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Pennsylvania has surpassed 1,000 measles cases this year, state health officials said Monday, making it the largest state outbreak in more than three decades.

The U.S. is enduring its worst year for measles since 1991, with nearly 3,900 reported cases, according to the CDC. The nation has seen eight reported measles-associated deaths in the past two years—more than the combined total of reported deaths over the previous three decades.

Since the beginning of last year, large outbreaks have been reported in several states, including Texas and Utah, as well as South Carolina, which had the largest with 997 cases reported.

The governor of New York on Monday declared a disaster emergency because of measles cases in neighboring states and in rural areas of New York. The executive order extends the pool of people who can administer measles vaccines to include paramedics, midwives and others, and allows nurses to join doctors in ordering testing. The state has more than 100 cases this year.

Health officials say Pennsylvania's current outbreak started in April, west of Philadelphia. There have been 1,004 cases, including 198 hospitalizations and five deaths, state officials said.

It's been decades since a U.S. state has seen an outbreak surpass 1,000 cases, stretching back to a multiyear outbreak in New York City in the early 1990s that infected more than 4,500 people.

The nation eliminated the domestic spread of measles in 2000 by maintaining high vaccination rates , but those rates have fallen in recent years to below the 95% coverage needed to prevent outbreaks.

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