Congress requests briefing on CDC measles death-reporting change
Pennsylvania has reported 731 measles cases, but Dr. John Goldman, an infectious disease specialist at the University of Pittsburgh Medical Center, said the figure is likely an undercount. Patients arriving at hospitals with measles frequently mention that others at home are sick but have not been tested, Goldman said. The outbreak “seems to be accelerating,” he added.
Members of Congress on Monday requested an “immediate briefing” on the CDC’s decision to change how measles deaths are reported as US cases rise to levels not seen in decades. A possible measles exposure was reported last week in the neonatal intensive care unit at Children’s Hospital of Philadelphia.
Debra Houry, the CDC’s former chief medical officer, called the delay in death reporting “curious.” Pennsylvania has concluded its investigation into the first two deaths, Houry said, meaning the CDC should already have those records. Death certificates are issued at the state or local level — there are no federal death certificates — and it typically takes one to two days for the CDC to receive updated data through the National Center for Health Statistics after states finish death investigations.
Doctors in Pennsylvania are now confronting clinical presentations they rarely encounter. Goldman said providers are 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, by 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.”
On average, one to three people per 1,000 measles cases die, and one in five are hospitalized, according to Goldman. 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 contact tracing challenging, 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.”
The CDC is now working with the Council of State and Territorial Epidemiologists to define deaths from measles, according to Emily Hilliard, a spokesperson for the US Department of Health and Human Services. While the CDC has its own measles case definition, it has relied on the World Health Organization’s definition of measles deaths. Until a measles death definition is created, the CDC is relying on National Center for Health Statistics data, which “identifies measles as the underlying cause based on death record information submitted by the states,” Hilliard said. She did not respond to questions about why the death count remains delayed or whether all deaths would receive a CDC definition.
Before this outbreak, measles deaths were rare in the United States; there were none for a decade. “When there aren’t deaths, you don’t need a precise definition,” Houry said. Pennsylvania has developed its own definition, and the CDC could consider adopting it, she added.
CDC Director Erica Schwartz denied in an interview that deaths were being miscounted for political reasons, pointing instead to the work of creating a definition. “If someone got hit by a bus, and they happened to have Covid, often that was called a Covid-related death,” Schwartz said, referencing misinformation about how Covid deaths were counted. Schwartz added that in reality, Covid deaths were likely under-counted.
Pennsylvania’s definition of “measles death” clearly excludes unrelated deaths, so the bus scenario would not apply, Houry said. “Dr Schwartz’s comments are not only not helpful, but contribute to misinformation,” Houry added. “I would focus less on the definition itself and responding to the measles outbreak, and that’s what the focus of the CDC director should be.”
Health and Human Services Secretary Robert F. Kennedy Jr. has cast doubt on the Pennsylvania deaths and reportedly instructed Schwartz not to include them in the CDC tally. Kennedy mentioned the measles outbreak once during a speech spanning nearly an hour and a half at an anti-vaccine conference on Thursday, noting only that deaths from measles make headlines while severe side effects and deaths from vaccines do not receive the same attention. About one to two people per million experience severe side effects from vaccines, while one in five people with measles are hospitalized and one to three per 1,000 die.
Pennsylvania has stood up more than 100 pop-up clinics and requested additional vaccination support from the CDC. The state department of health has “done a spectacular job of dealing with this,” Goldman said. Tests have a 24-hour turnaround time. “I have called them up on a Thursday before the holiday weekend and arranged for them to do testing before it closed at noon the following day,” Goldman said. “They have provided us with information, and they have provided us with really really good support.” While there is a likely undercount of cases, “it’s not because they couldn’t get a test,” Goldman said. “It’s because they were sick at home and did not seek medical care.” Houry said the response has not been limited to the health department. “Health systems and clinicians are really stepping up across the state to get vaccines to their communities,” Houry said.
Goldman, who treated measles cases in 1988 and 1992 and saw none between 1992 and 2026, said he now sees at least one case daily. He is preparing for three to six more months of the outbreak. “Never in my life did I think I was ever going to see measles again,” Goldman said. “In a way, I think this is a warning,” he said. He expressed concern about other vaccine-preventable diseases — whooping cough, diphtheria, polio — and said, “What worries me is measles is conceivably the canary in the coal mine.”