Pennsylvania has requested assistance from the Centers for Disease Control and Prevention (CDC) to manage an expanding measles outbreak, which has resulted in several deaths. However, the state indicated it would withdraw the request unless the CDC acknowledges four measles-associated deaths reported by Pennsylvania. The CDC stated it has not received any formal notification regarding this request.
The United States is experiencing its most significant measles outbreak since 1991, with multiple deaths reported in recent years. Measles was declared eliminated in the U.S. in 2000, but cases have risen, which some attribute to increased vaccine skepticism. Pennsylvania has been particularly affected.
In a letter to CDC Director Erica Schwartz, Pennsylvania Health Secretary Debra Bogen stated that the state's response is undermined by the CDC's failure to publicly recognize the deaths. She mentioned that if the CDC does not accurately communicate information about these deaths, the state would rescind its request for an Epi-Aid, a form of emergency assistance from the CDC.
Grace Davis Jamison, press secretary for the U.S. Department of Health and Human Services (HHS), responded by saying the CDC had not received Pennsylvania's request through the appropriate channels and emphasized that federal outbreak assistance is separate from the classification of deaths. Jamison stated, "CDC will not allow [Pennsylvania Democratic] Governor [Josh] Shapiro to politicize this process. We owe the American people accurate, consistent, and transparent public health information."
The dispute over the classification of the deaths began in August when Pennsylvania reported that two unvaccinated individuals died from measles in Lancaster County, which has a significant under-vaccinated population, including Amish and Mennonite communities. Initially, the CDC included these deaths in its national count but later removed them after Health Secretary Robert F. Kennedy Jr. questioned whether measles caused or contributed to the fatalities. The CDC stated that the available information did not confirm a direct link.
As of September 15, Pennsylvania reported 731 confirmed measles cases across 38 counties, with 141 hospitalizations. Of these cases, only four individuals, or less than one percent, were vaccinated. The disagreement between Pennsylvania and the CDC focuses on the terminology used to classify deaths, with Pennsylvania using "measles-associated" while HHS is working on a standardized definition.
Experts warn that the ongoing dispute may distract from efforts to control the outbreak. Matthew Ferrari, director of Pennsylvania State University’s Center for Infectious Disease Dynamics, noted that the term "measles-associated" has been a standard classification used by the World Health Organization and the CDC. He stated that this classification is valuable as it reflects cases that could have been prevented by vaccination or early intervention.
Dr. Andrew Pavia, a spokesperson for the Infectious Diseases Society of America, expressed concern that the dispute could lead to public confusion and erode trust in the CDC's communication. HHS reiterated that federal outbreak assistance and national mortality reporting are distinct processes and should not be conflated.
An Epi-Aid is a mechanism used by the CDC to provide rapid assistance during urgent public health issues, typically lasting one to three weeks. During this time, CDC personnel analyze data, evaluate surveillance systems, and recommend measures to control disease spread while the requesting health authority maintains overall leadership of the investigation.