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The Centers for Disease Control and Prevention\u2019s latest update Friday on the toll of measles<\/a> outbreaks nationally continued to omit two measles-related deaths reported last week in Pennsylvania, extending an unusual standoff between federal and state health authorities. <\/p>\n The agency instead placed an asterisk in a column where, if reported, the Pennsylvania deaths would be recorded as the first in the nation this year. A note below stated that \u201davailable information does not establish whether measles caused or contributed to the deaths or whether the individuals died from other causes while infected with measles.\u201d <\/p>\n The omission marked a clear departure from the agency\u2019s normal operating procedure, as President Donald Trump<\/a>\u2019s administration and Democratic Gov. Josh Shapiro<\/a> continue to clash over how the deaths were characterized. <\/p>\n States report to the CDC cases and deaths for dozens of infectious diseases<\/a>, such as hepatitis, influenza, and measles. The CDC has long compiled the data into reports that help epidemiologists monitor outbreaks and risk, and can inform lawmakers\u2019 efforts to improve public health policy.<\/p>\n In a rare break from that norm, Health and Human Services Secretary Robert F. Kennedy Jr. asked the CDC\u2019s newly appointed director, Erica Schwartz, to omit the Pennsylvania deaths, according to Reuters<\/a>.<\/p>\n The move escalated a spat<\/a> between Kennedy, a longtime anti-vaccine activist, and Shapiro, which began when the governor announced the deaths<\/a> last Tuesday at a news conference in Lancaster County. <\/p>\n Shapiro accused Kennedy of spreading vaccine misinformation that has contributed to declining measles vaccination rates, and Kennedy suggested that Shapiro\u2019s office had fabricated the deaths to win political points.<\/p>\n Public health experts warned that the ongoing political controversy sows doubt in what was designed as an unimpeachable health resource \u2014 national disease surveillance \u2014 and detracts from the ultimate public health goal of limiting the spread of illness. <\/p>\n \u201cEvery data point is a broken family, a mother crying, a future that\u2019s lost. Instead of grieving that and making sure it never happens again, you\u2019re debating the mechanism of death,\u201d said Brian C. Castrucci, an epidemiologist and president and CEO of de Beaumont Foundation, a community health philanthropy outside Washington, D.C. <\/p>\n \u00bb READ MORE: What do we know about the deaths reported in Pennsylvania\u2019s measles outbreak?<\/a><\/p>\n Pennsylvania measles-related deaths<\/p>\n The Pennsylvania Department of Health reported the two deaths to the CDC the morning of Aug. 25, and professional staff at the CDC \u201cdid not express any concern regarding the information,\u201d Neil Ruhland, a department spokesperson, said in an email. <\/p>\n He described the communication that followed as an extension of the department\u2019s ongoing communications around the state\u2019s outbreak:<\/p>\n The next day, the state health department discussed the details of each case with CDC professional staff. The CDC requested records containing identifiable information, which the health department did not share, consistent with its past practices. <\/p>\n Shapiro has cited state privacy laws, and the need to protect the privacy of the families involved to ensure community trust, with limiting his ability to release more information. <\/p>\n Instead, the health department asked the CDC for a case report form to provide de-identified information. The health department says it has not yet received that form.<\/p>\n Pennsylvania health officials have a measles outbreak response meeting with the CDC every other week, and most recently met on Tuesday. <\/p>\n \u201cCDC professional staff have repeatedly made it clear that it has been supportive of DOH\u2019s measles outbreak response,\u201d Ruhland said. <\/p>\n The CDC\u2019s website says the agency plans to update its measles death count once it has completed its review of Pennsylvania\u2019s cases. But officials have not said what additional information they need from Pennsylvania or when they expect to complete their review.<\/p>\n The agency did not respond to a request for comment in time for publication. <\/p>\n Joshua Sharfstein, a physician who served as Maryland\u2019s Health Secretary from 2011 to 2014, said he has never heard of the CDC omitting disease surveillance data reported by states. <\/p>\n \u201cI wouldn\u2019t say it\u2019s off the table for the CDC to want more information,\u201d but the way the agency went about it in Pennsylvania\u2019s case is unusual, said Sharfstein, who also served as Baltimore\u2019s health commissioner and currently works as a health policy professor at Johns Hopkins University. <\/p>\n He said he would expect the agency to report Pennsylvania\u2019s data, while alerting officials they are looking for more information. \u201cIt\u2019s supposed to be a collaborative relationship,\u201d Sharfstein said. <\/p>\n Pennsylvania officials initially provided no additional information to the public about the two people who had died, other than they were unvaccinated Lancaster County residents. <\/p>\n The state\u2019s decision to call the deaths measles-associated came after the state health department\u2019s \u201cepidemiology team thoroughly investigated and verified both individuals tested positive for measles,\u201d Pennsylvania Health Secretary Debra Bogen said in a statement<\/a>.