Pennsylvania’s health department has issued a health alert as cases of measles in pregnancy and congenital measles have surged. Before the current outbreak, such cases hadn't been seen in decades. The alert includes detailed guidance for managing measles exposure and cases in newborns. Many doctors have never encountered such cases in their careers due to the decades-long success of the MMR vaccine. However, with vaccination rates slipping nationwide, the highly infectious virus is gaining foothold in communities. As of October 19, Pennsylvania reported 1,286 measles cases, 247 hospitalizations, and six deaths. Pregnant people who have not been vaccinated against measles are at increased risk of hospitalization, pneumonia, and death. The MMR vaccine is not recommended during pregnancy due to its live attenuated nature, but intravenous immunoglobulin can be administered if given within six days of exposure.