sanctions.It is the most difficult the hospital can deal with and threatens federal funding if it does not solve the problem.

A spokeswoman for the mission said its staff is trained to handle airborne pathogens and follow federal guidelines.

As American hospitals face a growing risk of exposure to measles and pressure to detect it immediately, health care workers face an unusual barrier: Many don't know what it looks like.

"There's the word 'morbilliform,' which is like measles, and there are many viruses that cause a rash that looks like measles in children," said Theresa Flynn, MD, a pediatrician in Raleigh and president of the North Carolina Pediatric Society.According to her, in 30 years of working in the field of health care, she has never seen measles.

North Carolina has reported more than 20 cases since mid-December, and more than 3,000 people nationwide have been infected since early 2025.

Children living in areas with low vaccination rates are particularly vulnerable to outbreaks, prompting public health campaigns to promote measles vaccination. CMS Director Mehmet Oz urged the vaccine in a February 8 interview with CNN.

With two doses of the measles, mumps, and rubella vaccine, a person has a 3% chance of contracting the virus after exposure.According to the CDC, if exposed to an unvaccinated person, the chance of infection is 90%.It can take a week or two before a person infected with measles develops symptoms.

But over the past year, the Trump administration has raised doubts about the vaccine's effectiveness. Health and Human Services Secretary Robert F. Kennedy Jr. was a longtime anti-vaccine activist before taking office, and under his leadership, the Centers for Disease Control and Prevention has reduced the number of vaccinations recommended for children.

After a measles outbreak in West Texas last year, Kennedy publicly recommended unproven and unproven treatments for the virus, including steroids, antibiotics and cod liver oil.

Epidemiologists and doctors say federal policy forces health workers to rely on their own expertise or guidelines from state health systems to fight a disease that many people are about to see for the first time.

"As measles becomes more common, we all need to improve our ability to identify suspected measles and respond quickly," Flynn said.

Officially, the United States has maintained "measles-free status" since 2000, meaning the United States has avoided significant spread of the virus.After outbreaks in Texas, Arizona, Utah and now South Carolina, the country will lose that title later this year.Their own regulations link elimination status to the absence of sustained viral spread for 12 months.

A county in South Carolina, an hour's drive from Asheville, has more than 900 cases in the current outbreak — more than Texas will report in 2025.

Symptoms of measles, a virus that attacks the lungs and airways, can include fever, cough, blue rash and red, watery eyes.Researchers consider measles to be the most contagious disease, and the virus can remain active for up to two hours after an infected person leaves the room.

It is fatal, with 1 to 3 deaths per 1,000 cases in children.

In 2025, two children in Texas and one adult in New Mexico died from measles.

Along with surveillance data, the CDC provides a detailed report on measles detection on its website.Some local and regional health agencies have created posters to track outbreaks in places like hospitals, schools, grocery stores and airports.Large hospital systems developed staff training strategies last year and shared them with health facilities.

Look for the three Cs, the guide said: cough, coryza (cold symptoms) and conjunctivitis (pink eye).HCA Healthcare, which owns Mission Hospital, trained Mission staff on the three Cs early last year, according to CMS inspection reports.In addition to failing to immediately separate the twin patients, the mission staff did not have a designated area for patients with respiratory symptoms, investigators said.The government found them.

The CDC advises health care workers to immediately place patients with measles or suspicious symptoms in a special isolation room, where the air flow is controlled.

Mission spokeswoman Nancy Lindell said the hospital is equipped and staffed to deal with infectious diseases such as measles.

"Our hospital is working with state and federal health officials on preventive preparedness and we are following CDC guidelines," Lindell said.

(Dogwood Health Trust, a private foundation formed as part of HCA's purchase of Mission Health, helps fund KFF Health News coverage.)

Nurse Patsy Stinchfield, a former president of the National Foundation for Infectious Diseases, said most U.S. clinics and hospitals have never had measles.She called CMS’s “immediate danger mandate” penalties “excessive” because the virus is so difficult to detect.

"In the middle of winter right now, measles looks like any other viral respiratory infection that kids get," Stinchfield said.

Health workers and epidemiologists said the CDC has not communicated with clinics over the past year about their response to the outbreak.The disconnect began after Trump took office after a KFF Health News investigation found that West Texas health officials failed to talk to CDC scientists during measles outbreaks last February and March.

"We're certainly not feeling the support or the leadership from the CDC right now," said Brigette Fogleman, a pediatrician at Asheville Children's Medical Center, where staff have come up with their own methods for preventing the virus: screening patients over the phone and in their cars.

In response to questions about how the CDC is supporting health organizations during a measles resurgence, CDC spokesman Andrew Nixon said that "state and local health departments are leading the way in investigating measles cases and outbreaks" and that the CDC is providing support "as needed."He pointed to several guides and simulation tools the agency has developed as the virus spreads.

Jennifer Nuzzo, an epidemiologist and director of the Center for Epidemiology at Brown University, acknowledges that measles prevention is a major challenge and that coordination among public health authorities is critical to meeting this challenge.

Stinchfield attributed the spread of measles to a lack of communication from CDC leaders to clinics and the public — no ads on buses, no social media campaigns, no sense of urgency."When you're at the highest level of measles in 30 years, we should be seeing more from our federal government," Stinchfield said.

North Carolina braces for more measles cases

In North Carolina's Buncombe County, home to Asheville and Mission Hospital, health officials counted seven measles cases in mid-February and expected many more, according to state epidemiologist Zach Moore.It is unclear how much is related to Mission exposure.

"We are preparing for the future when we follow a trajectory like South Carolina," said Moore, "when we see cases piling up, and then suddenly there is a tipping point."

Fogleman, who is also a pediatrician, and Buncombe Health Department Director Jennifer Mullendore spoke during a recent Facebook Live broadcast in the district, urging families to get their children vaccinated, debunking misinformation about the vaccine and informing parents about local case numbers.

A few days ago, a local private school quarantined about 100 students after they were infected.According to government data, only 41% of the students there were vaccinated.

At the Fogleman hospital, parents are asked to wait in their cars with their children, and staff come out to triage them there.Some parents refuse to be vaccinated and have recently balked at the government's recommendation to vaccinate children under four, he said.

Kennedy hand-picked the committee members who made these recommendations, with several members having a history of spreading medical misinformation.

A parent recently told a nurse, "It's just measles. It doesn't kill anybody," Fogleman said.

That's not right, her team had to explain.

When the clinic keeps families in the parking lot trying to figure out whether symptoms point to a dangerous virus, it's hard to get the message across, Fogleman said, especially when the nation's largest disease agency isn't running a broad campaign to raise awareness about the risks of measles — or the vaccine's almost entirely preventable ability.

"We can't change the past," Fogleman said."All we can do is try to educate and move forward."

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