Pennsylvania’s Fourth Measles Death Meets a Federal Zero

Pennsylvania’s health department confirmed two more measles-associated deaths on Sept. 15, raising the state’s 2026 total to four. All four people were unvaccinated. They died in just over a month, the first measles-associated deaths recorded in Pennsylvania in 35 years.

The Centers for Disease Control and Prevention’s national measles page still lists none.

Four Deaths Land in One Month

The Pennsylvania Department of Health said it had confirmed two additional measles-associated deaths, one in Jefferson County and one in Mifflin County, after working with both county coroners. Both people were unvaccinated, the department said, and it will not release details that could identify them. Local coroners, it noted, operate under different disclosure rules.

Secretary of Health Dr. Debra Bogen tied the new deaths to an outbreak she called the state’s worst in more than three decades.

My thoughts are with the two families who lost loved ones to this highly-contagious virus, as Pennsylvania faces the worst measles outbreak in more than three decades.

Dr. Debra Bogen, Pennsylvania secretary of health, Sept. 15 statement

State epidemiologists said they required clinical evidence of measles, a positive laboratory test, and a finding that the death was not due to an unrelated cause. They also weighed whether the person had been exposed and what the medical records showed. The department used the same bar on Aug. 25, when it reported two measles-associated deaths in Lancaster County.

Measles still kills one to three deaths per 1,000 cases, a range the health department repeated as it added the new fatalities. The virus can hang in the air and on surfaces for up to two hours after an infected person leaves. Symptoms can start 7 to 21 days after exposure.

The CDC Count Is Still Zero

The CDC measles page, updated Sept. 11 with figures as of Sept. 10, reports 3,294 confirmed U.S. cases this year and says the National Center for Health Statistics has no 2026 death records listing measles as the underlying cause. The agency also says it is working with the Council of State and Territorial Epidemiologists on a standard definition for measles deaths.

That is a different test from the one Harrisburg is using. Pennsylvania counts a measles-associated death when lab-confirmed measles is present, the clinical picture fits, and investigators conclude the death was not from some unrelated cause. NCHS counts what death certificates list as the underlying cause, a slower vital-statistics stream that is built for long-run mortality trends.

HOW PENNSYLVANIA CALLS A MEASLES DEATH

• Lab proof: A positive laboratory test for measles is required before the state will call the death measles-associated.
• Clinical picture: Investigators must find clinical evidence of a measles infection, not only a test result on a chart.
• Other causes: The death cannot be written off as unrelated to the infection.
• Records and exposure: Medical records and whether the person was exposed before dying are part of the review.

On Sept. 10, the department said it sent that definition to the CDC and to CSTE, the body that writes uniform disease-death definitions for U.S. jurisdictions. Former CDC chief medical officer Dr. Debra Houry has said NCHS is not built to confirm a single case in the middle of an outbreak, because its job is long-term mortality trends.

WHAT WE KNOW

• State total: Pennsylvania has confirmed four measles-associated deaths in 2026, all in unvaccinated people.
• Federal total: The CDC page still shows no U.S. measles deaths this year, citing NCHS records.
• The handoff: Pennsylvania gave CDC and CSTE its death definition on Sept. 10, five days before it confirmed the Jefferson and Mifflin cases.

WHAT IS UNCONFIRMED

• The federal add: CDC has not said whether any of the four deaths will enter the national death total.
• The new rule: CSTE has not published the standardized measles-death definition the CDC says it is writing.
• The newborn: Lancaster County Coroner Stephen Diamantoni has said measles did not cause the newborn’s death, even as the state still counts it.

The first two Pennsylvania measles deaths still sit outside that federal count, a gap that opened when CDC Director Dr. Erica Schwartz held the Lancaster fatalities out of the weekly update. HHS Secretary Robert F. Kennedy Jr. has said CDC will record measles-caused deaths when NCHS has the underlying-cause records states submit, and he has denied telling the agency to hide them.

Who the Four People Were

County coroners have been more specific than the state. The four deaths now stretch from Lancaster County in the southeast to Jefferson County in the west and Mifflin County in the center, so they are no longer a single-cluster event.

THE FOUR DEATHS THE STATE COUNTED

The two infants were too young for the first routine MMR dose, which is given at 12 months. Diamantoni has said measles caused the 6-week-old’s death. He has also said the newborn’s immediate cause was a lacerated spleen, even though measles virus was found in lung tissue. State officials still list both as measles-associated, noting that measles can enlarge the spleen and make it more likely to rupture.

Jefferson County Coroner Greg Furlong said the 40-year-old woman tested positive for measles after exposure to a close contact who had also tested positive. He said she had COPD, asthma, anemia, and hypertension, that she went into acute chronic hypoxic respiratory failure, and that measles symptoms started six days before she died. Furlong called it the first measles-related death in the county and “a heartbreaking loss for the family and an unfortunate reminder that measles can be a serious and potentially life-threatening disease.”

Mifflin County Coroner Andrea Alcalde said an 18-year-old died of acute disseminated encephalomyelitis, a rare inflammation of the brain and spinal cord that can follow measles. That diagnosis is a documented measles complication, not a background lung disease and not a birth injury. It is also the death the comorbidity argument does not cover, and it is still absent from the federal board.

