Pennsylvania seeks CDC help amid dispute over US measles deaths

The CDC and officials from the US state differ over how four deaths should be classified as cases continue to spread.

A measles alert sign hangs outside the entrance to the Cohen Children's Medical Center on March 14, 2025 in New Hyde Park, New York, the United States [File: Shannon Stapleton/Reuters]

Pennsylvania has asked the United States Centers for Disease Control and Prevention (CDC) for help containing an expanding measles outbreak that has seen several people die, but says it will withdraw the request unless the federal agency recognises four measles-associated deaths reported by the state.

The CDC, however, said it has not been properly notified of any such request.

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The US is currently seeing the worst measles outbreak in the country since 1991, with several deaths over the last couple of years. Measles was declared eliminated in the US in 2000, but has made a comeback in recent years, which some have linked to a rise in vaccine scepticism . The US state of Pennsylvania has been hit especially hard.

In a letter sent to CDC Director Erica Schwartz on Wednesday, Pennsylvania Health Secretary Debra Bogen said the state had begun the process of requesting emergency assistance from the CDC, known as an Epi-Aid.

“The CDC’s choice not to publicly recognize the deaths undermines our response,” Bogen wrote. “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.”

However, in a statement to Al Jazeera, Grace Davis Jamison, press secretary for the US Department of Health and Human Services (HHS), said that the CDC had not received Pennsylvania’s request through its normal channels and that federal outbreak assistance was separate from how the agency tabulates deaths.

“CDC will not allow [Pennsylvania Democratic] Governor [Josh] Shapiro to politicize this process. We owe the American people accurate, consistent, and transparent public health information,” Jamison said. “CDC will not submit to political blackmail that conditions critical public health assistance. The people of Pennsylvania should never be used as leverage in a political dispute over how deaths are classified.”

Disagreement grows as Pennsylvania’s measles outbreak spreads

The dispute over the deaths began in August, when Pennsylvania reported that two unvaccinated people died of measles in Lancaster County, which is located in the South Central part of the state. Lancaster is considered the centre of Pennsylvania Dutch Country and home to the nation’s oldest Amish and Mennonite communities. Both communities have under-vaccinated populations.

The CDC initially included the deaths in its national tally, but subsequently removed them after Health Secretary Robert F Kennedy Jr questioned whether measles had caused or contributed to the fatalities. The agency said at the time that available information did not establish whether measles caused or contributed to the deaths.

Pennsylvania continued to stand by its determination.

The outbreak has spread well beyond its initial epicentre in Lancaster County. On September 13 , a county coroner reported that a 40-year-old woman had died from complications associated with measles. The state later confirmed the death as measles-associated and announced two additional deaths on September 15. All four people were unvaccinated, according to the state.

The state reported 393 cases across 28 counties when the first two deaths were announced on August 25. Pennsylvania now reports 731 confirmed cases across 38 counties and 141 hospitalisations. Of those reported cases, only four people, or less than one percent, are vaccinated.

What are officials arguing about?

The disagreement between Pennsylvania and the CDC centres on the distinction between a “measles-associated” death versus a death “caused” by measles. Pennsylvania uses “measles-associated” under its state surveillance definition, while HHS said it is working with the Council of State and Territorial Epidemiologists to establish a standardised definition for measles deaths.

Infectious disease experts warn that the dispute over how to classify the deaths puts the CDC at odds with a long-standing approach to tracking the consequences of measles. Matthew Ferrari, director of Pennsylvania State University’s Center for Infectious Disease Dynamics, told Al Jazeera that “measles-associated” death has long been a standard used by the World Health Organization and CDC.

“It’s the most useful distinction because it is a case that could have been prevented by a measles vaccination, or by early detection and isolation,” Ferrari said. “Measles is severely immunocompromising, so it is very often a secondary infection that is the ultimate cause of death.”

Experts say the CDC’s dispute with Pennsylvania risks distracting from efforts to contain the outbreak. Dr Andrew Pavia, spokesperson for the Infectious Diseases Society of America and professor at the University of Utah, told Al Jazeera the distinction should not be controversial.

“The impact, though, is confusion for the public and erosion of trust in the ability of CDC staff to communicate to the public without political interference,” Pavia said.

HHS said federal outbreak assistance and national mortality reporting are separate processes and rejected the idea that the two should be linked.

How would an Epi-Aid help Pennsylvania?

An Epi-Aid is a CDC mechanism for providing rapid, short-term assistance during an urgent public health problem. The CDC says Epi-Aids generally last one to three weeks, during which they deploy Epidemic Intelligence Service officers to analyse epidemiological data, evaluate surveillance systems, and recommend measures to control and prevent the spread of disease.

The requesting health authority retains overall leadership of the investigation, while CDC personnel provide technical assistance, including epidemiological expertise and access to laboratory resources.

“The most important thing for an effective response is communication and trust,” Ferrari said. “It is important for all partners to agree on the foundational elements of the problem and the metrics for evaluating the severity of the problem.”

