Since measles was declared eliminated in the US in 2000, the country's occasional cases have come mainly from international travelers—visitors from far-flung places where the virus still spreads freely—or unvaccinated US residents who return from abroad with a highly infectious souvenir. But as vaccination rates have slipped nationwide in recent years and outbreaks grow bigger and more frequent, domestic travel now poses a greater risk than international incursions.

In a study published this week in NEJM Evidence, Washington state health officials highlight that risk, detailing how an explosive outbreak in South Carolina reached their distant state through five distinct importation events over two weeks in January. In all, the introductions led to 26 cases among residents before officials stamped out the spread.

South Carolina's measles outbreak began on October 2, 2025, and was declared over on April 26, 2026. Officials confirmed 997 cases in the state during the outbreak. At the time, it was the largest measles outbreak recorded since the virus was declared eliminated, but Pennsylvania's ongoing outbreak has since surpassed it.

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Pennsylvania's health department issued a health alert Monday as cases of measles in pregnancy and, in turn, cases of congenital measles have continued to increase. Before the current outbreak—which continues to rage across the state—congenital measles cases hadn't been seen in decades, the department noted in its advisory.

The alert included detailed clinical guidance for managing measles exposures and cases during pregnancy as well as cases in newborns. Many doctors have never seen such cases in their careers given the decades of successful use of the measles, mumps, and rubella (MMR) vaccine. But now, with vaccination rates slipping nationwide, the highly infectious virus is better able to get footholds in communities and spread rapidly through under-vaccinated pockets, as is happening in Pennsylvania.

As of October 19, Pennsylvania had reported 1,286 measles cases this year across 42 counties. Of those, 247 have been hospitalized, and six people have reportedly died (though the latest reported death is still pending an investigation by the state health department before it is added to the state tally).

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A 39-year-old unvaccinated woman in Franklin County, Pennsylvania, has become the sixth person to die of the highly infectious virus amid a state outbreak that has stricken over a thousand people since it began in April.

The woman died on Saturday, October 10. She had several underlying health conditions and had recently tested positive for measles, according to an advisory posted on social media by Franklin County Coroner Jordan Conner. The advisory noted that the woman's death meets the definition of a measles death set by the state's health department.

In an emailed statement to The Washington Post, the coroner's office said the primary cause of death was listed as "probable acute cardiac event due to possible complications of the measles."

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