Pennsylvania Has 731 Measles Cases, 141 Hospitalizations and Four Dead, and Asked the CDC for Emergency Help. Then It Said It Will Withdraw the Request Unless the Agency Counts the Deaths RFK Jr. Ordered Removed From the National Tally. HHS Called That 'Political Blackmail.'

Pennsylvania has asked the Centers for Disease Control and Prevention for emergency help containing the worst measles outbreak the United States has seen since 1991, and in the same breath told the agency it will withdraw the request unless the CDC publicly recognizes the four Pennsylvanians who have died. The standoff, first reported by Reuters, pits Gov. Josh Shapiro's administration against Health and Human Services Secretary Robert F. Kennedy Jr., who intervened to keep the state's first two deaths out of the national count.

As of Wednesday, the state Department of Health had confirmed 731 cases across 38 counties, up from 393 cases in 28 counties when the first deaths were announced on Aug. 25. One hundred forty-one people have been hospitalized. Fewer than 1% of the cases are in vaccinated people, and all four who died were unvaccinated. The epicenter is Lancaster County, in Pennsylvania Dutch Country, home to the nation's oldest Amish and Mennonite communities, where vaccination rates lag.

The first two deaths, in August, were in Lancaster County; one was a newborn who tested positive for measles and died shortly after birth from a lacerated spleen. On Sept. 1, the CDC removed those deaths from its national tally. A 40-year-old woman died of respiratory failure from measles on Sept. 13, and on Tuesday the state announced two more deaths, including an 18-year-old who developed a rare and severe neurological complication. The state classifies all four as "measles-associated" deaths, a standard that infectious disease experts say matches World Health Organization practice and the CDC's own historical approach. HHS has said the federal and state agencies use different classification standards.

In a letter to CDC Director Erica Schwartz, Health Secretary Debra Bogen said the state had begun the process of requesting an Epi-Aid, the CDC's mechanism for sending a team of epidemiologists into the field, typically for one to three weeks. But she attached a condition. "CDC's choice not to publicly recognize the deaths undermines our response," Bogen wrote, and if the agency "is unable to transparently and accurately communicate information about those measles-associated deaths, the Department will respectfully rescind its request for a CDC Epi-Aid." The state had earlier resisted federal assistance, and Bogen's letter marks a reversal driven by the outbreak's growth.

HHS responded with unusual heat. Spokesperson Grace Davis Jamison said the agency had not received a request for an Epi-Aid through "normal channels," that "CDC will not submit to political blackmail that conditions critical public health assistance," and that "CDC will not allow Governor Shapiro to politicize this process." Matthew Ferrari, director of Penn State's Center for Infectious Disease Dynamics, and Dr. Andrew Pavia of the Infectious Diseases Society of America have both said the state's classification is consistent with established public health practice. Measles was declared eliminated in the United States in 2000.