New York Gov. Kathy Hochul declared a statewide measles disaster emergency Monday amid an outbreak described as spreading from Pennsylvania. New York has reported 108 cases. Pennsylvania recorded 977 cases and five deaths as of Oct. 2, with most cases in rural communities.

Hochul also issued an order expanding who can administer measles vaccines. Pharmacists can vaccinate children as young as 2, while registered nurses can order tests for suspected cases. The order requires MMR vaccinations to be reported to state or New York City immunization registries within 72 hours and waives adults’ consent for that reporting.

Officials warned that some travelers may have been exposed to measles in parts of Philadelphia International Airport. The Centers for Disease Control and Prevention reports nearly 3,900 U.S. cases this year, the highest annual count since 1991.