Pennsylvania health officials request emergency assistance from the U.S. Centers for Disease Control and Prevention (CDC) as the state confronts a major measles outbreak, according to a document reviewed by Reuters and reported by other outlets. The request is also tied to a demand that the CDC recognize four measles-associated deaths reported by Pennsylvania.

The move heightens an ongoing standoff between Pennsylvania Governor Josh Shapiro and U.S. Health Secretary Robert F. Kennedy Jr. Multiple sources describe prior clashes between the state and the federal administration over how measles-related deaths should be determined and counted. Reuters and related reporting say Kennedy has questioned whether deaths reported in U.S. measles outbreaks since he took office are caused by the virus, and directed the CDC not to include Pennsylvania’s fatalities in a national tally. Disease experts cited in the coverage characterize this as unusual federal interference in state determinations.

Forbes’ account focuses on Pennsylvania’s call for emergency CDC aid and the issue of recognition of the deaths, framing it within the broader disputes involving Shapiro and Kennedy. Overall coverage converges on the outbreak-management request and the death-recognition condition as the central points.