“First and foremost, we want to keep them out of the ER if we can,” said Moody. “We even have suggestions for how doctors’ offices should handle this to try and reduce the risk in their own population.”

Urgent isolation with highly contagious viruses with measles is essential to reduce spread.

“I can’t really think of another virus more contagious than measles,” warned Moody. “If you have a room of 30 kids and there are five of them that are susceptible, if a case comes in and they’re in there for any substantial length of time, those kids are going to get it. It’s not 100%, but it’s really high.”

Dr. David Wohl, an Infectious Disease Specialist with UNC Health, shared the state’s high number of communities with low vaccination rates is cause for concern.

“The biggest threat is that we still have people who are not vaccinated,” said Wohl. “If we were all vaccinated or at least 95% of us, this wouldn’t be an issue. It’s people who are unvaccinated, largely children, who really are susceptible and then can spread it to others who are not vaccinated.”

Two doses of the MMR vaccine are 97% effective against measles infection, according to the CDC.

The NCDHHS Kindergarten Immunization Data Dashboard reports 92.3% vaccination compliance statewide. The MMR (measles, mumps, and rubella) vaccine is required for public and private schools.

Wake County’s vaccination compliance was 92.5%, Durham County reported 91.5% compliance and Orange County reported 96.9% compliance.

A 95% vaccination rate is considered the threshold for herd immunity – the level of vaccination or immunity needed to prevent the spread of infectious diseases within a community.

“This is different than COVID where we are all susceptible in the beginning,” explained Wohl. “This is something where most of us are immune, but some of us are not. Increasingly over time, we’ve seen people more immune to measles because they’re not getting vaccinated.”

Navigating vaccine hesitancy starts with direct communication between medical personnel and families, doctors say.

Moody shared his own approach to speaking to his pediatric patients and their parents has shifted.

“I think what has changed for me personally is that I need to make sure I am approaching all of this with a sense of sensitivity and recognize parents really do want to do the right thing,” reflected Moody. “There is no parent coming in saying, ‘I want to do wrong by my child,’ so how can I give them the information they need to really make an informed decision – and, if they choose not to, that they really understand the risks.”

Wohl added ‘consistent and clear messaging’ are crucial for North Carolina physicians as cases climb in other states.

“We do see as the threat level increases, people are more likely to pick up on some of that messaging,” said Wohl. “I think the best we can do is be very clear, very sincere, and transparent. We know there are a lot of different messages out there, some of which are not correct. We have a very long history with measles and with the vaccine.”

He continued, “We also know a lot about what measles does to people, and it’s not good. We really do encourage people to think hard about this given some of the devastating outcomes we’ve seen in Texas.”

Doctors warn that increasing awareness of signs and symptoms among staff and the public is vital as cases climb nationwide.

“It is really difficult to diagnose something if you don’t think about it,” said Moody. “It’s reminding people: What does measles look like, what are the symptoms, and what are the things to look for.”

Wohl further added UNC Health Systems have hosted a series of webinars with internal staff to increase awareness about measles symptoms.

Discussions and training within UNC’s health system involved personnel at all levels of the health system including frontline clinicians, nurses, emergency room staff, ambulatory staff and hospital administrators.

Wohl shared that the goal is to host public webinars soon to further engage with and inform the public.

“It’s really a balance of if you do it too soon, or too late, and finding that sweet spot,” said Wohl. “Right now, we haven’t had cases in North Carolina recently so we can kind of prepare but really be at the ready.”

Nolan added WakeMed is continuing to share health alert network memos and is actively reviewing policies with staff.

“We work closely with Environmental Health and Safety and Infectious Diseases,” Nolan added. “We communicate with the local health department as needed as well.”

In addition to having lower vaccination rates, Moody cautioned that North Carolinians – particularly those in the Triangle – may face a heightened risk of measles due to a larger number of patients receiving treatments that weaken the immune system.

“People may be getting treatment for things that would reduce their ability to fight it off. We’ve got people who are getting treatment for cancer or autoimmunity, and they are at risk as well,” he explained. “Having it jump into this area, puts us at risk not just for people who have chosen not to be immunized for whatever reason, but also people who were immunized and still are susceptible because of that. It’s a double-edged risk.”

All three hospital systems say lessons learned from COVID-19 place them in a better position to respond to another threat, like measles.

Wohl shared the focus is on staying ahead of the next outbreak.

“I think all the time about what we could have done had we known what was going to happen with COVID-19, back in early 2020. We don’t want to be in that situation again,” the UNC physician said. “Everything we’re doing is: how can we do better, given the knowledge we have now that we wish we had for COVID-19 – but we do for measles, or bird flu, or any other threat coming along?”

WRAL asked if UNC, Duke and WakeMed hospitals have considered setting up dedicated measles wards. While none currently anticipate the need for separate units, they say protocols are in place to create them if case counts warrant it.