The Centers for Disease Control (CDC) has left two recent measles-associated deaths reported by Pennsylvania out of its public disease tracker, saying it needs more information before deciding whether measles caused or contributed to either death.
Pennsylvania reported the deaths to the CDC on the morning of August 25. The agency’s professional staff initially accepted the state’s description of the cases and “did not express any concern regarding the information” when the deaths were reported, according to the account of the dispute.
Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. later asked CDC Director Erica Schwartz to withhold the deaths from the federal tally. The CDC delayed its usual Friday update. When it published the data on Sunday, the Pennsylvania deaths were excluded and marked with an asterisk.
The agency said it was reviewing “additional information regarding the circumstances and causes of death” in both cases. It added: “At this time, available information does not establish whether measles caused or contributed to the deaths or whether the individuals died from other causes while infected with measles.”
The decision departs from the CDC’s usual practice of accepting and publishing data supplied by state health authorities. It has also opened a disagreement between federal and state officials over the meaning of a measles-associated death and over who should settle such questions in public disease surveillance.
Deb Houry, a former chief medical officer at the CDC, said: “CDC doesn't adjudicate those cases or deaths.” The CDC is investigating the Pennsylvania deaths without working with the state health department.
Pennsylvania Health Secretary Debra Bogen said the state’s epidemiology team had thoroughly investigated both cases and confirmed that both people had tested positive for measles. The state counts a death as measles-associated when there is evidence of measles, including where a coroner does not identify the disease as the immediate cause of death.
Both people who died were unvaccinated Lancaster County residents. One was a newborn who had contracted measles before birth and died after a ruptured spleen. Lancaster County coroner Stephen Diamantoni said he did not believe measles caused the newborn’s death.
The baby’s death certificate listed measles among “conditions contributing to death but not resulting in the underlying cause.” Details of the second death have not been made public. There have also been conflicting accounts from county and state health officials about what occurred in relation to the deaths.
Pennsylvania described the cases as its first measles-related deaths in 35 years. The state has reported 577 measles cases and 83 hospitalizations from measles.
The dispute comes during the most severe year for measles in the US since 1991. The country had recorded 2,777 cases as of Thursday. It has also recorded five measles deaths in the last two years, more than the combined number of reported deaths over the previous three decades.
The immediate issue is whether the federal tracker should use Pennsylvania’s broader measles-associated classification or require evidence that measles directly caused, or contributed to, a death. The CDC has not said whether it will eventually add the two cases to its official count. The available information also leaves the circumstances of the second death undisclosed.
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