Pennsylvania has confirmed 26 more measles cases in its latest update of the outbreak, bringing the statewide total to 1,286.

Berks County remains at seven cases in the update issued Monday by the sate Department of Health.

The state continues to report five deaths, acknowledging that it is investigating a recent death in Franklin County.

The Franklin County coroner on Oct. 12 reported the measles-associated death of a 39-year-old woman on Oct. 11.

Cases have been reported in 42 counties, an adjustment since the Oct. 16 updated reported 43 counties.

A health department spokeswoman said two cases that were reported as being from Forest County on Oct. 16 were later determined to be Clarion County residents. For both cases, the individual’s home address was initially reported inaccurately to the department, but through the department’s contact tracing efforts, the correct address was confirmed, and case counts have been updated appropriately.

Since there are no other confirmed cases in Forest County, she said, the county was removed from the dashboard.

The department’s update noted the following:

• New positive cases since Oct. 16: 26

• Total counties: 42

• Total cumulative cases: 1,286

• Total hospitalizations: 247

•  Total confirmed measles-associated deaths: 5

• Measles cases among vaccinated individuals: 4 (less than 1% of cases)

According to the department’s dashboard at pa.gov/measles, Lancaster County remains the leader in cases with 455.

Cases in the region: Chester County, 91; Lebanon County, 21; Montgomery County, 3; Schuylkill County, 3; and Lehigh County, 2.

State health center staff have administered more than 6,200 measles, mumps and rubella (MMR) vaccinations at 212 pop-up vaccination clinics in affected communities since the outbreak began in late April, officials said.

Overall, the department has given nearly 9,700 MMR vaccine doses this year.

Officials said health care providers continue to see an increase in residents interested in the MMR vaccinations. Providers typically administer about 25,000 doses of the vaccine a month. They said more than 56,000 doses were given in September and that more than 23,000 MMR vaccines were given in the first two weeks of October.

Because measles continues to spread, the department said it recommends an additional early zero dose for infants between the ages of 6 and 11 months who live in or travel to counties flagged on the measles dashboard for sustained community transmission. They said the early dose does not replace the two routine doses. Children 12 months and older who have not received any dose should get one now and a second dose at least 28 days later.

Those who have two documented doses of MMR do not need another, the department said. Adults who have only one dose or cannot find their vaccination records should talk with a health care provider or pharmacist about getting vaccinated.

Measles is spread when someone who is infected breathes, coughs or sneezes. The virus remains infectious in the air and on surfaces for up to two hours after the infected person leaves the area, the department said.

Symptoms begin with fever, cough, runny nose, and red, watery eyes (conjunctivitis), followed by a rash that starts on the head and spreads downward.

Without proper protection or supportive care, measles can be deadly, officials said. Symptoms can start seven to 21 days after exposure.

If you believe you were exposed to measles and are experiencing symptoms, you are advised to contact your health care provider or call the health department’s hotline at 877-PA-HEALTH (877-724-3258).