Babies are being born with measles. The AAP wrote the FAQ because clinics had almost no playbook.

Pennsylvania’s health department confirmed **903 measles cases across 39 counties** on 28 September 2026, with **176 hospitalizations** and **four measles-associated deaths**. That is the state’s largest modern outbreak, and it is no longer only a school-age story.

NBC News reported on 24 September that **at least six Pennsylvania babies were born already infected**, two of them sick enough for intensive care. Congenital measles — infection acquired in the womb or in the hours around birth — was rare enough in the United States that most pediatricians had never seen a case. The American Academy of Pediatrics published a Red Book FAQ in early September because that gap is now a live problem.

This is editorial context for parents, not medical advice. Decisions about vaccines, immunoglobulin, isolation, or a sick newborn belong with the clinicians who can examine that child.

## Background

The United States declared measles eliminated in 2000. Elimination means the virus was no longer continuously spreading here. It never meant the virus disappeared. Imported cases still start outbreaks when they land in communities with low two-dose MMR coverage.

Two doses of MMR protect about 97 percent of people for life. Infants under 12 months are too young for the routine first dose, so they depend on everyone around them. When pregnant people get measles, the virus can cross the placenta.

The AAP FAQ defines congenital measles as clinical or laboratory evidence of measles in the first 10 days of life after intrauterine exposure. Historical series put vertical transmission at roughly **25 to 30 percent** when the mother is infectious in the days before delivery. A 2024–2025 Canadian provincial report found 9 congenital cases among 51 confirmed measles infections in pregnancy — a reminder that the old percentages were never precise.

Presentation ranges from no symptoms, to the classic rash, to multi-organ disease and death. A Lancaster County coroner described one 2026 newborn death as congenital measles with a lacerated spleen. That case is part of why state and federal dashboards still disagree on how many 2026 deaths “count.”

## What changed this week

- **28 September 2026, Pennsylvania DOH:** 903 cumulative cases, 39 counties, 176 hospitalizations, 4 confirmed measles-associated deaths, 13 new positives since 25 September. Fewer than 1 percent of cases were in fully vaccinated people. The state has given more than 5,300 MMR doses at 173 pop-up clinics since late April.
- **24 September 2026, CDC / AAP Red Book outbreaks page:** 3,659 confirmed U.S. cases in 2026 — already more than any year since elimination. CDC’s dashboard lists **one** confirmed 2026 measles death. Pennsylvania lists four associated deaths.
- **24 September, NBC News:** at least six congenital infections in Pennsylvania; two infants in ICU.
- **8 September, AAP Red Book:** congenital measles FAQ for prevention, diagnosis, immunoglobulin, infection control, and follow-up. Measles-containing vaccine is not given in known pregnancy. Babies born within about two weeks of the mother’s rash may qualify for immunoglobulin.

The practical change for parents is not a new product. It is that “newborn rash workup” in outbreak counties now has to include measles, and that a pregnant household contact is no longer a theoretical risk.

## Competing viewpoints

**State health departments and county coroners** are counting measles-associated deaths the way outbreak investigations usually do: the person had measles, and measles contributed to the fatal course. Pennsylvania has been explicit that all four associated deaths were in unvaccinated people.

**CDC / NCHS** confirm deaths only after national vital-statistics review. That is slower and stricter. It is why the federal dashboard still shows one 2026 death while the largest state outbreak shows four.

**HHS leadership** publicly questioned some Pennsylvania attributions earlier this month, including the newborn with a lacerated spleen who also tested positive for measles. Coroners and the state did not withdraw the associated-death classification.

**Pediatric infectious-disease groups** are not waiting for the dashboard fight to end. The AAP FAQ exists because clinicians asked for something they could use this season. There is still no single trial-sized playbook — which is the point of publishing expert consensus when the case count will never support a large randomized study.

None of those disputes change the parent-facing facts: two MMR doses remain the most reliable way to keep measles out of a household, and infants too young for the shot are the group that cannot opt out of other people’s coverage.

## What to watch next

- Whether CDC’s death count moves as NCHS finishes reviews.
- Additional congenital cases as fall respiratory season overlaps with measles in under-vaccinated counties.
- Nursery and school exclusion rules when a pregnant staff member or parent is exposed.
- Early MMR at 6 months for infants traveling to or living in outbreak areas — that dose does not replace the 12–15 month and 4–6 year doses.
- Immunoglobulin availability for newborns delivered within two weeks of maternal rash.

If someone in the house is pregnant, has a baby under 12 months, or is immunocompromised, ask the obstetric or pediatric office what the local outbreak map means for that household. Official case maps: [pa.gov/measles](https://www.pa.gov/measles) and the CDC measles page.

Sources: Pennsylvania Department of Health (28 Sep 2026), AAP Red Book Online outbreaks update (28 Sep 2026), AAP congenital measles FAQ (8 Sep 2026), AAP news release on the FAQ, NBC News (24 Sep 2026), CIDRAP coverage of the FAQ.