Key facts
- The CDC is not counting four measles deaths in Pennsylvania on its national dashboard.
- An outbreak of measles is accelerating in Pennsylvania, with cases appearing in novel ways.
- Members of Congress have requested an immediate briefing on the CDC's reporting decision.
- Doctors are treating congenital measles, which was once exceedingly rare.
- Pennsylvania has reported 731 measles cases, but this is likely an undercount.
- The CDC is working with the Council of State and Territorial Epidemiologists to define measles deaths.
The US Centers for Disease Control and Prevention (CDC) updated its measles dashboard on Friday, but it is still not counting four measles deaths in Pennsylvania, where the outbreak appears to be accelerating and cases are presenting in unprecedented ways. Members of Congress on Monday requested an “immediate briefing” on the decision to change how measles deaths are reported as cases continue to rise throughout the United States to levels not seen in decades.
Debra Houry, former CDC chief medical officer, described the delay in death reporting as “curious,” even after the CDC changed its counting methods. She noted that it typically takes one to two days for the CDC to receive updated data from states after death investigations are concluded, and Pennsylvania had already concluded its investigations into the first two deaths.
Dr. John Goldman, an infectious disease specialist at the University of Pittsburgh Medical Center, stated that the outbreak “seems to be accelerating” and that doctors are seeing “types of measles we’ve never seen before.” This includes congenital measles, where newborns contract the virus in utero or at birth, a condition that was once exceedingly rare due to widespread vaccination or prior childhood infection.
Pennsylvania has reported 731 cases, but Goldman believes this is an undercount, as many sick individuals at home are not tested. He noted that typically one to three people per 1,000 cases die from measles, and one in five are hospitalized. Houry agreed that the current numbers in Pennsylvania are “definitely not proportional to what would be expected” and are likely a significant undercount.
The CDC typically collects data from states, relying on death certificates issued at the state or local level. Currently, the agency is working with the Council of State and Territorial Epidemiologists to define measles deaths, using the World Health Organization’s definition in the interim. Emily Hilliard, a spokesperson for the US Department of Health and Human Services, confirmed the CDC is relying on NCHS data for this attribution. She did not respond to questions about the delay or whether all deaths would receive a CDC definition.
Erica Schwartz, the CDC director, denied that deaths were being miscounted for political reasons, attributing the situation to the process of creating a definition. Houry countered that Pennsylvania’s definition of “measles death” clearly excludes unrelated deaths, and suggested that Schwartz’s comments contribute to misinformation. Houry urged a focus on responding to the outbreak rather than the definition itself.
Robert F Kennedy Jr, HHS secretary, has reportedly cast doubt on the Pennsylvania deaths and instructed Schwartz not to include them in the CDC tally. Kennedy mentioned the measles outbreak briefly in a speech at an anti-vaccine conference, contrasting the attention given to measles deaths with that of severe vaccine side effects.
Pennsylvania has implemented aggressive measures, including over 100 pop-up clinics and requests for additional CDC vaccination support. Goldman praised the state department of health's response and testing turnaround times. He noted that the undercount of cases is due to people not seeking medical care, not a lack of testing availability. Health systems and clinicians across the state are also stepping up to provide vaccines.
Goldman, who had not seen a measles case between 1992 and 2026, is now seeing at least one case daily and anticipates three to six more months of this trend. He fears for other vaccine-preventable diseases and views the measles outbreak as a potential warning sign, or “canary in the coal mine.”