Pennsylvania health officials have reported the first two US measles deaths of 2026 in unvaccinated Lancaster County residents as nationwide infections reach 2,777.
The two fatalities mark the first measles deaths recorded in Pennsylvania in 35 years. Both individuals lived in Lancaster County, located about 60 miles outside Philadelphia. State health authorities have not released additional details regarding the victims. Pennsylvania has logged 393 confirmed measles cases across 28 counties so far this year.
Dr Debra Bogen, Secretary of Health for the Pennsylvania Department of Health, expressed condolences to the families affected by the outbreak. "My deepest sympathies are with the loved ones who are facing this unimaginable loss," Dr Bogen said. "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."
Outbreaks expanding in Maryland and Iowa
State health authorities in Maryland declared a measles outbreak in three counties on Monday after confirming 14 new cases. The latest infections bring Maryland's total for 2026 to 31 cases, with 27 of those cases confirmed within the last six weeks among unvaccinated individuals. The cases are distributed across four counties: St. Mary's County with 13 cases, Carroll County with eight, Cecil County with five, and Charles County with one.
Dr Meena Seshamani, Secretary of the Maryland Department of Health, said state officials are coordinating with local health agencies. "Measles is highly contagious and we are actively working with healthcare professionals and local health departments to support impacted communities, respond to cases and mitigate further spread," Dr Seshamani said. "The overall risk remains low if you are fully vaccinated. We ask that Marylanders join us in our effort to help keep our youngest safe and protect those who are most at risk. Checking your vaccination status and getting vaccinated if you are not up-to-date is the simplest and most effective way to do that." State officials noted that no public exposures were identified among the 14 recent Maryland cases.
In Iowa, a growing outbreak in the southern region of the state has reached 17 confirmed cases following two newly reported infections. Public health officials warned that the outbreak may have exposed thousands of people across nearly a dozen commercial and medical locations.
Iowa authorities identified nine specific sites where public exposure to the virus may have occurred:
- Natural Grocer's in Clive, Iowa
- Menards in Clive, Iowa
- Vero Health Center in West Des Moines, Iowa
- Office Depot in West Des Moines, Iowa
- Menards in Des Moines, Iowa
- Pizza Ranch in Ottumwa, Iowa
- Wells Hometown Drug in Bloomfield, Iowa
- JR Feed and Supply in Bloomfield, Iowa
- Sunnyside Grocery in Bloomfield, Iowa
Nationwide totals hit three-decade high
The US Centers for Disease Control and Prevention (CDC) reported that nationwide measles cases reached 2,777 as of August 20. This is the highest annual case count recorded in the United States since 1991, when public health agencies logged 9,643 cases. In comparison, the CDC recorded 2,289 measles cases and three deaths throughout the entirety of 2025.
The vast majority of infected individuals in both 2025 and 2026 were unvaccinated against measles, mumps, and rubella. The MMR vaccine is administered in a two-dose series, with the first dose given between 12 and 15 months of age and the second between four and six years. According to the CDC, receiving both doses reduces the risk of measles infection by 97 percent. Among unvaccinated individuals exposed to the virus, nine out of ten will contract the disease.
Nationwide, 92.4 percent of kindergarten students are fully vaccinated against measles, falling short of the 95 percent threshold required for community herd immunity. State MMR vaccination rates vary across the affected regions, with Pennsylvania reporting a rate of 94.6 percent, Maryland at 96 percent, and Iowa at 90 percent. Vaccine exemption rates have also risen to 4.2 percent nationwide, reflecting a 17 percent increase from 1.6 percent just over a decade ago.
Symptoms, transmission, and severe complications
Measles is a highly contagious airborne illness characterized by high fever, cough, and a distinctive blotchy rash that begins on the face before spreading down the body. Patients may also develop Koplik spots, which are tiny white spots inside the mouth. The measles virus spreads through direct contact with infectious airborne droplets. Infected individuals are contagious from four days before the rash appears until four days after its onset. Enclosed environments such as airports and airplanes present an exceptionally high risk for transmission.
Once inside the body, the virus initially invades the respiratory system before spreading to the lymph nodes and broader organ systems, including the lungs, brain, and central nervous system. While some patients experience milder symptoms like diarrhea, sore throat, and body aches, measles causes pneumonia in approximately six percent of otherwise healthy children, with higher rates observed in malnourished children.
Although brain swelling, known as encephalitis, occurs in roughly one out of every 1,000 cases, it proves fatal in 15 to 20 percent of patients who develop it. Furthermore, about 20 percent of those affected by brain swelling suffer permanent neurological damage, including intellectual disability, deafness, or permanent brain damage. The virus can also damage a child's immune system, leaving them vulnerable to other dangerous bacterial and viral infections.
Prior to the introduction of the MMR vaccine in the 1960s, global measles epidemics caused up to 2.6 million deaths annually. Widespread immunization efforts reduced worldwide measles fatalities to approximately 107,000 by 2023.
Dr Bogen reiterated the importance of vaccination to prevent further loss of life during the current outbreak. "We want to ensure every Pennsylvanian has the information they need to protect themselves, their loved ones and their communities," Dr Bogen said. "As a physician, I want to make sure that people understand that the MMR vaccine is safe and provides the best protection we have against measles."
