Two unvaccinated individuals have died of measles in Pennsylvania, state health officials announced on Tuesday. The deaths are the first in the state in 35 years and have been announced just one day after Maryland declared a measles outbreak in three counties.

On Monday, Maryland declared a measles outbreak in St Mary’s, Carroll and Cecil counties. There are 31 confirmed cases in the state. New York urged residents to get vaccinated on Monday, citing an uptick in cases in rural parts of the state around the capital, central and western regions.

The news comes just one week after the Centers for Disease Control and Prevention (CDC) released data showing the largest ever one-year increase in requests for vaccine exemptions – the process by which parents can request not to have their child vaccinated and still send them to school. The same data showed a long, slow decline in vaccination rates, particularly for measles.

The news also comes after Donald Trump and his health secretary, Robert F Kennedy Jr, held a press conference in which they linked vaccines to autism, a decades-old claim from the anti-vaccine movement that has been repeatedly debunked by scientific studies.