Pennsylvania Ties CDC Measles Help to Four Uncounted Deaths

Pennsylvania asked the CDC for emergency measles help on September 16 and wrote down the terms for taking that ask back. Health Secretary Debra Bogen told CDC Director Erica Schwartz the state will cancel its Epi-Aid request unless the agency publicly recognizes four measles-associated deaths.

The department already lists 731 confirmed cases, 141 people in the hospital, and four deaths. The CDC’s measles page still lists no 2026 deaths. HHS press secretary Grace Davis Jamison said the CDC “will not submit to political blackmail that conditions critical public health assistance.”

The Letter Puts the Detectives on a Timer

Bogen’s letter, sent Wednesday evening and later reviewed in Washington, said the department had started the process of requesting an Epi-Aid, the CDC’s short-term field help during an outbreak. She wrote that staff would benefit only if she could tell them the federal team would not undercut their work, including timely public information about the deaths.

The CDC’s choice not to publicly recognize the deaths undermines our response. For this reason, if CDC is unable to transparently and accurately communicate information about those measles-associated deaths, the Department will respectfully rescind our request for a CDC Epi-Aid.

Debra Bogen, Pennsylvania secretary of health, letter to CDC Director Erica Schwartz

Jamison said the CDC had not received the request through “normal channels,” and that outbreak help is a separate issue from how the agency tabulates deaths. That answer leaves the detectives in limbo: Pennsylvania says it asked, HHS says the paperwork did not arrive the usual way, and the condition is still on the page.

The shift is late. When the first two deaths were announced on August 25, the outbreak stood at 393 cases in 28 counties, and Governor Josh Shapiro declined extra CDC staff on the ground. Kennedy and Schwartz have spent weeks saying the state would not take the offer. The letter now takes the offer and pins it to the death count.

THE PATH TO THE CONDITIONAL ASK

1. Late April 2026: The outbreak begins in the Lebanon-Lancaster region and later moves well beyond it.
2. August 25, 2026: The state reports two measles-associated deaths in Lancaster County at 393 cases in 28 counties and does not ask for an Epi-Aid team.
3. August 30, 2026: The CDC measles page lists two 2026 deaths, then the same afternoon replaces them with an asterisk.
4. September 15, 2026: The state confirms two more deaths, in Jefferson and Mifflin counties, and the case count stands at 693.
5. September 16, 2026: The department reports 38 new cases in two days, bringing the total to 731 in 38 of 67 counties, and Bogen sends the letter.
6. September 17, 2026: Jamison calls the condition political blackmail and says help and death tabulation are separate questions.

Matthew Ferrari, director of the Center for Infectious Disease Dynamics at Penn State, said the state’s caution is understandable if federal and state leaders cannot agree on how severe the deaths are. He also said spread is accelerating and the true number of infections could be 10 times the official count. That is his estimate, not a second official tally.

Four Deaths the State Says It Already Proved

On September 16 the department said it had 731 measles cases across 38 counties, 141 hospitalizations, and four measles-associated deaths. Four of those cases, less than 1 percent, were in vaccinated people. The 38 new infections since September 14 are why the September 15 figure of 693 and the September 16 figure of 731 describe the same outbreak two days apart.

Bogen said investigators worked with county coroners, required a positive lab test, required clinical evidence of measles, and had to show the death was not from an unrelated cause. That bar is the state’s measles case definition for a measles-associated death. The department said it will not release details that could identify the families.

THE FOUR DEATHS PENNSYLVANIA HAS COUNTED

• Lancaster, August: Two unvaccinated infants, announced August 25, the state’s first measles-associated deaths in 35 years. County Coroner Stephen Diamantoni described one as a newborn boy who died August 14 with a ruptured spleen and evidence of measles infection.
• Jefferson, September: An unvaccinated 40-year-old woman who died September 12. County officials said a positive test supported an active measles infection at death; she also had COPD and asthma and had been on oxygen.
• Mifflin, September: An unvaccinated 18-year-old. County Coroner Andrea Alcalde said the teen died of acute disseminated encephalomyelitis, a rare and severe neurological complication of measles.
• Shared finding: The department said all four people were unvaccinated and that both new September deaths met the same investigation standard used in Lancaster.

