Science1 publisher2 min readPublished
CDC director says the agency was not notified of Pennsylvania's third measles death
Pennsylvania has recorded 676 measles cases and three deaths in recent weeks. The CDC has not registered the two infant deaths as measles-related, and its director says the state did not notify the agency of the third.
The Scientist · Science desk
What happened
- A 40-year-old woman died Saturday in Pennsylvania from measles-related illness, the third death involving measles in the state in recent weeks.
- The state had recorded 676 measles cases as of Friday, the day before the woman died, so her case falls outside that tally.
- CDC Director Erica Schwartz said late Sunday the agency had not been notified of the latest death and that the state has not taken up repeated offers of on-the-ground outbreak support.
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Why it matters
- contradiction A county coroner has attributed three deaths to measles while the federal record holds fewer, so the measles fatality figure circulating this week depends on which body is counting.
- exposure Anyone sizing risk from a federal table right now is working from a number that leaves out two deaths the state has counted. That understatement lands hardest on parents of infants too young to be vaccinated.
- constraint If the CDC's account of unaccepted support offers is right, case finding and contact tracing in a 676-case outbreak rest on state capacity alone. That capacity is a limit on how far the denominator can be trusted to be complete.
Three deaths divided by 676 confirmed cases is a crude fatality ratio of 0.44 percent [11]. Count only the death a coroner certified this weekend, and set aside the two infants the CDC has not registered, and the same denominator gives 0.15 percent [12]. The gap is all in the numerator: three deaths or one, against the same 676 cases [13].
Both figures are provisional in the ordinary way. The 676 count was current as of Friday and the woman died Saturday, so she is not in it [14]. Any infections that never reached a clinician are not in it either, and each one that surfaces later pushes the crude ratio below 0.44 percent [15].
Greg Furlong, the coroner for Jefferson County, reported the death in a statement posted to Facebook; the woman was 40 and was not identified, according to STAT [2]. "This is a heartbreaking loss for the family and an unfortunate reminder that measles can be a serious and potentially life-threatening disease," he said [3].
Late Sunday, CDC Director Erica Schwartz said in a statement that the agency had not been notified by Pennsylvania officials of this latest death [8]. She also said the state has yet to avail itself of repeated offers from the CDC to provide "on-the-ground measles outbreak support" [9]. STAT's Helen Branswell described the statement as an apparent rebuke of the state's handling of the outbreak [10]. A federal death tally is assembled from what states send in, so a missing notification is one reason the two records do not agree.
Attribution is the other reason. Health Secretary Robert F. Kennedy Jr. has disputed the role measles played in the two infant deaths, and the CDC has not yet registered either as measles-related [6][7]. Neither side has published the evidence it is relying on. Until the records are reconciled, a practitioner reading a federal count is reading a figure that excludes two of the three deaths Pennsylvania has counted [1][7].
The question a parent in Jefferson County is asking is risk given exposure and vaccination status, which is a different question from either ratio. The case-fatality ratio in an active outbreak is a summary of surveillance, and the state and the federal agency are arguing about the surveillance itself [8][9].
What to watch
- Whether the CDC registers the Jefferson County death and the two infant deaths, and on what evidence each determination rests.
- Whether Pennsylvania takes up the CDC's offer of on-the-ground outbreak support, and whether reported case counts move once federal staff are in the field.
- The next state case update: the 676 figure was dated Friday, before the third death.