Pennsylvania’s Two Measles Deaths Follow a Long Coverage Slide

Pennsylvania confirmed two measles-associated deaths on Tuesday in unvaccinated Lancaster County residents. They are the first U.S. measles deaths of 2026 and the first in the state in 35 years.

Health officials withheld ages, names, and medical histories, citing family privacy. The state’s wording was careful: measles-associated, with the official cause of death still under review. That gap matters, because the larger failure around these patients is not a mystery. Kindergarten measles coverage has sat below the 95 percent line for years, and Lancaster County was already short of that mark when the virus arrived.

Pennsylvania Confirms Two Measles-Associated Deaths

The Pennsylvania Department of Health on Aug. 25 confirmed two measles-associated deaths. Both people lived in Lancaster County, west of Philadelphia, and neither had been vaccinated. Secretary of Health Dr. Debra Bogen said the department would release no further identifying detail.

Because measles was largely eliminated in the Commonwealth for more than three decades, people are not familiar with this disease and don’t fully understand the potential severity of the illness.

Dr. Debra Bogen, Pennsylvania secretary of health, Aug. 25 statement

The department’s own fact sheet, issued with the announcement, puts the stakes in clinical terms. Measles can cause pneumonia and brain swelling. About 20 percent of people who get it are hospitalized. Death, though uncommon, occurs in one to three patients per 1,000 cases. The virus can hang in air and on surfaces for up to two hours after an infected person leaves a room. Symptoms can start 7 to 21 days after exposure.

Lancaster County Coroner Dr. Stephen Diamantoni said Tuesday that his office had not handled measles deaths. He said the office was investigating an infant who tested positive for measles and died from a ruptured spleen. Department of Health press secretary Neil Ruhland told local reporters that “measles-associated” is used when laboratory or epidemiologic evidence of measles is present but the official cause of death is still under investigation.

WHAT IS KNOWN

• Who died: Two unvaccinated Lancaster County residents; the state will not release ages or other identifiers.
• What the state confirmed: Measles-associated deaths, the first in Pennsylvania in 35 years and the first in the United States this year.
• Where cases stand: The department has confirmed 393 cases in 28 counties in 2026.

WHAT IS UNCONFIRMED

• Cause of death: Official cause remains under investigation, and the county coroner said his office had not logged a death from measles.
• Ages and community: Officials refused to say whether the patients were children or members of Plain communities.
• National count: The CDC measles page, updated Aug. 21 with data through Aug. 20, still listed zero U.S. measles deaths for 2026.

That last point is timing, not a contradiction. The federal tracker had not yet absorbed Tuesday’s state announcement. Gov. Josh Shapiro, speaking at Penn Medicine Lancaster General Health, called the illness and the deaths “completely preventable.”

Kindergarten MMR Coverage Fell to 92.4 Percent

The CDC posted 2025-26 school-year figures on Aug. 17. Two-dose MMR coverage among U.S. kindergartners fell to 92.4 percent, matching polio, with DTaP at 92.0 percent. Coverage dropped in more than half of states. The agency counted about 280,000 kindergartners without MMR documentation.

Exemptions from one or more vaccines rose to 4.2 percent from 3.6 percent the year before. About 155,000 kindergartners had an exemption. The share went up in 41 states and Washington, D.C., and 24 states now sit above 5 percent. KFF, using the same CDC file, said nonmedical exemptions drove the rise, from 2.2 percent in 2019-20 to 4.0 percent in 2025-26, while medical exemptions stayed near 0.2 percent.

Dr. Andrew D. Racine, president of the American Academy of Pediatrics, said more than a quarter of a million children started kindergarten last year without protection from the MMR vaccine. He noted that community immunity for measles requires over 95 percent of susceptible people to be immunized. Dr. Jeanne Marrazzo, quoted with the same data release, said the United States beat the virus’s infectiousness with very high vaccination rates, which is how elimination was won.

Pennsylvania’s own measles coverage has moved in the same direction. Reporting on state and CDC compilations put the state’s measles vaccination rate at 96.7 percent in 2017 and 92.7 percent in 2026. The two-dose MMR series, the Pennsylvania department said, provides 97 percent lifetime protection.

