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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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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Over the weekend, the World Health Organization released a disease outbreak report on the events surrounding the death of a Russian infectious disease researcher earlier this month, highlighting that Russia has yet to report a confirmed cause of death. With that "key uncertainty," the United Nations health agency said it remains impossible to assess the risk of the event or whether the public health measures Russia took were adequate to prevent spread of the unknown disease.

The WHO reported that, so far, it has seen no evidence of ongoing transmission of the mystery disease. "However, confidence in the assessment remains limited by the absence of a confirmed etiological diagnosis, and the remaining uncertainty regarding the source and mode of exposure," the agency wrote in its report.

The agency laid out the order of events as information trickled out from Russian authorities, noting that it only became aware of the death via media reports on October 2. The WHO subsequently made contact with Russian authorities and requested information on October 3, 6, 7, and 8.

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