Four deaths among 731 confirmed cases is about 5.5 deaths per 1,000, above the 1 to 3 per 1,000 the department cites as typical for measles. That gap can mean the confirmed list is missing milder infections, which is the reading Ferrari is pushing, or that this outbreak has been harsher among the people who were tested. It does not create a fifth death.

Mifflin County now has the second-highest case load and sits more than 100 miles from the Lancaster start point, which is how a local cluster became a statewide problem. The virus remains infectious in air and on surfaces for up to two hours, and symptoms can start 7 to 21 days after exposure.

What an Epi-Aid Team Would Do on the Ground

An Epi-Aid is not a takeover. CDC materials describe it as rapid, short-term field help, generally one to three weeks, by Epidemic Intelligence Service officers and other specialists. The requesting health department keeps overall leadership. The team has to include at least one EIS officer from outside the state, and the point of the visit is practical control steps, not a press conference.

Kennedy named six states that already took that offer: Texas, South Carolina, Virginia, Kansas, New Mexico, and Wisconsin. He said those teams helped bring outbreaks under control. Pennsylvania, by Bogen’s account, had already been meeting CDC staff and had sought technical help short of a full Epi-Aid. The new ask is for people on the ground. The new catch is that those people can be sent home if the federal death page does not move.

WHAT WE KNOW

• The ask: Pennsylvania has begun an Epi-Aid request and tied it to public recognition of four deaths.
• The state’s count: 731 confirmed cases, 141 hospitalizations, four measles-associated deaths, four vaccinated cases.
• The federal death line: The CDC page lists no 2026 measles deaths because NCHS has no records with measles as the underlying cause.

WHAT IS UNCONFIRMED

• Paperwork: Whether HHS will treat Bogen’s letter as a valid Epi-Aid request through its usual intake.
• The bargain: Whether Schwartz will change the public death line, and whether Bogen will actually rescind if she does not.
• The certificates: Whether any 2026 death record will later list measles as the underlying cause once NCHS files catch up.

If the request dies on the condition, Ferrari said experts from other states could still fill some of the gap. That is a backup, not a second federal team.

The Federal Count Now Waits on Death Certificates

For years, measles deaths on the CDC outbreak page followed what states reported through the National Notifiable Diseases Surveillance System, the same pipeline that feeds weekly notifiable disease case tables. In early September the agency shifted the death line to the National Center for Health Statistics, which reads death certificates and is built for long-run mortality trends, not a weekly outbreak board.

Emily Hilliard, an HHS spokesperson, has said the CDC will report measles deaths if and when NCHS reports measles as the underlying cause. The agency is also working with the Council of State and Territorial Epidemiologists on a standard definition of a measles death. Senator Bill Cassidy, the Republican chair of the Senate health committee and a physician, said at a September 16 hearing that CDC is “working on a definition of death by measles,” and that someone had told him the country had not needed that work for decades.

TWO COUNTS, TWO CLOCKS

The NCHS rule has a timing cost and a wording cost. Certificates arrive late. Measles often kills through pneumonia, brain swelling, or a later immune storm, and those complications have their own names on a form. A count that only accepts measles as the underlying cause will run lower than a state’s case-investigation count, especially in the weeks before files are coded. On August 30 the public page briefly showed two 2026 deaths, then took them down the same afternoon. The current footnote says NCHS does not have 2026 records indicating measles as the underlying cause. The 2025 line still shows three deaths.

Cassidy, speaking as the panel considered health nominees, called the measles surge “a terrible legacy” for the administration and blamed “misinformation and misguided policies.” He said vaccines are overwhelmingly safe and effective and do not cause autism. He also noted the country has not had to write a measles-death definition in decades because people were not dying of measles.

