HARRISBURG, DAUPHIN CO. (WOLF) — Pennsylvania’s measles outbreak has grown to 977 confirmed cases across 39 counties, with five confirmed measles-associated deaths, according to a new update from the state Department of Health.

The department reported 34 new cases since Sept. 30 and said 195 people have been hospitalized since the outbreak began in late April.

Only four of the 977 confirmed cases were among vaccinated people, the department said.

The state said more than 53,000 doses of the measles, mumps and rubella vaccine were administered statewide in September — more than double the approximately 25,000 doses typically given in a month.

Health officials said the increase in vaccinations reflects heightened interest from residents as the outbreak continues.

State health center staff have administered more than 5,600 MMR vaccinations at 189 pop-up clinics in affected communities since the outbreak began. Including state health centers, Department of Health nurses have provided more than 8,700 MMR doses statewide this year.

In August, health care providers administered more than 49,000 MMR vaccine doses, the department said.

The Department of Health continues to recommend two documented doses of the MMR vaccine as the best protection against measles. The department said two doses provide 97% lifetime protection. People with two documented doses do not need another, officials said.

Adults who have received only one dose or cannot locate their vaccination records should speak with a health care provider or pharmacist about vaccination, the department said.

Measles is a highly contagious respiratory virus that can lead to serious complications, including pneumonia and brain swelling. Nearly 20% of Pennsylvanians identified with measles during the outbreak have required hospitalization, according to the department.

The virus can spread when an infected person breathes, coughs or sneezes. It can remain infectious in the air and on surfaces for up to two hours after the infected person leaves an area.

Early symptoms can include fever, cough, runny nose and red, watery eyes. A rash typically follows several days later, beginning on the head and spreading downward. Symptoms can begin seven to 21 days after exposure.

People who believe they were exposed to measles and are experiencing symptoms should contact a health care provider or call the Department of Health hotline at 877-PA-HEALTH, or 877-724-3258.