Why Lancaster County Became the State’s Hot Spot

Lancaster County has taken roughly half of Pennsylvania’s 393 measles cases this year, Health Secretary Bogen said at Tuesday’s briefing, in a county where about 88 percent of kindergartners were up to date on measles shots last school year. The state counted 70 hospitalizations among this year’s cases, and Shapiro said nearly 20 percent of patients have needed hospital care. He also said every confirmed case was in someone not fully vaccinated.

The county is the center of Pennsylvania’s Amish and conservative Mennonite communities, groups that often keep a distance from routine medical care. The New York Times cited a 2025 estimate that only about a quarter of people in the local Amish community had been vaccinated against measles. Some clinicians in Lancaster have said the official case count is low because families treat measles at home and do not call health departments.

Shapiro pushed back on pinning the outbreak on one religious group. Measles has been found in 28 counties with different makeups, he said, and “this disease does not respect county lines or religious lines.” He added that he did not want anyone to conclude it was “just a problem in one particular community.”

Cleveland Health Director Dr. David Margolius, who works with a coalition of big-city health departments, has heard a different kind of shrug from residents during vaccine drives. People ask whether anyone even dies from measles, he said, and why the city keeps calling. The Pennsylvania deaths are the answer that sentence was waiting for, and they landed in a county that was already below the coverage line health agencies use to keep one imported case from becoming a local chain.

The 1989 to 1991 Wave Forced a National Push

CDC historical tables list 9,643 U.S. measles cases in 1991, after 27,808 in 1990 and 17,914 in 1989. A CDC MMWR summary of those years counted about 55,000 cases and 132 suspected measles-associated deaths from 1989 to 1991. Pennsylvania alone reported 1,448 cases in 1991. Philadelphia was among the hardest-hit cities, in part because two churches discouraged vaccination.

That wave is why the two-dose childhood schedule was driven so hard in the 1990s. The United States declared measles eliminated in 2000, meaning no continuous domestic spread. After that, most years stayed in the dozens or low hundreds. The post-elimination peak until this stretch was 1,274 cases in 2019.

In 2025 the country recorded three measles deaths, the first since 2015, when a woman with underlying conditions died. Two were unvaccinated school-age children in Texas with no known underlying conditions, CDC said in an MMWR update, and one was an unvaccinated adult in New Mexico. The West Texas outbreak that started around Gaines County in January 2025 was later declared over, but other chains kept moving in South Carolina, Utah, Arizona, Virginia, and Pennsylvania.

As of Aug. 20 the CDC listed 2,777 confirmed measles cases in 47 jurisdictions plus 16 among international visitors. That already tops 2025’s full-year 2,289 and is the most since 1991. Ninety-four percent of this year’s cases are outbreak-associated. Ninety-four percent of patients are unvaccinated or have unknown status. Hospitalizations are 193 of 2,777, or 7 percent, down from 11 percent in 2025, but the raw case load is higher and still climbing. CDC added 211 cases in the Aug. 21 weekly update, more than double the prior week’s 101, with most of the new infections in Pennsylvania and Ohio.

Shapiro Took Kennedy’s Call in the Parking Lot

Shapiro arrived nearly 30 minutes late to the Lancaster briefing because, he said, he had been sitting in the parking lot on the phone with U.S. Health Secretary Robert F. Kennedy Jr. Kennedy offered federal staff. Shapiro declined, saying Pennsylvania’s health department could manage the response.

“I was very, very blunt with him,” Shapiro said. “I made very clear that his actions and the rhetoric that’s coming from this administration are having a negative impact on communities across America, particularly right here in Pennsylvania.” He added that there are “real-life consequences to scaring people and not relying on actual doctors and actual medical professionals to provide unbiased information to parents.” Federal health officials did not immediately comment on the deaths or on Shapiro’s account.

The same county is the backdrop for an older Kennedy visit that started circulating again on Tuesday. The New York Times reported that in 2021 he went to a farm in Lancaster County and told the Amish community that health authorities wanted them to vaccinate “because they cannot stand the fact that you are healthy.” Video from that period, paired this week with the death announcement, shows him talking up chicken soup and vitamin A as the response to measles. Adults who sat through those talks were often already immunized. The people now in hospital beds, and the two who died, were not.