Shapiro and Kennedy Accuse Each Other of the Same Thing

Each man says the other is playing politics with a body count. Shapiro, after the third and fourth deaths, said Kennedy was “playing games with public health and safety” and that it was “deeply concerning to learn that the Secretary personally intervened in an otherwise administrative process to direct the CDC to not report these Pennsylvania deaths.” Kennedy answered that the suppression claim is false, that CDC is applying a national standard rather than letting politicians pick which deaths appear, and that Shapiro had refused the Epi-Aid that other states accepted.

Governor Shapiro has chosen to politicize this outbreak instead of implementing a unified public health response. He continues to point the finger at me and the federal government and to malign the Amish while refusing the federal assistance that might help end the outbreak.

I… https://t.co/z589J4Shfr

— Secretary Kennedy (@SecKennedy) September 15, 2026

Kennedy also said Shapiro continues “to malign the Amish” and that CDC’s MMR recommendation is unchanged. “I have repeatedly stated that MMR vaccination is the most effective way to prevent measles infection,” he wrote. The louder objection to Pennsylvania’s four-death list is that a ruptured spleen, COPD, asthma, and ADEM are other conditions. Those are also the ways measles puts people in the ground. ADEM is an immune attack on the brain and spinal cord that can follow the infection. Respiratory failure in a person with COPD can still be the measles course. A newborn spleen catastrophe can still sit inside a measles investigation. The state’s label is measles-associated, not “measles was the only line on the certificate.”

Kennedy has questioned measles deaths since he took office, including last year’s three, two in Texas and one in New Mexico. Schwartz, confirmed as CDC director in August, is the official whose page now carries the NCHS footnote. Disease specialists have called a health secretary stepping into a state death determination unusual. HHS has called some of those accounts false and misleading. The artifact is simpler than the leak fight: the number went up to two, then it became an asterisk, then it became a different data system that currently shows none.

Pop-Up Clinics Have Not Closed the Gap

The department said getting vaccinated is still the best protection and that two MMR doses are 97 percent effective at preventing measles for life. People with two documented doses do not need another. Adults with one dose, or with no records, are told to talk to a clinician or pharmacist.

SHOTS THE STATE CAN COUNT

• Pop-up clinics: Nearly 4,400 MMR doses at 140 clinics in affected communities since late April, with more clinics on the calendar.
• State health centers: More than 6,800 MMR doses in 2026.
• Private and hospital providers: About 25,000 MMR doses in a typical month; more than 46,000 in August 2026.
• The leftover risk: 95 percent of confirmed U.S. cases this year were in people who were unvaccinated or whose status was unknown, on the CDC’s September 10 table.

Provider demand jumped in August. The outbreak did too. Nationally the CDC, in its September 18 update, reported 3,471 confirmed cases as of September 17 across 47 jurisdictions plus 17 cases in international visitors, with 95 percent of cases (3,296 of 3,471) tied to outbreaks. The United States recorded 2,289 confirmed cases for all of 2025. Measles was declared eliminated here in 2000. Four measles deaths in one year were last tallied in 1992. The federal page still has not added 2026 to that list.

Bogen’s letter can still be pulled. Jamison’s office can still decide the request never arrived. NCHS can still file a certificate that names measles, or file one that names pneumonia and leaves the virus off the underlying-cause line. Until one of those things happens, Pennsylvania’s dashboard holds four deaths and 731 cases, and the CDC’s dashboard holds a blank where those deaths would be.

Disclaimer: This article is news reporting and analysis of public statements, state health bulletins, and CDC data. It is informational only and is not medical advice, a diagnosis, or a recommendation about vaccination, testing, or treatment for any person. Readers who think they were exposed to measles, who have symptoms, or who have questions about MMR doses should speak with a licensed physician, nurse practitioner, or pharmacist, or call Pennsylvania’s health hotline at 877-PA-HEALTH (877-724-3258), before making a health decision. Case counts, death classifications, and the status of the Epi-Aid request can change as investigations and federal records are updated.