Pennsylvania has reported 1,004 measles cases since an outbreak began west of Philadelphia in April, making it the largest outbreak in the state in more than three decades, state health officials said Monday, Oct. 5. The outbreak has led to 198 hospitalizations and five deaths, according to state officials. The case count surpasses the 997 reported in South Carolina, previously the largest state outbreak recorded since the start of 2025. The national toll has also climbed. The Centers for Disease Control and Prevention has reported nearly 3,900 measles cases in the United States this year, the highest annual total since 1991. Eight measles-associated deaths have been reported nationwide over the past two years—more than the total reported during the preceding three decades. Large outbreaks since the beginning of last year have also been reported in Texas and Utah. New York Gov. Kathy Hochul declared a disaster emergency Monday over cases in rural parts of her state and neighboring areas. The order broadens who may administer measles vaccines to include paramedics and midwives, and permits nurses, along with doctors, to order testing. New York has reported more than 100 cases this year. The Pennsylvania figures underscore the toll of a highly contagious disease spreading across state lines, with hospitalizations and deaths adding urgency to efforts to limit transmission.