The Keystone State has reached a somber threshold, with four confirmed measles-linked fatalities this year already exceeding the highest yearly total of such deaths in the United States since 1992. The Pennsylvania Department of Health announced the deaths in mid-September, and the state has logged over 800 measles infections, with outbreaks gathering strength within communities long marked by doubt about vaccines.
The oddity comes from comparing two counts. The CDC’s measles dashboard shows a single measles-related death this year, marked with an asterisk. That figure differs from the Pennsylvania tally, and the difference suggests a shift in how the federal government reports these deaths. Rather than depending on prompt state reports from health officials, the CDC now waits for death records from the National Center for Health Statistics (NCHS).
The CDC’s New Rule
Secretary Robert F. Kennedy Jr. of Health and Human Services has said that the CDC will now only count measles-caused deaths when the NCHS lists measles as the underlying cause, using death record data sent in by the states. This marks a change from how things were done before, when state health officials would report cases, including symptoms, hospitalizations, and deaths, directly to the CDC.
The shift means outbreak fatalities will no longer be visible on the CDC tracker right away. Instead they will surface only once death certificates are recorded, processed, and compiled by the NCHS — a procedure that can take weeks or months.
How Death Certificates Work
Local and state health officials, including doctors, medical examiners, and coroners, fill out death certificates. The information on those forms is later sent to the NCHS National Vital Statistics System through state vital registries. Submission timelines differ from state to state, and automated coding relies on the International Classification of Diseases system. More complicated cases sometimes require manual review, which can last weeks to months.
Researchers and decision-makers can find both underlying and contributing causes through the CDC WONDER database. However, the CDC tracker, which serves the public, currently displays only underlying cause data. This presents a more limited view of what is happening on the ground.
The Asterisk Problem
The CDC tracker currently has an asterisk next to its measles death count, which signals that the data has been suppressed to protect the privacy of the person who died. The National Center for Health Statistics does not report death counts in any category from one to nine. To see the actual death count on CDC WONDER, including for the CDC measles dashboard, the total number of measles-causing deaths in the U.S. without naming Pennsylvania or any other localities must exceed the threshold of 10.
Going forward, the CDC’s tracker dashboard will recognize measles-causing deaths only when measles is listed as the underlying cause on a death certificate, instead of being counted as a contributing cause.
What Gets Lost
The NCHS mortality statistics do not offer early warning for outbreaks when case counts are still small. That is precisely what the current system is designed to do — it signals trouble before it turns into a full-blown crisis. By contrast, the new system does not flag anything at all until the data are officially confirmed.
One example comes from Pennsylvania, where the state has confirmed four deaths but the CDC tracker still shows just one. The public sees a single death where the count is actually four.
Why This Matters
Numbers that reflect death counts matter for public health. If those numbers get undercounted or put off, trust gets lost. People stop seeing the figures as something worth following. They stop changing their behavior based on what they see.
It is the job of the CDC to tell the public what it knows, not to keep it hidden. Waiting before sharing numbers is better than never sharing them at all, but it is still not the best way to share information. That asterisk reveals something: the CDC prefers to hold back the full count until it can be released without causing alarm.
Pennsylvania’s health department has delivered its reports, counting the dead and offering the circumstances behind them. The CDC, however, has failed to fulfill its duty, keeping the complete toll from the public entirely hidden.
What Comes Next
Eventually, the CDC will confirm the Pennsylvania deaths using the NCHS process. Still, the asterisk will stay on the tracker even after NCHS verification, and the public will keep seeing a suppressed count below 10. As the outbreak continues to unfold, the public will only be shown a fraction of the toll.
The Pennsylvania figure represents a fuller count according to the standard definition used for tracking outbreaks. It takes in both underlying and contributing causes, and it shows what medical officials actually observed on the ground. The CDC figure is the number put forward for the public, though it arrives later.
| Stage | Action |
|---|---|
| Pennsylvania reports | Four confirmed measles-associated deaths |
| CDC dashboard shows | One measles-related death, with asterisk |
| NCHS process | Death certificate submission, coding, adjudication |
| CDC WONDER database | Both underlying and contributing causes |
| CDC tracker | Underlying cause only, suppressed below 10 |
A new CDC rule has added confusion to the count of measles deaths. The figure for Pennsylvania stands as the honest number in the traditional sense. The CDC’s figure, by contrast, is the delayed number. The public ought to have both figures, yet receives neither.
The asterisk is a warning flag.
Where the paper stands
The paper backs the citizens and local groups pushing back against government surveillance and is against the camera networks, data dragnets and vendors lobbying to keep them, even as it notes the federal measles death count differs from Pennsylvania’s and raises questions about how the government reports these deaths. The situation here is not about cameras or data collection, but it shares the same core concern: government secrecy and delay that keeps the public from knowing what it needs to know.
The CDC’s new rule for reporting measles deaths — waiting on NCHS death certificates instead of relying on state health officials — creates a gap between what Pennsylvania reports and what the public sees on the CDC tracker. That gap hides the full count of deaths while the outbreak gathers strength. The asterisk on the tracker is not a technical detail; it is a signal that the CDC prefers to hold back the full count until it can be released without causing alarm.
The paper wants the CDC to show the full count. Numbers that reflect death counts matter for public health. If those numbers get undercounted or put off, trust gets lost. People stop seeing the figures as something worth following. They stop changing their behavior based on what they see.
Source material: “Opinion: RFK Jr.’s use of the National Center for Health Statistics will add confusion to measles deaths count,” STAT.
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