Pennsylvania officials have reported a fourth measles-associated death.

The latest death involved an 18-year-old resident of Mifflin County, in the center of the state, the county coroner’s office said in a Facebook post. The cause was acute disseminated encephalomyelitis, a rare and severe neurological complication of measles, it said.

On Saturday, a 40-year-old woman from Jefferson County, a rural area in western Pennsylvania, died of measles complications. And last month, two measles-infected infants died in Lancaster County, in the southeastern part of the state.

None of the four were vaccinated, according to the state health department. The infants were too young for vaccinations, according to current recommendations.

The U.S. is enduring its worst year for measles since 1991 and has seen seven reported measles-associated deaths in the last two years — more than the combined total of reported deaths over the previous three decades.

Pennsylvania’s measles outbreak continues to grow, with nearly 700 illnesses reported so far this year across 38 counties, including about 100 cases in the last seven days. The measles-associated deaths are the first reported in the state in 35 years, state officials said.

“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,” the state’s health secretary, Debra Bogen, said in a statement Tuesday, referring to the two most recent deaths.“We remain committed to working with our partners across Pennsylvania to stem this outbreak and prevent more deaths. That means ensuring people have the facts about measles and access to the MMR vaccine, which kept measles outbreaks at bay for decades.”

Trump administration health officials, including Secretary of Health and Human Services Robert F. Kennedy Jr., have questioned and sown doubt about the established safety of vaccines at an unprecedented level while also defunding local efforts to improve vaccination rates.

Pennsylvania Gov. Josh Shapiro pointed to Kennedy on social media after the death was reported Tuesday. “This serious situation continues to be made worse by RFK Jr. playing games with public health and safety,” the Democratic governor said on X. “It’s long past time for @SecKennedy to stop stoking vaccine skepticism and misinformation and compromising the serious mission of the nation’s public health agencies.”

Kennedy responded by saying that he has offered aid to help states control the outbreaks. “Governor Shapiro has chosen to politicize this outbreak instead of implementing a unified public health response,” he said on X, adding that he has “repeatedly stated that MMR vaccination is the most effective way to prevent measles infection.” The MMR vaccine includes inoculation against measles.

The nation eliminated the domestic spread of measles in 2000 by maintaining high vaccination rates, but they have fallen in recent years to below the 95% coverage needed to prevent outbreaks. Meanwhile, measles infections have been surging in recent years.

In November, international health officials will meet to determine if the U.S. and Mexico have lost their measles-free status.

The problem has been years in the making, as fewer kids get routine vaccines due to parental waivers, health care access issues and rampant disinformation.

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