PHILADELPHIA — Pennsylvania health officials on Tuesday confirmed two more deaths associated with measles involving a resident of Jefferson County and a resident of Mifflin County.

The state has now reported four measles-related deaths amid a growing outbreak that has sickened nearly 700 people this year. The deaths mark the state’s first in three decades related to the highly contagious disease.

Both residents tested positive for measles and were unvaccinated, state officials said. They declined to release any additional information on the deaths, citing privacy laws.

An 18-year-old in Mifflin County had died due to measles complications, the county coroner said in a news release Tuesday. The cause of death was acute disseminated encephalomyelitis, “a rare and severe neurological complication of measles.”

The death of a 40-year-old woman was reported over the weekend by Jefferson County’s coroner, an elected Republican. She had also severe respiratory conditions and died of respiratory failure after showing signs of measles.

She had been exposed to a person with a lab-confirmed case of measles, and the coroner on Monday evening confirmed in a press release that postmortem testing showed the woman had an active measles infection when she died.

According to the health department’s measles outbreak website, Pennsylvania defines a “measles-associated death” as one that occurs within 30 days of symptom onset in a person with clinical evidence of infection, a positive laboratory test, and who did not die of another unrelated cause, like a car crash.

Measles deaths are rare, with typical symptoms including a high fever, a cough, runny nose, red, watery eyes, and a rash. Yet the disease can cause severe complications, especially in young children, including pneumonia and brain swelling.

Shapiro again criticizes RFK Jr.

Since last month, state and federal officials have sparred over whether two other deaths reported in Pennsylvania were tied to the state’s measles outbreak.

In its latest update Friday, the CDC still had not listed those deaths on its website highlighting data on ongoing measles outbreaks around the country.

U.S Department of Health and Human Services press secretary Emily G. Hilliard said that state officials had notified the CDC of the two additional deaths reported Tuesday.

“CDC remains in contact with state health officials as they continue to assess these deaths,” she said in a statement.

With the news of the additional deaths, Democratic Gov. Josh Shapiro on Tuesday continued his criticism of President Donald Trump’s HHS secretary, Robert F. Kennedy Jr., for spreading misinformation about vaccine safety through his longtime anti-vaccine activism.

“This serious situation continues to be made worse by RFK Jr. playing games with public health and safety,” Shapiro said in a X post Tuesday.

Shapiro also noted news reports that Kennedy directed the CDC’s decision not to include the deaths on its website, adding “it is also deeply concerning to learn that the Secretary personally intervened in an otherwise administrative process to direct the CDC to not report these Pennsylvania deaths, presumably because it doesn’t fit his phony narrative.”

Kennedy has accused the Shapiro administration of “fabricating” the deaths, although he later said one had been caused by measles.

Federal health officials also note that unlike several other states with measles outbreaks, Pennsylvania has not required an “Epi-Aid” team from the agency, “which would deploy epidemiologists to provide on-the-ground measles outbreak support.”

State health officials have said they meet regularly with the CDC and will continue to evaluate if they need additional support from the agency.

Scrutiny of the deaths began after the state’s initial announcement of two deaths. Lancaster County’s coroner said he had investigated one death caused by measles, in an infant with a deadly genetic disorder that made her vulnerable to respiratory infections.

He investigated another death in an infant who contracted measles before birth and died shortly after. The coroner, an elected Republican, has said that infant’s death was caused by a lacerated spleen, not measles. Yet prominent physicians have noted measles can weaken a person’s spleen, putting it at risk of rupture.

Both children were too young to be vaccinated against the virus that is transmitted through the air, when an infected person coughs or sneezes, and can linger in the air for up to two hours.

Two doses of the measles, mumps, and rubella vaccine has proven 97% effective at preventing the disease, the CDC says. The more people who are vaccinated, the less likely it is for measles to spread. Scientists say that about 95% of a community should be vaccinated to prevent spread.

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