693 Cases Across 38 Counties

The department’s Sept. 14 update put Pennsylvania at 693 measles cases in 38 counties, the highest state total in the country this year. Seventeen of those cases had been added since Sept. 11. Governor Josh Shapiro later described the map as 38 of the state’s 67 counties.

HOW THE OUTBREAK LOOKS ON PAPER

• Hospital care: 133 people with measles have been hospitalized in Pennsylvania.
• Breakthrough infections: 4 people who were vaccinated for their age have gotten measles, less than 1% of cases, and none of those four were hospitalized.
• New cases: 17 confirmed infections were added between Sept. 11 and Sept. 14.
• School coverage: 93.2% of Pennsylvania kindergarteners had two MMR doses in 2025-26, down from 93.7% the year before; Lancaster County’s kindergarten rate was 87.6%.

Dr. Amesh Adalja, a Pittsburgh infectious-disease physician and senior scholar at the Johns Hopkins University Center for Health Security, said many infected people are not getting tested, so the true number of infections is likely higher than the official tally. Two doses of MMR are listed by the state as providing 97% lifetime protection. The remaining gap is not a rounding error in a county where kindergarten coverage has already fallen well below the 95% level used to keep measles from spreading in a community.

The United States recorded three measles deaths in 2025, two in Texas and one in New Mexico. Public health tallies treat 1992 as the last year the country logged four measles deaths in a single year. Measles was declared eliminated in the United States in 2000.

Harrisburg and Washington Count the Dead Differently

Shapiro said four families are grieving, called the outbreak the worst in the country, and accused Kennedy of stoking vaccine skepticism and of stepping into “an otherwise administrative process” so CDC would not report the Pennsylvania deaths.

Today, the Pennsylvania Department of Health confirmed two more measles-associated deaths after local coroners reported these individuals died from complications associated with measles. That's four total measles-associated deaths in our Commonwealth and the first Pennsylvania…

— Governor Josh Shapiro (@GovernorShapiro) September 15, 2026

Kennedy said Shapiro is politicizing the outbreak instead of running a unified response, pointing at the federal government and maligning the Amish while refusing help. He said he offered a CDC Epi-Aid, which would put agency epidemiologists on the ground, and that Texas, South Carolina, Virginia, Kansas, New Mexico, and Wisconsin used that help. He also said Shapiro’s claim that he directed CDC to suppress the deaths is false, and that the agency is applying a national standard rather than letting politicians pick which deaths appear in federal mortality statistics.

Shapiro has already declined that federal team. The fight around his post quickly shifted from the 18-year-old’s brain inflammation to Lancaster’s Amish community and to the Jefferson County woman’s oxygen-dependent lungs. Calley Means, who backs Kennedy’s health agenda, told the governor to stop spreading misinformation and denigrating the Amish. That is the third rail the counting dispute now runs through: if the dead can be described as already sick, already fragile, or already from a community the state is accused of smearing, the federal zero gets easier to defend.

The 18-year-old’s ADEM file does not give that argument much room. The political file still does, which is why a state can confirm four measles-associated deaths and a national dashboard can still read zero.

Pop-Up Clinics Put 4,300 Extra Shots in Arms

The outbreak began in late April in the Lancaster-Lebanon region. State staff have given nearly 4,300 MMR doses at 130 pop-up clinics in affected communities, and more than 6,300 MMR doses through state health centers in 2026 as a whole. Private providers usually give about 25,000 MMR doses in a typical month in Pennsylvania. In August they gave more than 46,000.

Bogen has urged residents to talk to a trusted clinician and has pointed people with possible exposure to the department’s hotline at 877-PA-HEALTH (877-724-3258). The department said the Jefferson and Mifflin deaths would be added to its measles dashboard on Sept. 16 as part of the regular update.

Dr. Paul Offit, an infectious-disease specialist at Children’s Hospital of Philadelphia, told interviewers he dreads the illness and death still ahead, especially with a large number of unvaccinated children back in school. Measles has historically climbed in winter and spring.

I think we’re going to see more children suffering, more children being hospitalized, and more children dying of this disease.

Dr. Paul Offit, Children’s Hospital of Philadelphia, to CIDRAP News

The CDC measles page, updated Sept. 11 with case counts through Sept. 10, still shows no 2026 measles deaths. Pennsylvania’s four are already on the state ledger, including an 18-year-old whose coroner signed a measles complication that does not depend on a disputed infant autopsy.

Disclaimer: This article is news reporting and analysis of official statements, coroner findings, and public health data. It is for information only and is not medical advice, a diagnosis, or a recommendation about whether any person should receive or refuse a vaccine. Readers who have questions about measles exposure, MMR vaccination, pregnancy, or a child’s immunization schedule should talk with a licensed physician, pediatrician, or local health department before making a health decision. Case counts, death classifications, and dashboard totals reflect the Pennsylvania Department of Health and CDC figures cited above and can change as investigations and death-certificate reviews continue.