(NEW YORK) -- Pennsylvania health officials confirmed two additional measles-associated deaths in the state on Tuesday, bringing the total number of deaths in 2026 to four.

Both of the individuals were unvaccinated, according to the Pennsylvania Department of Health.

The Corner of Mifflin County said in a statement Tuesday that one of the deaths was a was an 18-year-old who died from “complications of measles.”

The coroner said they died from acute disseminated encephalomyelitis (ADEM), which is a rare and severe complication of the measles virus and includes brain inflammation and swelling.  

On Sunday, the Jefferson County Coroner's Office confirmed the other of the two deaths was a 40-year-old woman who died the day prior.

As of Tuesday, the Pennsylvania Department of Health has reported 693 measles cases in the state, in 38 counties. Of the cases, 124 have been hospitalized, and nearly all cases are among those unvaccinated against the virus, according to data from the health department.

The last time the U.S. reported four measles deaths was in 1992. Last year, Texas reported two deaths and New Mexico reported one. 

“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,” Pennsylvania's Secretary of Health Dr. Debra Bogen said in a statement.

“We remain committed to working with our partners across Pennsylvania to stem this outbreak and prevent more deaths. That means ensuring people have the facts about measles and access to the MMR vaccine – which kept measles outbreaks at bay for decades,” Bogen added.

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