Why the CDC is excluding measles deaths in Pennsylvania even as outbreak appears to be ‘accelerating’

Centers for Disease Control and Prevention refuses to count four measles deaths in the state though doctors are ‘seeing new forms’ of disease

The US Centers of Disease Control and Prevention (CDC) updated its measles dashboard on Friday – but it’s still not counting four measles deaths in Pennsylvania , where the outbreak appears to be accelerating and cases are appearing in ways providers have never seen before.

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, reaching levels not seen in decades. A possible measles exposure was reported in the neonatal intensive care unit (NICU) at Children’s Hospital of Philadelphia last week.

The delay in death reporting is “curious” even after the CDC switched how it counts deaths, said Debra Houry, former CDC chief medical officer. It takes one to two days for the CDC to receive updated data to the National Center for Health Statistics (NCHS) after states finish death investigations.

“Pennsylvania concluded the investigation on the first two deaths, so CDC would have these records by now,” Houry said.

Meanwhile, the outbreak “seems to be accelerating”, said Dr John Goldman, an infectious disease specialist at the University of Pittsburgh Medical Center. “And we’re seeing, actually, types of measles we’ve never seen before,” he added.

Doctors are now treating congenital measles – newborns who contracted the virus in utero or at birth – which was once exceedingly rare because most pregnant people were protected by vaccines or, before immunization, surviving measles in childhood.

“Because of this, we’re literally seeing new forms of measles,” Goldman said. “We don’t have a lot of information about what happens with it.”

Pennsylvania has reported 731 cases , but that number is likely an undercount, he said. Frequently when patients come to the hospital with measles, they mention that others at home are sick as well – but they haven’t been tested, Goldman said. On average, one to three people for every 1,000 cases will die of measles, and one in five will be hospitalized.

The current deaths and hospital admissions in Pennsylvania are “definitely not proportional to what would be expected”, Houry said, and she believes the official numbers are “very much an undercount”. Under-testing can make it challenging to do contact tracing and sick people may not realize they need to isolate – both of which can make the spread of measles more likely.

Providers are preparing for more cases and more deaths. “It’s not rocket science. If we see more measles, we’ll see more deaths,” Goldman said. “I suspect that we’re not going to see a break until most people in most communities are immune either by vaccine or infection.”

Typically, the CDC collects data from states, including causes of death. Death certificates are issued at the state or local level; there are no federal death certificates.

But now, the agency is working with the Council of State and Territorial Epidemiologists to define deaths from measles.