Pennsylvania reports fifth measles death; CDC national count stays at two

Mixed · 2On Wednesday 30 September, the Pennsylvania Department of Health reported a fifth measles-associated death this year, an unvaccinated resident of Lancaster County. 1 2 Right · 1The state gave no further details; the Lancaster County coroner said his office did not handle the death. 1 Mixed · 2The earlier deaths were two infants in Lancaster County, an 18-year-old in Mifflin County and a 40-year-old woman in Jefferson County, all unvaccinated. 1 3

Left · 2As of Monday 5 October the state counted 1,004 confirmed cases across 39 counties, up from 943 the previous week, with at least 198 hospitalisations; Lancaster County has 391 cases. 4 5 Left · 1Detail on the deaths: a teenager with severe brain inflammation, a 40-year-old woman with asthma and two babies, one a newborn born a month early; little is known about the fifth. 6 Left · 1The CDC counts only two measles deaths nationally and has not said where they occurred; it reported 3,887 confirmed US cases as of 1 October, the most since 1991. 5

Mixed · 2AP, carried by Gulf News, and Just the News (citing Politico) say the US has seen eight reported measles-associated deaths in two years, more than the combined total of the previous three decades. 7 8 Left · 2Al Jazeera and Ars Technica say the CDC recently changed how it counts measles deaths, moving to National Center for Health Statistics mortality data; the CDC says it is working with state epidemiologists on a standard definition. 9 3 Right · 1Shapiro accused Kennedy of directing the CDC not to report the Pennsylvania deaths, and said he would refuse federal aid until they are counted. 10

Mixed · 2Kennedy denied interfering and accused the governor of politicising the outbreak; he has questioned whether the deaths were caused by measles, including in an August post suggesting they may have been fabricated. 10 2 Left · 1The state has threatened to withdraw its request for CDC outbreak support unless the deaths are recognised, which the federal health department called "political blackmail"; the Conversation says Pennsylvania's first measles deaths in 35 years. 11 Left · 1The CDC told ABC News it was "deeply saddened" by the fifth death, said it had received no formal Epi-Aid request from Pennsylvania, and said it stood ready to send epidemiologists if asked. 4

Left · 1Pennsylvania uses "measles-associated" for a person with confirmed measles who dies within 30 days of symptom onset, unless the death resulted from an unrelated event; epidemiologists told Al Jazeera this long-standing standard is used by the WHO and CDC. 2 Left · 1The Conversation's Philip Broadbent notes the coroners' findings diverge: Lancaster County's coroner concluded one newborn died of a lacerated spleen with no measles contribution, but found a second infant with a rare genetic condition did die of measles, while Mifflin County's coroner attributed the 18-year-old's death to acute disseminated encephalomyelitis, a measles complication. 11 Left · 1The CDC adds a death only once its National Center for Health Statistics verifies measles as the underlying cause, and the Conversation says there is no agreed national definition; it adds that the CDC initially included the first two Pennsylvania deaths and then removed them after Kennedy questioned them, a departure from usual practice. 11

Centre · 1AP's account differs on sequence: it says the CDC dashboard counted no deaths for weeks, then added one about two weeks ago and a second last week, and that CDC officials had "quietly begun to acknowledge" the Pennsylvania deaths. 7 Left · 1The 1,004 cases make Pennsylvania's the largest US state outbreak in more than three decades, passing South Carolina's 997; NBC quotes Dr John Goldman of UPMC expecting it to run another three to six months, and says the state has given 8,843 MMR doses in response, against about 15,000 in South Carolina. 6 Mixed · 2Neighbouring New York Gov. Kathy Hochul declared a month-long disaster emergency on 5 October, and Ohio has reported more than 200 cases. 12 6

Mixed · 2Officials expect the outbreak to spread: Pennsylvania has local health departments in only seven of 67 counties, and Chester and Montgomery county officials say they are preparing for cases moving out of Lancaster; STAT notes confirmed cases are only part of the true total, with Paul Offit saying it is "much worse than is being claimed". 13 14 Left · 1Lancaster County's school measles vaccination rate was 88% last year against 97% statewide; the Conversation, whose author is a Glasgow-based public health registrar, argues for a national definition of a measles death and publication of basic details of each counted death so federal and state figures can be reconciled. 11 Right · 1International health officials meet in November to decide whether the US and Mexico have lost measles-free status. 1