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Two measles-associated deaths in Pennsylvania last week were omitted from the Centers for Disease Control and Prevention’s latest measles outbreak update, continuing an increasingly political clash over the nature of the deaths announced by the state last week.

The two deaths reported by Pennsylvania — the first in the country this year — were not included because ”available information does not establish whether measles caused or contributed to the deaths or whether the individuals died from other causes while infected with measles,” the agency says in an update posted to the CDC’s website Sunday.

President Donald Trump’s head of the Department of Health and Human Services, Robert F. Kennedy Jr., has disputed what Democratic Gov. Josh Shapiro and state health officials have disclosed about the deaths.

Kennedy, a longtime anti-vaccine activist, wrote on X that the deaths may have been “fabricated” by the Shapiro administration, which has confirmed the deaths announced last Tuesday were “measles-associated.”

Pennsylvania “thoroughly reviews” all reported measles cases to ensure they meet CDC definitions and has provided “all required epidemiological data” on the measles-associated deaths to the CDC, state health department spokesperson Neil Ruhland said in a statement.

The state health department said it has death and medical records associated with the cases and the department’s investigation of them. The state does not disclose death certificates but does provide “de-identified” information to the CDC.

“DOH values its long-standing collaborative relationship with professional staff at the CDC and will continue to work with federal partners moving forward to address the ongoing measles outbreak,” Ruhland said.

The department declined to comment on “information the CDC may have obtained from third parties.” Kennedy said last week on social media the state was not providing requested information to the CDC.

“CDC has a responsibility to ensure its reporting accurately and transparently reflects what is known and what remains unconfirmed,” HHS press secretary Grace Davis Jamison said in a statement Monday, adding that Pennsylvania’s two announced measles-associated deaths “have not been confirmed based on the information currently available to CDC.”

Shapiro’s administration did not respond to a request for comment. He told reporters on Friday that “getting into a back-and-forth with people online who are spewing irresponsible conspiracy theories” does not “serve the public interest.”

Measles cases in Pennsylvania

The CDC publishes weekly updates tallying measles cases and deaths by state, tracking the spread of a highly contagious disease that was once considered eradicated in the United States due to widespread vaccination.

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As of Thursday, 2,887 confirmed measles cases were reported by 47 states, with another 16 cases reported among international visitors, according to the CDC’s latest update.

As of Monday, Pennsylvania had reported 497 measles cases in 2026, with 87 hospitalizations, amid the state’s largest outbreak in three decades. Officials said they had recorded 100 new cases in just a week, and half of Pennsylvania’s counties have now reported at least one measles case this year.

About a third of the cases were diagnosed in children under 18. All were in unvaccinated residents. The disease is so contagious that it can infect nine in 10 unvaccinated people.

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Pennsylvania health officials have said they define “measles-associated deaths” as deaths of people where evidence of measles is present, even when the highly contagious disease may not be assessed by the coroner as the immediate cause of death.

The state has not provided any additional information on the deaths beyond confirming both people were unvaccinated residents of Lancaster County, and one patient was a newborn.

Measles deaths are rare. Although most patients recover after mild illness, the virus can cause pneumonia and brain swelling and kills about one to three patients in 1,000.

Controversy around communications

Public health experts have said that, by not disclosing information like the victims’ ages, reasons for being unvaccinated, and causes of death, state officials created an information vacuum in which conspiracy theories could spread.

Officials said that state law prevents them from revealing more details about the deaths.

“There’s been a complete politicization of this event,” said Paul Offit, a Children’s Hospital of Philadelphia physician who heads the hospital’s Vaccine Education Center.

A longtime Kennedy critic, Offit said the state should have released more information on the deaths to prevent a “void” for conspiracy theorists to fill.

He’s also concerned that debate over the deaths will obscure efforts to address the growing outbreak centered in Lancaster County, which has some of the lowest kindergarten vaccination rates in the state.

“It’s August. This is only going to get worse. What can we do to prevent more children suffering and being hospitalized?” he said. “That’s really the question, and that’s not the question we’re asking.”

