Pennsylvania reports teen as fourth measles death amid feud with RFK Jr.

The Trump administration has altered its method of counting measles deaths amid a Pennsylvania outbreak, following the third apparent measles-related death reported by a local coroner on Sunday. The US Centers for Disease Control and Prevention (CDC) now relies on data from the National Center for Health Statistics (NCHS) to track mortality trends over time, according to a note published on the agency's website on September 4.

Former CDC chief medical officer Debra Houry described this change as "puzzling", stating that it doesn't make sense since the system is not meant to confirm individual cases but rather focus on long-term mortality trends. Previously, the CDC used the National Notifiable Diseases Surveillance System (NNDSS), which aggregates data from local jurisdictions and states to the federal government.

The CDC will only report measles deaths if the National Center for Health Statistics reports measles as the underlying cause on the death certificate. Pennsylvania has confirmed two measles-related deaths this year, a newborn and a six-week-old infant, as well as a 40-year-old woman in Jefferson county who died on Saturday from probable measles.

The woman was unvaccinated, had COPD with oxygen support, and had not sought medical care for her symptoms. She had the classic measles rash and symptoms, and a close contact had recently tested positive for measles. The death will be classified as probable measles-related due to the epidemiological connection to a confirmed case.

Pennsylvania has reported 676 confirmed measles cases as of Friday, but officials believe the actual case numbers are an undercount. The county's coroner emphasized the importance of maintaining a measles immunization rate of at least 95% to protect vulnerable individuals, including infants and pregnant people.