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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 say.
"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, Dr. Debra Bogen, said in a statement Tuesday, referring to the two most recent deaths -- those of the adults.