Pennsylvania has reported its fourth measles-associated death after an 18-year-old from Mifflin County died from a rare and severe neurological complication of the infection.The Pennsylvania Department of Health confirmed two additional measles-associated deaths on September 15, including the 18-year-old and an unvaccinated person from Jefferson County. The state has now recorded four measles-associated deaths in 2026 as its outbreak continues to expand.The latest casualty highlights acute disseminated encephalomyelitis (ADEM), one of the most serious complications of measles can cause. In this condition, the inflammation damages the brain and spinal cord.How Can Measles Affect The Brain?According to Mifflin County Coroner Andrea Alcalde, a review of medical records and available investigative information determined that the 18-year-old died from acute disseminated encephalomyelitis, which she described as a rare and severe neurological complication of measles.Ruled as a natural death, the individual was unvaccinated, according to Pennsylvania health officials. ADEM entails inflammation of the brain and spinal cord. It can cause neurological symptoms and in extreme cases, can become life-threatening.Measles itself is highly contagious and can cause complications that could impact multiple organs. Pennsylvania health officials say serious complications can include pneumonia and brain swelling, while around 20% of people identified with measles in the state have required hospitalisation during the current outbreak.Also read: Chile Eliminates Dog-Transmitted Rabies: What Other Countries Can LearnPennsylvania Has Now Recorded 4 DeathsThe latest deaths come as Pennsylvania continues to experience its worst measles outbreak in more than three decades. The state has recorded 693 confirmed measles cases across 38 counties in 2026, according to the Pennsylvania Department of Health.The four deaths include two infants from Lancaster County reported in August, a 40-year-old woman from Jefferson County who died from measles complications, and the 18-year-old from Mifflin County. The outbreak has been concentrated in Lancaster and Mifflin counties, although infections have now been reported across more than half of Pennsylvania's counties.The state health department said all four individuals were unvaccinated. The two infants were too young to receive routine measles vaccination.Pennsylvania Secretary of Health Dr Debra Bogen said, “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.”She added, “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.”Also read: 3D-Printed Mosquito ‘Toilets’ Track West Nile, Find New Virus In AmericasWorst Measles Outbreak In History Measles is among the world's most contagious infectious diseases. It spreads through respiratory droplets and airborne particles when an infected person coughs, sneezes or breathes.The Pennsylvania Department of Health says measles-associated deaths, while rare, occur in around one to three people per 1,000 cases. The department also says two doses of the measles, mumps and rubella (MMR) vaccine provide 97% lifetime protection. The state has identified four breakthrough infections among appropriately vaccinated people during the current outbreak.