Pennsylvania health officials confirmed a fifth measles-associated death this year, an unvaccinated Lancaster County resident, as the state's outbreak neared 1,000 cases (943 confirmed across 39 counties). Lancaster County, home to large, under-vaccinated Amish and Mennonite communities, has now recorded three of the deaths, and cases have more than doubled since August. The toll matters because Governor Josh Shapiro's administration is in a dispute with US Health Secretary Robert F Kennedy Jr over how such deaths are counted, even as the US faces its worst measles outbreak since 1991.