(The Atlantic) – The two latest deaths suggest that the true number of infections is much larger than reported.

Four deaths in roughly four weeks suggest that the state is in the midst of an enormous outbreak. The Pennsylvania health department lists total cases at 693, with 99 in the past week. But considering that measles kills about one to three of every 1,000 children it infects, the actual number is likely much larger. Milder cases are going unreported. Many who fall ill, particularly in the Amish community, aren’t getting tested; the Amish parents of the infant who died with a ruptured spleen told me that their 13 living children had all caught the virus, but they never got swabbed.

These deaths are occurring after three unvaccinated people, including two young girls, died of measles in Texas and New Mexico last year. Those were the first measles deaths in the country in a decade. The last time the United States experienced four measles deaths in a calendar year was in 1992, at the tail end of a years-long outbreak that killed more than 100 Americans. (Read More)