Democratic state lawmakers who are also medical professionals came to Shapiro’s defense on Monday, saying that the governor was right to announce the deaths and that it wasn’t surprising to see the ensuing public debate.

“Our governor had a responsibility to speak out. We’re glad that he did,” said State Sen. Maria Collett, a Montgomery County Democrat and registered nurse.

State Rep. Arvind Venkat, an Allegheny County Democrat and an emergency physician, said an immediate determination of death can be imprecise and require further evaluation. He urged the public to not “get distracted by this debate about the immediate versus underlying cause of death” when there is no doubt that the infant contracted measles in utero.

“I’ve had to fill out death certificates,” Venkat said. “It’s not a simple thing, and I’m not surprised that there is this controversy. But I think we’re losing the forest for the trees.”

State Rep. Bridget Kosierowski, a Lackawanna County Democrat and nurse, said advocating for vaccination to stop the spread of measles was personal.

On Monday morning, she was receiving treatment for breast cancer and considering the outsized impact measles would have on her and other patients if they weren’t vaccinated.

“It is really dangerous, and the outcomes can be catastrophic for people that are fighting cancer right now,” Kosierowski said.

What’s known about the measles death

Lancaster County’s coroner has said he handled one of the deaths, a newborn who died shortly after birth.

The coroner, Stephen Diamantoni, has said the child had a measles infection acquired before birth and died from a ruptured spleen, citing trauma to the torso. Diamantoni, a Republican elected official, said he was still investigating and that he does not believe measles was the cause of death. Measles can cause the spleen to become fragile, heightening the risk of rupture, Offit has noted, saying the coroner’s statements were also adding to the public confusion.

Diamantoni told The Inquirer last week that he had spoken with the CDC about his conclusions on the child’s death. He did not respond to an additional request for comment on the child’s death certificate on Monday.

Measles was listed on the baby’s death certificate, he told the Pittsburgh Tribune-Review, in a section of the certificate that reports other “conditions contributing to death but not resulting in the underlying cause.” Measles was included on the death certificate “to offer a broader view of the general health of the child,” he told the Pittsburgh paper.

The CDC’s latest measles update features an asterisk in lieu of a number for measles deaths in 2026, explaining that the agency is reviewing “additional information regarding the circumstances and causes of death.”

The agency updated the dashboard multiple times this weekend, and at one point had included the two deaths, the Washington Post reported.

“The information currently posted reflects the best available information and our commitment to transparency and telling the American people the truth — a foundational principle of the Trump Administration,” said Jamison, the HHS press secretary.

Lancaster Online reported late on Monday that Diamantoni said his office is investigating another death of a person infected with measles.

He would not provide details on the circumstances of the person’s death and said he was investigating “if measles has played any role.”

State health officials would not confirm whether the case Diamantoni is investigating is the second-measles associated death announced last week, Lancaster Online reported, adding that Diamantoni said his office “did not get information about the death from the state.”

A Lancaster family grieves

An Amish family in Lancaster County detailed in an article published Sunday in The Atlantic how their son had died shortly after birth earlier this month, after his mother was infected with measles.

The child had died on the same day as the newborn whose death was investigated by Diamantoni, who would not confirm the baby’s identity to The Atlantic.

The family has 13 surviving children, all of whom recently contracted measles. Only the father, identified by a pseudonym in The Atlantic, had been vaccinated against measles. Both parents said they did not have “strong feelings against vaccination.”

They had not known that their child’s death was potentially at the center of a national controversy and did not know who Shapiro or Kennedy were, they said.

They also hadn’t spoken to the coroner about the cause of their child’s death, but assumed that his mother’s illness had contributed. A midwife had told them measles was likely a factor in the boy’s death, they said in the report.

Still grieving the loss of their child, they said his death was “part of God’s plan,” the magazine reported.

The father confirmed to an Inquirer reporter that he had spoken to the Atlantic but declined to comment further.

Inquirer staff writers Sam Janesch and Michelle Baruchman contributed to this article. Editor’s note: This story has been updated with additional comment and developments.