Pennsylvania health officials confirm two new measles-associated deaths, bringing total to four as state outbreak grows

Pennsylvania health officials on Tuesday confirmed two more deaths associated with measles, involving a resident of Jefferson County and a resident of Mifflin County.

The state has now reported four measles-related deaths amid a growing outbreak that has sickened nearly 700 people this year. The deaths mark the state’s first in three decades related to the highly contagious disease, and the most reported in the U.S. in a year since 1992.

Both residents tested positive for measles and were unvaccinated, state officials said.

An 18-year-old in Mifflin County died due to measles complications, the county coroner said in a news release Tuesday. The cause of death was acute disseminated encephalomyelitis, “a rare and severe neurological complication of measles.”

The condition occurs after a measles infection triggers a harmful autoimmune response, said Paul Offit, a physician and vaccine expert who heads Children’s Hospital of Philadelphia’s Vaccine Education Center.

“It’s rare. It occurs in maybe one in 1,000 cases. But it’s real, and it can be fatal,” he said.

The death of a 40-year-old woman was reported over the weekend by Jefferson County’s coroner. She also had severe respiratory conditions and died of respiratory failure after showing signs of measles.

She had been exposed to a person with a lab-confirmed case of measles, and the coroner on Monday evening confirmed in a news release that postmortem testing showed the woman had an active measles infection when she died.

Health Secretary Debra Bogen, offering condolences to the victims’ families, noted the state’s efforts to “stem this outbreak and prevent more deaths” include ensuring people have access to and accurate information about the measles, mumps, and rubella (MMR) vaccine.

Measles deaths are rare, with typical symptoms including a high fever, a cough, runny nose, red, watery eyes, and a rash.

Yet the disease can cause severe complications, including pneumonia and brain swelling, especially in young children. About one to three children for every 1,000 infected will die from complications, according to the Centers for Disease Control and Prevention.

With 693 cases in 38 counties confirmed so far in Pennsylvania this year, experts fear the mounting death toll indicates that significant numbers of cases are going unreported.

“I think we are severely underestimating this epidemic,” Offit said.

Mifflin County, where the 18-year-old patient died, had reported 79 measles cases as of Monday — the second-highest total in the state, behind Lancaster County, where 296 people have been sickened and two deaths were previously reported.

State officials also warned Monday that a person with measles may have exposed others in a Mifflin County Aldi supermarket earlier this month.

Jefferson County, where the 40-year-old woman died, has seen 28 cases of measles so far this year.

Pennsylvania defines a “measles-associated death” as one that occurs within 30 days of symptom onset in a person with clinical evidence of infection and a positive laboratory test, and who did not die of another unrelated cause, like a car crash.

Since last month, state and federal officials have sparred over whether two other deaths reported in Pennsylvania were tied to the state’s measles outbreak.

U.S. Department of Health and Human Services press secretary Emily G. Hilliard said that state officials had notified the CDC of the two additional deaths reported Tuesday.

“CDC remains in contact with state health officials as they continue to assess these deaths,” she said in a statement.

With the news of the additional deaths, Democratic Gov. Josh Shapiro on Tuesday continued his criticism of President Donald Trump’s HHS secretary, Robert F. Kennedy Jr., accusing him of spreading misinformation about vaccine safety through his longtime anti-vaccine activism.

“This serious situation continues to be made worse by RFK Jr. playing games with public health and safety,” Shapiro said in a X post Tuesday.

In its latest update Friday, the CDC still had not listed the first two deaths on its website highlighting data on ongoing measles outbreaks around the country.

Shapiro also noted a news report that Kennedy directed the CDC’s decision not to include the deaths. “It is also deeply concerning to learn that the Secretary personally intervened in an otherwise administrative process to direct the CDC to not report these Pennsylvania deaths, presumably because it doesn’t fit his phony narrative,” he wrote.

HHS representatives have called the report “false and misleading.”

Kennedy has accused the Shapiro administration of “fabricating” the first two deaths, although he later said one had been caused by measles.

Federal health officials also note that unlike several other states with measles outbreaks, Pennsylvania has not required an “Epi-Aid” team from the agency, “which would deploy epidemiologists to provide on-the-ground measles outbreak support.”

In a post on X, Kennedy said that Shapiro had “chosen to politicize this outbreak instead of implementing a unified public heath response.”

“He continues to point the finger at me and the federal government and to malign the Amish while refusing the federal assistance that might help end the outbreak,” he wrote. (The two Lancaster County deaths occurred in Amish children.)

State health officials have said they meet regularly with the CDC and will continue to evaluate if they need additional support from the agency.

Kennedy also said he had not directed the CDC to “suppress Pennsylvania deaths.”

“CDC is applying a consistent national standard rather than allowing politicians to decide which deaths appear in federal mortality statistics. CDC will report measles-caused deaths when the National Center for Health Statistics reports measles as the underlying cause based on death record information submitted by the states,” he wrote.

He added that MMR vaccination is “the most effective way to prevent measles infection.”

Pennsylvania officials have declined to publicly release additional information on the deaths, citing state privacy laws.

Details on the circumstances involved with the deaths have come from local coroner’s offices, which at times has heightened the scrutiny on the state’s reporting.

Lancaster County’s coroner said he had investigated one death caused by measles, in an infant with a deadly genetic disorder that made her vulnerable to respiratory infections.

He investigated another death in an infant who contracted measles before birth and died shortly after. The coroner, a physician and an elected Republican, has said that infant’s death was caused by a lacerated spleen, not measles. Yet prominent physicians have noted measles can weaken a person’s spleen, putting it at risk of rupture. State officials have maintained that the death was associated with measles.

Both children were too young to be vaccinated against the virus that is transmitted through the air, when an infected person coughs or sneezes, and can linger in the air for up to two hours.

Jefferson County’s coroner, also an elected Republican, said from his first news release Sunday that complications associated with measles were behind the death of the 40-year-old woman in his county. He said her death was due to “suspected measles” and other underlying conditions, because she had symptoms of the disease, including a rash and fever, and had been exposed before her death.

He shared on Monday that he was updating the woman’s death certificate to read “probable measles” after receiving paperwork confirming the woman had been in contact with an infected person with a positive lab test for measles. Later that night, he confirmed in a news release that the woman’s postmortem measles test was positive.

He told the Guardian that she would not have died were it not for the measles. He did not immediately return a call for comment Tuesday.

Two doses of the MMR vaccine are 97% effective at preventing the disease, the CDC says.

The more people who are vaccinated, the less likely it is for measles to spread. Scientists say that about 95% of a community should be vaccinated to prevent spread.

But vaccination rates in Pennsylvania have dropped in recent years, including in areas now seeing measles-related deaths.

In Mifflin County, for example, MMR vaccination rates for kindergartners dropped from 92.3% during the 2024 school year to 89% in the 2025 school year.

Lancaster County’s kindergarten MMR rates were already low and dropped by about 1 percentage point to 87.5% in 2025.

About 93% of Jefferson County kindergartners were vaccinated in 2025, a slight decrease from the year before.

Staff writer Stephen Sterling contributed to this article.