President Donald Trump this month signed an executive order calling for revamped childhood vaccine recommendations. He has argued for splitting the combined MMR shot into three separate vaccines and for giving childhood immunizations at separate visits when possible. On Aug. 10 he also claimed, without evidence, that vaccinating against measles, mumps, and rubella at the same time could be “quite lethal.” Two doses of MMR, the Pennsylvania department repeated Tuesday, remain the protection on offer, at 97 percent after the series is complete.

What PAHO’s November Review Will Weigh

In November, the Pan American Health Organization’s Regional Verification Commission will hold its regular annual meeting and complete a review of measles elimination status for the United States and Mexico. The analysis window is one year from the start of the reported outbreaks: Jan. 20, 2025, in the United States and Feb. 1, 2025, in Mexico. Endemic transmission, PAHO says, means uninterrupted circulation of the same virus genotype and lineage for 12 months or more in a defined geographic area.

THE ELIMINATION CLOCK

1. 2000: The United States is declared to have eliminated measles after high two-dose childhood coverage.
2. January 20, 2025: The outbreak that PAHO is using as the U.S. start date begins, later tied to West Texas.
3. November 2025: The Americas lose regional measles-free status after the commission finds endemic transmission re-established in Canada for at least 12 months.
4. March 2, 2026: PAHO announces that the U.S. and Mexico reviews move from a planned April session to the November annual meeting, in part so U.S. authorities can finish genome sequencing and a bioinformatics platform.
5. August 25, 2026: Pennsylvania confirms two measles-associated deaths while transmission is still active in multiple states.
6. November 2026: The commission reviews all member states, with extra weight on countries that have had a year of sustained transmission.

Losing country-level elimination status does not change how measles treats an unvaccinated patient. It does change how the region classifies the United States: from a place that imports measles and stamps it out to a place where the virus is judged to have a domestic foothold. CDC scientist Dr. David Sugerman told the agency’s vaccine advisory committee in April 2025 that measles would have to keep spreading through Jan. 20, 2026, for the United States to lose the designation. That date is now more than seven months past, and 1,375 of this year’s 2,777 cases are still being counted as part of outbreaks that started in 2025.

Monthly MMR Doses Rose to 35,000 and Two People Still Died

Pennsylvania has been running pop-up clinics since the outbreak was identified in late April. Shapiro said department staff have administered more than 4,100 MMR doses statewide this year, held 91 pop-up clinics, and given more than 1,000 doses in Lancaster County. Providers in the state usually give about 25,000 MMR doses a month. In the past month they gave about 35,000, Bogen said.

THE SHOT PUSH IN PENNSYLVANIA

• Pop-up clinics: 91 sites, with more dates posted on the health department’s measles page.
• Lancaster doses: More than 1,000 MMR shots this year, after state health-center staff more than tripled Lancaster vaccinations compared with all of 2025.
• Monthly pace: About 35,000 MMR doses in the latest month, up from a typical 25,000.
• How to get help: The department’s toll-free line is 877-PA-HEALTH (877-724-3258) for people who think they were exposed or have early symptoms.

A July 14 state release said Lancaster County health-center staff had already given more than 600 doses since cases appeared there in late April, against 179 measles vaccinations in that county for all of 2025. Clinics can raise the monthly total. They cannot rewind a kindergarten cohort that entered school at 92.4 percent, or a county that entered this outbreak at about 88 percent.

Bogen asked residents who have fever, cough, runny nose, or red watery eyes, and who may have been exposed, to call a clinician early, because those first days look like other viral illnesses. The two patients who died will likely stay unnamed. The coverage numbers that left them unprotected are public, and they have been public for several school years.

Disclaimer: This article is news reporting and analysis of official case counts, vaccination coverage, and public statements. It is for information only and is not medical advice, a diagnosis, or a recommendation about whether any person should receive a vaccine. Readers should talk with a licensed physician, pediatrician, or other qualified clinician about measles exposure, vaccination timing, and personal health risks. Case totals, death classifications, and school coverage figures reflect the Pennsylvania Department of Health, CDC, and PAHO sources as of Aug. 26, 2026, and those figures can change as investigations and weekly updates continue.