CDC Withholds Pennsylvania's Measles Deaths From National Dashboard Amid Political Standoff

The Centers for Disease Control and Prevention (搜索)搜索该公司's latest update on the national toll of measles (搜索)搜索该疾病 outbreaks continued to omit two measles-related deaths reported in Pennsylvania, extending an unusual standoff between federal and state health authorities. The agency instead placed an asterisk in a column where the Pennsylvania deaths would be recorded as the first in the nation this year, with a note stating that "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 omission marked a clear departure from the agency's normal operating procedure, as President Donald Trump's administration and Democratic Gov. Josh Shapiro continue to clash over how the deaths were characterized. In a rare break from that norm, Health and Human Services Secretary Robert F. Kennedy Jr. asked the CDC's newly appointed director, Erica Schwartz, to omit the Pennsylvania deaths, according to Reuters.

A Break From Standard Disease Surveillance

States report to the CDC cases and deaths for dozens of infectious diseases, such as hepatitis, influenza, and measles (搜索)搜索该疾病. The CDC has long compiled the data into reports that help epidemiologists monitor outbreaks and risk, and can inform lawmakers' efforts to improve public health policy.

The Pennsylvania Department of Health reported the two deaths to the CDC the morning of Aug. 25, and professional staff at the CDC "did not express any concern regarding the information," Neil Ruhland, a department spokesperson, said in an email. The next day, the state health department discussed the details of each case with CDC professional staff. The CDC requested records containing identifiable information, which the health department did not share, consistent with its past practices.

Shapiro has cited state privacy laws, and the need to protect the privacy of the families involved to ensure community trust, with limiting his ability to release more information. Instead, the health department asked the CDC for a case report form to provide de-identified information, which the state says it has not yet received.

The Political Dispute

The spat between Kennedy, a longtime anti-vaccine activist, and Shapiro began when the governor announced the deaths at a news conference in Lancaster County. Shapiro accused Kennedy of spreading vaccine misinformation that has contributed to declining measles (搜索)搜索该疾病 vaccination rates, while Kennedy suggested that Shapiro's office had fabricated the deaths to win political points.

"Every data point is a broken family, a mother crying, a future that's lost. Instead of grieving that and making sure it never happens again, you're debating the mechanism of death," said Brian C. Castrucci, an epidemiologist and president and CEO of de Beaumont Foundation.

Joshua Sharfstein, a physician who served as Maryland's Health Secretary from 2011 to 2014, said he has never heard of the CDC omitting disease surveillance data reported by states. "I wouldn't say it's off the table for the CDC to want more information," but the way the agency went about it in Pennsylvania's case is unusual, said Sharfstein, who currently works as a health policy professor at Johns Hopkins University. "It's supposed to be a collaborative relationship."

Conflicting Accounts of the Deaths

Pennsylvania officials initially provided no additional information to the public about the two people who had died, other than they were unvaccinated Lancaster County residents. The state's decision to call the deaths measles (搜索)搜索该疾病-associated came after the state health department's "epidemiology team thoroughly investigated and verified both individuals tested positive for measles," Pennsylvania Health Secretary Debra Bogen said in a statement.

Pennsylvania defines a measles (搜索)搜索该疾病-associated death as deaths of people where evidence of measles is present, even when the disease may not be assessed by the coroner as the immediate cause of death.

Lancaster County's coroner, Stephen Diamantoni, added confusion when he contradicted the state's account. Diamantoni, a physician and elected Republican, said his office was investigating one death involving a newborn and said postmortem testing showed the infant had a measles (搜索)搜索该疾病 infection acquired before birth, but he did not believe measles contributed to the child's death. The child died shortly after birth of a lacerated spleen with trauma to the torso, Diamantoni said.

He later said measles (搜索)搜索该疾病 was noted on the infant's death certificate as a significant condition "contributing to death but not resulting in the underlying cause," because the baby tested positive for measles. On Friday, he said a 6-week-old Amish infant who was being treated for a deadly genetic disorder had died of measles in mid-August.

The Outbreak's Toll

As of Friday, there have been 577 measles (搜索)搜索该疾病 cases in Pennsylvania, including 115 reported within the last week, according to the state health department's online measles dashboard. Only South Carolina has reported more measles cases than Pennsylvania so far this year, according to the CDC's measles webpage. There have been 3,134 cases nationally this year, the agency reported in its latest update.

Former CDC officials Debra Houry, M.D., M.P.H., and Demetre Daskalakis, M.D., M.P.H., wrote that more than 400 people have been infected in Pennsylvania, including 83 who have been hospitalized. "Some children will face serious complications. Measles (搜索)搜索该疾病 can cause pneumonia and encephalitis, erase immune memory and leave children more vulnerable to other infections, and, in rare cases, lead years later to a devastating fatal neurological disorder," they wrote.

Concerns Over Scientific Integrity

Public health experts warned that the ongoing political controversy sows doubt in what was designed as an unimpeachable health resource — national disease surveillance — and detracts from the ultimate public health goal of limiting the spread of illness.

"A death tally that can be altered by officials whom it embarrasses will not be trusted by anyone, including the officials who edited it," wrote Jake Scott, a clinical associate professor of infectious diseases at Stanford University, in an opinion piece published by the Center for Infectious Disease Research and Policy at the University of Minnesota.

Houry and Daskalakis, who resigned from the CDC in protest last summer because of political interference and concerns for scientific integrity, raised a troubling question: "Is CDC now applying different standards to state data depending on who governs the state or what political party won an election?"

They noted that when Texas reported the nation's first measles (搜索)搜索该疾病 death in a decade, followed quickly by the second, Texas followed the standard protocol — state officials investigated the cases, made the determinations, and notified the CDC, which then included the deaths in its national reporting. "It is unclear what was different other than the state being 'blue' and its governor's criticism of the administration," they wrote.

The CDC's website says the agency plans to update its measles (搜索)搜索该疾病 death count once it has completed its review of Pennsylvania's cases, but officials have not said what additional information they need or when they expect to complete their review. Pennsylvania's measles-associated deaths remain an asterisk.