The new director of the Centers for Disease Control and Prevention ordered agency officials to challenge two measles deaths reported by Pennsylvania, shunning the agency’s normal procedure of accepting data shared by states and amplifying comments made by her boss, Health Secretary Robert F. Kennedy Jr.
The incident draws the C.D.C. into a highly political disagreement about whether the deaths were a result of measles or merely coincided with the infection, echoing similar disputes over causes of death during the coronavirus pandemic.
It also pits the agency against a state health department, an extraordinary move for the C.D.C. But the episode is emblematic of the Trump administration’s continuing tussle with states, particularly those led by Democrats, over health policies and priorities.
“This week’s measles outbreaks update will not include the two measles-associated deaths reported by the Pennsylvania Department of Health on Aug. 25,” the C.D.C. posted on its website, after Mr. Kennedy, in a social media post, accused the state’s Democratic governor of “manipulating” the truth.
One of the two deaths involved a newborn with a ruptured spleen. Details of the second case have not been disclosed, but both people were unvaccinated and both tested positive for the measles virus, according to the Pennsylvania Health Department.
Dr. Erica Schwartz, who has expressed strong, public support of childhood vaccines, was confirmed as C.D.C. director this month, despite persistent questions during her confirmation hearing about her willingness and ability to push back against Mr. Kennedy’s actions. She has repeatedly promised to “follow the science” and promised the agency’s staff that she was prepared to disagree with her superiors when needed, and that she would work to build trust with state partners.
But the current incident threatens to do the opposite, some public health experts cautioned.
“Having the C.D.C. question what the state is sharing will only lead to a further erosion of what is a really critical partnership between states and the federal government,” said Dr. Anne Zink, a public health expert at Yale University and a former chief medical officer for Alaska.
Dr. Schwartz did not respond to a request for comment.
The Department of Health and Human Services, which oversees the C.D.C., said the agency “has a responsibility to ensure its reporting accurately and transparently reflects what is known and what remains unconfirmed.”
“The two measles-associated deaths announced by Pennsylvania have not been confirmed based on the information currently available to C.D.C.,” the department said in a statement. “The information currently posted reflects the best available information and our commitment to transparency and telling the American people the truth — a foundational principle of the Trump administration.”
Pennsylvania is in the midst of a rapidly expanding measles outbreak that had sickened 497 people and hospitalized 87 as of Monday. Following the standard process for reporting cases of notifiable diseases like measles, the state’s Health Department reported two deaths to the C.D.C. last week, saying two people had tested positive for measles.
At a news conference last Tuesday, Gov. Josh Shapiro said the federal government was partly to blame for the hesitancy surrounding measles vaccinations.
“When the information we see coming from the federal government in some cases isn’t driven by facts and by science,” he said, “it makes it even more confusing for parents, and that has a serious impact.”
In a social media post on Wednesday, Mr. Kennedy accused the governor of taking “giddy delight in announcing two measles deaths” and suggested the deaths may have been “fabricated by one of the Governor’s hopeful staffers.” He added, “The Lancaster County Coroner says that it has no record of any measles deaths.” Contrary to Mr. Kennedy’s assertion, however, the state is not required to inform the county coroner of all deaths.
The state’s Health Department characterized the deaths as “measles-associated.” It uses that term “when laboratory or epidemiologic evidence of measles is present, but the disease may not be assessed by the medical certifier or coroner to be the immediate cause of death,” the department clarified in a social media post.
The disagreement involves in part the report of a newborn, whose mother was sick with measles, and who died shortly after birth. Although the newborn tested positive for the virus as well, the immediate cause of death was a ruptured spleen, Dr. Stephen Diamantoni, the Lancaster County coroner, said in an interview. Measles is more typically associated with complications such as pneumonia and encephalitis, but infection can lead to an enlarged spleen, which may make the organ more vulnerable to rupture.
On Friday, the C.D.C. did not update its weekly tally for measles cases and deaths as it was expected to, saying only that the update had been “delayed.” Staff members then updated the site on Sunday, appending an asterisked explanation about the Pennsylvania deaths that the “available information does not establish whether measles caused or contributed to the deaths or whether the individuals died from other causes while infected with measles.”
Dr. Schwartz ordered that highly unusual statement be added to the website, according to officials with knowledge of the events, who spoke on the condition of anonymity because they were not authorized to talk about the matter.
“C.D.C. has historically relied on expertise of state and local health departments,” said Dr. Debra Houry, who served as the agency’s chief medical officer until she resigned a year ago.
“This is a moment for the C.D.C. director to speak publicly about the outbreak,” Dr. Houry said. “Delays in reporting of data further erode trust and create confusion.”
Neil Ruhland, a spokesman for the Pennsylvania Department of Health, said the state had meticulously investigated the deaths. “Every reported measles case is thoroughly reviewed to confirm it meets the Centers for Disease Control and Prevention’s (C.D.C.) case definition for a measles case. To date, D.O.H. has provided all required epidemiological data to the C.D.C.”
Dr. Zink said she could not remember a time when the C.D.C. publicly questioned a state’s determination of cause of death. State officials are increasingly “choosing not to share data with the C.D.C. because of mistrust how it might be used,” she said.
“It’s definitely unusual, tragic and frustrating to see publicly this sort of back-and-forth disagreement with counties, states and the federal government over the cause of death,” she added.
Having a lacerated spleen may not be a well-known complication in part because experts know little about how measles affects a fetus, said Dr. William Moss, a measles expert at the Johns Hopkins Bloomberg School of Public Health. Congenital measles has been exceptionally rare since the virus was declared eliminated in 2000, and measles infection in pregnancy significantly increases the risk of miscarriage or stillbirth.
It is possible that the C.D.C. is hesitating to document the deaths in order to further investigate the exact cause, Dr. Moss said. But that does not explain why the agency failed to log the second death reported by Pennsylvania health officials as related to measles, he said.
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