CDC Confirms Third U.S. Measles Death of 2026 as Pennsylvania Counts Five

Since Pennsylvania announced its first deaths in August, the state and the federal government have been counting differently. On Tuesday, Oct. 20, the CDC added a third death to its national tally. It did not say which state it occurred in.

The CDC said it confirmed the death after the National Center for Health Statistics verified that measles was listed as the underlying cause of death on a death certificate. The agency also said its count could change as further reviews are completed.

Pennsylvania had 1,286 confirmed cases and five measles-associated deaths as of Monday, Oct. 19. The CDC reported 4,410 cases nationwide as of Oct. 15.

Why the numbers don't match

The CDC's method changed. It now relies on NCHS mortality data rather than reports from state health departments. The agency has told Al Jazeera it is working with the Council of State and Territorial Epidemiologists (CSTE) on a standardized definition of a measles death. Until that exists, NCHS data is its measure.

Pennsylvania uses its own definition. The Department of Health counts a measles-associated death when it occurs within 30 days of symptom onset in a person with clinical evidence of measles and a positive lab test, and when the person did not die of an unrelated cause. The definition is modeled on national definitions for influenza- and RSV-associated deaths. The department does not count a death if the person fully recovered from measles beforehand.

Before Tuesday, the CDC had acknowledged only two measles deaths on its data dashboard and had not specified where they occurred. It has said the other Pennsylvania deaths are "under review." The CDC has not said how many of its three deaths are in Pennsylvania. The state has five confirmed.

The state's confirmed deaths include two infants and another resident in Lancaster County, an 18-year-old in Mifflin County and a 40-year-old woman in Jefferson County.

A sixth death under review

The Franklin County coroner's office reported a sixth death on Oct. 12. The victim was a 39-year-old woman with several underlying conditions. A spokesperson for the office said the primary cause of death was "a probable acute cardiac event due to possible complications of the measles."

The coroner's office did not say when she was diagnosed or whether she had recovered from measles before she died. The state Health Department says it is conducting a thorough review.

The political fight

Health Secretary Debra Bogen wrote to CDC Director Erica Schwartz on Friday, Oct. 16, demanding that all Pennsylvania deaths be acknowledged and asking how the CDC tracks them. "By not acknowledging the deaths, the CDC obscures the seriousness of this disease and the toll of measles across the U.S," Bogen wrote.

The dispute has become personal. Gov. Josh Shapiro, a Democrat, has blamed Health and Human Services Secretary Robert F. Kennedy Jr. for spreading misinformation that contributed to lower vaccine rates. At an unrelated media event in Chester County that Friday, Shapiro called Kennedy a "grifter" who "continues to sow doubt, continues to lie about what's happening here in the commonwealth of Pennsylvania, and continues to play games."

Kennedy has suggested Shapiro's staff "fabricated" at least one of the first two reported deaths. His claim followed a county coroner's statement that he believed a Lancaster County infant died of a lacerated spleen, not measles. Prominent physicians have noted that measles can weaken the spleen and make it vulnerable to rupture. State officials maintain that all five confirmed deaths fit the state definition.

Federal help is arriving anyway

The CDC announced last week that it would send an Epidemic Intelligence Service officer, a "disease detective," to Pennsylvania. State officials said the officer would arrive Monday under the agency's Epi-Aid program. The CDC is also releasing nearly $4 million for the state's response.

Pennsylvania accepted the help. Officials said they want the CDC's expertise in understanding how measles is spreading and how large the outbreak really is. Experts have warned for months that many cases are likely going unreported to the state.

The outbreak has reached 42 counties and has passed South Carolina's 997-case outbreak, which ended with no deaths. Lancaster County, the center of the outbreak, had more than 415 confirmed cases as of Oct. 9. It is the largest county in Pennsylvania without its own health department. Alice Yoder, a Lancaster County commissioner and former critical care nurse, told the Guardian that without one the county is at a clear disadvantage.

What the numbers would predict

The CDC has long estimated one to three measles deaths per 1,000 cases. At that rate, 1,286 cases would imply roughly one to four deaths. Matthew Ferrari, director of Penn State's Center for Infectious Disease Dynamics, said the outcomes in these outbreaks are "entirely within the level of variation that we would expect."

Scott Thorpe, a former South Carolina public health official who now leads the Southern Alliance for Public Health Leadership, said chance plays a large role in who gets severe disease. South Carolina's cases were mostly school-age children, who are generally at lower risk of severe complications than infants and older adults.

Still unresolved: the CDC has not said where its three deaths occurred, and CSTE has not issued its national definition. Pennsylvania has not ruled on the Franklin County case, and it is not clear whether the CDC will add any of the state's remaining deaths to the federal count.