<\/p>\n Pennsylvania defines a measles-associated death as deaths of people where evidence of measles is present, even when the disease may not be assessed by the coroner as the immediate cause of death.<\/p>\n Lancaster County\u2019s coroner, Stephen Diamantoni, added confusion last week when he contradicted the state\u2019s account. <\/p>\n Diamantoni, a physician and elected Republican, said his office was investigating one death involving a newborn and said postmortem testing showed the infant had a measles infection acquired before birth. But he said he did not believe measles contributed to the child\u2019s death. <\/p>\n The child died shortly after birth of a lacerated spleen with trauma to the torso, Diamantoni said. He did not know what caused the lacerated spleen or trauma.<\/p>\n He later said measles was noted on the infant\u2019s death certificate as a significant condition \u201ccontributing to death but not resulting in the underlying cause,\u201d because the baby tested positive for measles.<\/p>\n On Friday, he said a 6-week-old Amish infant who was being treated for a deadly genetic disorder had died of measles<\/a> in mid-August. He said he did not know if the case was the second measles-related death Pennsylvania reported, saying that he reported the death to the CDC on Friday. <\/p>\n Pennsylvania\u2019s health department said it was aware of the information the coroner reported Friday and had \u201cno new measles-associated deaths to report at this time.\u201d<\/p>\n Shapiro reshared a news article about the death on X. In his post, he blamed Kennedy for creating \u201ca firestorm of conspiracy theories that denied these families\u2019 pain, invaded their privacy, and undermined public health.\u201d <\/p>\n \u201cIt\u2019s long past time for RFK to stop playing games with people\u2019s lives, report these deaths accurately on the CDC dashboard, and heed the guidance of actual medical experts so people get accurate information to discuss with their trusted healthcare providers and can best protect themselves and their children against this deadly disease,\u201d he wrote.<\/p>\n Kennedy fired back, highlighting the Lancaster coroner\u2019s disclosures, in another X post later on Friday: \u201cThe facts emerging now demonstrate why CDC waited for the evidence rather than allowing political grandstanding to dictate its reporting.\u201d<\/p>\n Politicizing public health<\/p>\n Fixating on whether a patient died \u201cbecause of\u201d or \u201cwith\u201d measles inevitably politicizes the issue and does not benefit people\u2019s health, Jake Scott, a clinical associate professor of infectious diseases at Stanford University, wrote in an opinion piece<\/a> published online by the Center for Infectious Disease Research and Policy at the University of Minnesota. <\/p>\n Measles usually kills through the complications it causes, such as pneumonia, encephalitis, secondary bacterial infections, and pregnancy complications, he wrote.<\/p>\n \u201cA death tally that can be altered by officials whom it embarrasses will not be trusted by anyone, including the officials who edited it,\u201d Scott wrote. <\/p>\n Diamantoni, Lancaster\u2019s coroner, told The Inquirer earlier this week he did not want \u201cto be dragged into a political fray.\u201d<\/p>\n \u201cOur role in our office is not political in any way. We\u2019re focused on determining the cause and manner of death, and using objective and scientific methods to do that,\u201d he said. \u201cWe\u2019ve worked hard to be sure that the information we\u2019re providing is based on objective things.\u201d<\/p>\n More than a week into the controversy, lawmakers continue to take political jabs.<\/p>\n \u201cI am disgusted the Trump administration is putting Pennsylvania families at risk by spreading dangerous misinformation and politicizing these tragic deaths,\u201d U.S. Rep. Brendan Boyle (D., Phila.) said in a statement. <\/p>\n Pennsylvania\u2019s highest-ranking federal lawmakers \u2014 U.S. Sens. John Fetterman<\/a>, a Democrat, and Dave McCormick<\/a>, a Republican \u2014 did not respond to a request for comment Thursday about the state\u2019s standoff with the CDC. McCormick voted to approve<\/a> Schwartz as the new CDC director; Fetterman voted against. <\/p>\n U.S. Rep. Brian Fitzpatrick<\/a> (R., Bucks), the only federal GOP lawmaker in the Philadelphia region, also did not respond to a request for comment. Neither did U.S. Rep. Lloyd Smucker, the Republican who represents Lancaster County and who blasted Shapiro last week<\/a> for not providing more information about the measles-associated deaths. <\/p>\n Measles outbreak continues <\/p>\n Public health leaders, doctors, and epidemiologists say that finding a path forward has become an increasingly partisan issue at a time of rising vaccine hesitancy. <\/p>\n Medical experts will be tasked with trying to rebuild trust in health authorities in order to contain a rapidly spreading outbreak.<\/p>\n \u201cHow can any American citizen begin to make decisions about their health right now, in the milieu of misinformation and falsehoods we\u2019ve created?\u201d said Castrucci, de Beaumont\u2019s CEO. \u201cWe have to get back to a point where at least the data can be trustworthy.<\/p>\n