Pennsylvania Health Secretary Debra Bogen has initiated a request for emergency assistance from the CDC, known as an Epi-Aid, to address a growing measles outbreak that has resulted in multiple deaths, according to a letter sent to CDC Director Erica Schwartz on Wednesday.

Dispute Over Death Classification Intensifies

The CDC has not recognized four deaths reported by Pennsylvania as measles-associated, prompting Bogen to warn that the state will rescind its request for assistance if the agency continues to withhold recognition. “The CDC’s choice not to publicly recognize the deaths undermines our response,” Bogen wrote in the letter.

Grace Davis Jamison, press secretary for the US Department of Health and Human Services (HHS), stated that the CDC had not received Pennsylvania’s request through its normal channels and emphasized that federal outbreak assistance is separate from how deaths are classified. “CDC will not allow Governor Josh Shapiro to politicize this process,” Jamison said, while “We owe the American people accurate, consistent, and transparent public health information.”

Outbreak Spreads Beyond Initial Epicentre

The dispute over the deaths began in August when Pennsylvania reported that two unvaccinated individuals died from measles in Lancaster County. The CDC initially included the deaths in its national tally but later removed them after Health Secretary Robert F Kennedy Jr questioned the causal link between measles and the fatalities.

Pennsylvania has since confirmed four measles-associated deaths; a 40-year-old woman died from complications associated with measles on September 13, with two additional deaths announced on September 15. All four individuals were unvaccinated, according to the state.

The outbreak has spread to 38 counties in Pennsylvania, with 731 confirmed cases and 141 hospitalisations; Only four of the reported cases, or less than one percent, are vaccinated.

Experts Warn of Confusion and Erosion of Trust

Matthew Ferrari, director of Pennsylvania State University’s Center for Infectious Disease Dynamics, noted that the term “measles-associated” death has long been a standard used by the World Health Organization and CDC. “It’s the most useful distinction because it is a case that could have been prevented by a measles vaccination, or by early detection and isolation,” Ferrari said.

Dr Andrew Pavia, spokesperson for the Infectious Diseases Society of America and professor at the University of Utah, warned that the distinction should not be controversial. “The impact, though, is confusion for the public and erosion of trust in the ability of CDC staff to communicate to the public without political interference,” Pavia said.

HHS said federal outbreak assistance and national mortality reporting are separate processes and rejected the idea that the two should be linked.

“The most important thing for an effective response is communication and trust,” Ferrari said — “It is important for all partners to agree on the foundational elements of the problem and the metrics for evaluating the severity of the problem.”