The Centers for Disease Control and Prevention updated its measles dashboard on Friday but still did not count four measles deaths in Pennsylvania, even as doctors say the outbreak there is speeding up. Pennsylvania has reported 731 cases, and the gap in the death count has become part of the story because it lands while officials are still arguing over how measles deaths should be defined.
That question is not academic in Pennsylvania. A possible measles exposure was reported in the neonatal intensive care unit at Children's Hospital of Philadelphia last week, and Dr John Goldman said doctors are now treating congenital measles in newborns who contracted the virus in utero or at birth. He said the outbreak seems to be accelerating and added that doctors are seeing types of measles they have never seen before.
The pressure on the CDC grew again on Monday, when Members of Congress requested an immediate briefing on the decision to change how measles deaths are reported. The agency has said it is working with the Council of State and Territorial Epidemiologists to define deaths from measles, after relying on the World Health Organization's definition. Until that definition exists, the CDC is using National Center for Health Statistics data, which identifies measles as the underlying cause based on death record information submitted by the states.
That is why Pennsylvania's four deaths are still being left off the dashboard. Pennsylvania concluded the investigation on the first two deaths, yet the CDC has not counted any of the four. The mismatch has fueled concern among doctors and officials that the reported toll is running behind the outbreak itself, especially when the state's own case count is already high and the illness is appearing in newborns, where it was once exceedingly rare.
Dr Goldman said the pattern is what should worry people most. Measles can kill one to three people for every 1,000 cases, and he said, “It’s not rocket science. If we see more measles, we’ll see more deaths.” He also said, “I suspect that we’re not going to see a break until most people in most communities are immune either by vaccine or infection.”
The unresolved issue is not whether Pennsylvania has a serious outbreak. It does. The question is why the CDC still has not counted the four deaths while the state has already finished at least part of its review and the dashboard continues to be updated. Until the death definition is settled, the public count will remain the weaker number.
