What We Know About Pennsylvania’s Two ‘Measles-Associated’ Deaths

After the Pennsylvania Department of Health announced two cases of measles-related deaths in one county, the local coroner appeared to contradict the account. And in an ongoing spat with Pennsylvania Gov. Josh Shapiro, Health and Human Services Secretary Robert F. Kennedy Jr. has alleged that a Shapiro staffer may have even “fabricated” the deaths. We’ll lay out what we know.

The saga brings to mind a pandemic-era falsehood that the vast majority of people classified as dying from COVID-19 did not die of the disease, but died of other causes while they happened to be infected. And when two children died of measles complications in Texas last year, Kennedy, along with activists in his former nonprofit, baselessly alleged that the kids did not die of measles, despite evidence to the contrary.

The situation in Pennsylvania is less clear. One of the deaths appears to be of an infant who tested positive for measles and died of a ruptured spleen. It is possible that the rupture was due to infection with measles, but the coroner has said the pathologist determined measles was not involved. There is no information about the second death. Meanwhile, the state has acknowledged that the term it has used to describe the deaths – “measles-associated” – includes cases in which measles infection is detected but “may not be assessed by the medical certifier or coroner to be the immediate cause of death.” 

As we’ll explain, that statement may not mean as much as it appears to, since measles deaths would not be expected to have measles listed as an immediate cause anyway. But without more information about the cases, it is difficult to say what has happened, leading many – including Kennedy – to speculate that the deaths were not measles-related after all.

“Pennsylvania created its own information vacuum and then seemed surprised when someone else filled it,” Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security and an infectious diseases attending physician in Pittsburgh, told us in an email. “The coroner’s account and the state’s account are not necessarily in conflict — they are two offices answering two different questions — but nobody in Harrisburg explained that, so the public was left to choose between fraud and incompetence.”