随着病例持续蔓延，美国疾病控制与预防中心和州政府官员对四例死亡病例的分类存在分歧。

2025年3月14日，美国纽约州新海德公园，科恩儿童医疗中心入口外悬挂着麻疹警示标志。[图片：Shannon Stapleton/路透社]

宾夕法尼亚州已向美国疾病控制与预防中心 (CDC) 请求帮助，以控制不断扩大的麻疹疫情，该疫情已导致多人死亡。但该州表示，除非联邦机构承认该州报告的四例与麻疹相关的死亡病例，否则将撤回请求。

然而，疾控中心表示，尚未收到任何此类请求的正式通知。

（共3位共和党参议员之一）在麻疹死亡人数上升之际抨击特朗普疫苗政策

美国卫生部门对宾夕法尼亚州麻疹相关死亡人数提出异议（名单共3份）。

（共3条）卫生官员称，美国已有第三人死于麻疹。

美国目前正经历自1991年以来最严重的麻疹疫情，过去几年已有数人死亡。麻疹曾于2000年在美国被宣布消除，但近年来卷土重来，一些人认为这与疫苗怀疑论的抬头有关。宾夕法尼亚州受灾尤为严重。

宾夕法尼亚州卫生部长黛布拉·博根周三在致美国疾病控制与预防中心主任埃里卡·施瓦茨的信中表示，该州已开始向美国疾病控制与预防中心申请紧急援助，即“流行病援助”。

博根写道：“疾控中心选择不公开承认这些死亡病例，削弱了我们的应对措施。因此，如果疾控中心无法透明、准确地传达有关这些麻疹相关死亡病例的信息，卫生部将撤回我们向疾控中心提出的流行病援助请求。”

然而，美国卫生与公众服务部 (HHS) 新闻秘书格蕾丝·戴维斯·贾米森在接受半岛电视台采访时表示，美国疾病控制与预防中心 (CDC) 没有通过正常渠道收到宾夕法尼亚州的请求，而且联邦疫情援助与该机构统计死亡人数的方式是分开的。

“疾控中心不会允许宾夕法尼亚州州长（民主党人）乔什·夏皮罗将这一过程政治化。我们有义务向美国人民提供准确、一致且透明的公共卫生信息，”杰米森说。“疾控中心不会屈服于任何以政治勒索为条件提供关键公共卫生援助的行为。宾夕法尼亚州人民绝不应被当作政治筹码，卷入关于死亡病例分类的政治纷争。”

宾夕法尼亚州麻疹疫情蔓延，分歧加剧

这场关于死亡事件的争议始于8月，当时宾夕法尼亚州报告称，兰开斯特县有两名未接种疫苗的人死于麻疹。兰开斯特县位于该州中南部，被认为是宾夕法尼亚荷兰乡村的中心，也是美国最古老的阿米什人和门诺派教徒社区的所在地。这两个社区的疫苗接种率都很低。

美国疾病控制与预防中心最初将这些死亡病例纳入全国统计数据，但在卫生部长小罗伯特·F·肯尼迪质疑麻疹是否直接或促成了这些死亡病例后，该中心随后将其删除。该机构当时表示，现有信息不足以确定麻疹是否直接或促成了这些死亡病例。

宾夕法尼亚州继续坚持其决定。

疫情已远远超出最初的兰开斯特县中心区域。9月13日，该县验尸官报告称，一名40岁女性死于麻疹并发症。州政府随后确认该死亡病例与麻疹相关，并于9月15日宣布新增两例死亡病例。据州政府称，这四人均未接种疫苗。

8月25日宣布首例死亡病例时，宾夕法尼亚州报告了28个县共393例确诊病例。目前，宾夕法尼亚州报告38个县共731例确诊病例，其中141例住院治疗。在这些确诊病例中，仅有4人接种过疫苗，接种率不到1%。

官员们在争论什么？

宾夕法尼亚州与美国疾病控制与预防中心（CDC）的分歧主要在于区分“麻疹相关”死亡和“由麻疹引起”的死亡。宾夕法尼亚州在其州级监测定义中使用“麻疹相关”一词，而美国卫生与公众服务部（HHS）表示，正在与州和地区流行病学家委员会合作，制定麻疹死亡的标准化定义。

传染病专家警告说，关于如何对死亡病例进行分类的争议，使美国疾病控制与预防中心（CDC）长期以来追踪麻疹后果的方法相悖。宾夕法尼亚州立大学传染病动力学中心主任马修·法拉利告诉半岛电视台，“麻疹相关”死亡长期以来一直是世界卫生组织和美国疾病控制与预防中心使用的标准。

“这是最有用的区分，因为这种病例原本可以通过接种麻疹疫苗或早期发现和隔离来预防，”法拉利说。“麻疹会严重损害免疫系统，因此，导致死亡的往往是继发感染。”

专家表示，疾控中心与宾夕法尼亚州的争议可能会分散人们控制疫情的注意力。美国传染病学会发言人、犹他大学教授安德鲁·帕维亚博士告诉半岛电视台，这种区别不应该引起争议。

帕维亚说：“但这对公众造成了困惑，并削弱了公众对疾控中心工作人员在不受政治干预的情况下与公众沟通能力的信任。”

美国卫生与公众服务部表示，联邦疫情援助和国家死亡率报告是两个独立的过程，并驳斥了将两者联系起来的想法。

Epi-Aid 能如何帮助宾夕法尼亚州？

流行病援助计划（Epi-Aid）是美国疾病控制与预防中心（CDC）在应对紧急公共卫生问题时提供快速短期援助的机制。CDC表示，流行病援助计划通常持续一到三周，在此期间，CDC会派遣流行病情报服务人员分析流行病学数据、评估监测系统，并提出控制和预防疾病传播的措施建议。

提出请求的卫生部门保留调查的总体领导权，而疾控中心人员提供技术援助，包括流行病学专业知识和实验室资源。

法拉利表示：“有效应对的关键在于沟通和信任。所有合作伙伴必须就问题的基本要素以及评估问题严重程度的指标达成一致。”