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LEWISTOWN -- Mifflin County's confirmed measles count climbed to 93, an increase of 14 in one week and the second-highest county total in Pennsylvania.
Only Lancaster County, with 323 cases, has reported more infections, according to the Pennsylvania Department of Health's measles dashboard, updated Sept. 21. Chester County ranks third with 76 cases.
Mifflin County had 79 confirmed cases Sept. 14. Its total has more than tripled since the state reported 29 cases Aug. 25.
Pennsylvania has recorded 792 cases in 39 counties this year, an increase of 99 cases since Sept. 14. Hospitalizations rose from 133 to 155 during the same period.
The dashboard lists 97 new cases during the latest seven-day period, down slightly from 99 during the previous period. Patients younger than 18 account for 31% of the statewide total, up from 30%. Fewer than 1% of confirmed cases involved fully vaccinated people.
The state continues to report four measles-associated deaths, including an unvaccinated 18-year-old Mifflin County resident whose death was confirmed Sept. 15.
After reviewing medical records and investigative information, Mifflin County Coroner Andrea L. Alcalde determined the cause of death was acute disseminated encephalomyelitis, or ADEM, a rare and severe neurological complication of measles. She ruled the manner of death natural. Her office didn't release the resident's name or provide additional information.
"Our thoughts and prayers remain with the family and all those affected by this loss," Alcalde said.
The Department of Health announced the deaths of the Mifflin County resident and an unvaccinated Jefferson County resident. The other two deaths involved Lancaster County infants who were too young to receive the measles, mumps, and rubella vaccine.
State health officials have found evidence of community transmission in 11 counties: Centre, Chester, Clearfield, Indiana, Jefferson, Lancaster, Mifflin, Snyder, Somerset, Union and York.
The department defines community transmission as spread across multiple generations outside the original household that can't be traced to a separate introduction of measles. Officials said those counties may need additional steps, including catch-up vaccinations or early MMR doses.
Elsewhere in the region, Snyder County's total rose by eight cases since Sept. 14, reaching 36. Centre County remains at 19, Perry County has four and Huntingdon County increased by one to three. Juniata County hasn't recorded a confirmed case.
Department of Health staff has administered 7,582 MMR vaccine doses in 2026. The figure doesn't include every MMR dose administered across Pennsylvania.
Two doses of the MMR vaccine provide about 97% protection against measles, according to health officials. One dose provides about 93% protection.
Measles spreads through the air when an infected person breathes, coughs, or sneezes. The virus can remain infectious in the air and on surfaces for as long as two hours after the person leaves. People with measles can spread the virus before the rash appears.
Dr. Stanley Martin, Geisinger's director of infectious diseases, said schools can help by training employees to recognize symptoms and giving parents accurate vaccination information. He said people who can't locate their vaccination records can ask a health care provider about an immunity blood test. Those who have completed the two-dose series don't routinely need a booster.
State health officials also announced a potential exposure at the Aldi supermarket at 339 Freedom Ave. in Burnham. An infected person visited the store Sept. 3 between 9 a.m. and 2 p.m.
Health officials advised people who were there during that period to monitor for symptoms through Sept. 24. Symptoms can appear seven to 21 days after exposure and include fever, cough, runny nose and red, watery eyes. A rash usually follows, beginning on the head or face before spreading downward.
Anyone who develops symptoms should call a health care provider or 877-PA-HEALTH (877-724-3258) before visiting a medical facility so employees can take precautions.
Martin warned during an Aug. 27 interview that Pennsylvania's outbreak hadn't run its course.
"I don't think we see an end to the cases just yet by any means. And I don't think any of us would be surprised if they continue to spike upwards over the next couple of months," Martin said.