One of the two unvaccinated people in Lancaster County, Pennsylvania, who died with measles was a newborn, but the exact cause of death is unclear.
According to the Philadelphia Inquirer, the Lancaster county coroner found that the infant died shortly after birth from a laceration of the spleen. He said that a postmortem test on the baby’s lung tissue showed that the child had a measles infection acquired before birth.
The coroner did not immediately respond to CIDRAP News’ requests for comment.
When it first announced the measles-associated fatalities on August 25, the Pennsylvania Department of Health (DOH) provided minimal information about the people who died, citing patient privacy. The DOH said it uses the term “measles-associated” when laboratory or epidemiologic evidence of measles is present, “but the disease may not be assessed by the medical certifier or coroner to be the immediate cause of death.”
Shapiro, Kennedy spar
Pennsylvania Gov Josh Shapiro, a Democrat, told reporters during a press conference, “Today, we see the consequences of a lack of immunizations in the first measles-associated deaths that our Commonwealth has seen in 35 years.”
Emphasizing the importance of vaccination, Shapiro partially blamed the federal government and Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. for the state’s falling vaccination rates, saying that the secretary has sowed misinformation and mistrust in immunizations.
In response to the additional information about the two deaths from the county coroner, Kennedy, a long-time vaccine skeptic, attacked Shapiro while ignoring the seriousness of the growing number of measles cases in the United States.
In a post on the social media platform X, Kennedy alleged that the deaths were fabricated and accused Shapiro of fearmongering, “and the weaponization of infectious disease fears for political gain.”
In a follow-up X post to Kennedy’s comments, the Centers for Disease Control and Prevention (CDC) said this afternoon it is working to determine what actually occurred.
“These discrepancies raise important questions, particularly because the Governor’s Office has not provided CDC with information relevant to the outbreak and has declined our offers of assistance,” said the CDC.
The DOH posted a comment on X yesterday from its secretary, Debra Bogen, MD, that her staff meets regularly, as recently as that afternoon, with the CDC to discuss the state’s measles outbreak.
“I deeply appreciate the supportive working relationship between the PA DOH and CDC professional staff,” she said.
Measles might have played a role in lacerated spleen
Measles does not typically rupture the spleen, though it’s possible it played a role in the newborn’s death, Amesh Adalja, MD, a Pittsburgh-based infectious disease physician and senior scholar at the Johns Hopkins Center for Health Security, told CIDRAP News.
As he explains on his blog Tracking Zebra, an infection might have been passed in utero and enlarged the baby’s spleen, making it more fragile and vulnerable to laceration during delivery. Adalja added that the academic literature is sparse on this.
Because the spleen is full of immune cells, it provides an environment in which the measles virus can survive and multiply, the DOH told CIDRAP News. While it did not specify how measles affected the newborn, the department noted that once the virus enters someone’s spleen, it causes inflammation and damage to the internal tissue.
If the spleen wasn’t enlarged and then lacerated because of measles, then the Lancaster County Coroner should provide an alternative explanation, said Paul Offit, MD, director of the Vaccine Education Center at Children’s Hospital of Philadelphia.
Offit told the Inquirer that the additional information from the coroner doesn’t give much context, and that through conversations with state health officials, he’s learned that, “these patients would not have died were it not for measles.”
Finger-pointing doesn’t stop measles
Kennedy’s deflection of responsibility and political squabbling is dangerous, said Jess Steier, DrPH, founder of Unbiased Science.
“It baffles me that Secretary Kennedy chose this moment to do anything other than underscore the critical importance of MMR [measles, mumps, and rubella] vaccination in the name of public health, to prevent further tragedies,” Steier told CIDRAP News.
However, Adalja is also disappointed with the governor’s handling of these measles-associated deaths. The lack of transparency created an unforced error, which Adalja said provided ammunition for Kennedy.
When the DOH announced the two measles-associated deaths, there was no mention that either might have been caused by something in addition to, or other than, measles. The department only disclosed that both people were unvaccinated and residents of Lancaster County, the epicenter of the country’s largest current measles outbreak.
“Either you believe measles caused these deaths and you show your evidence, or you do not yet know and you publish the timeline on which you will,” said Adalja.
Like other infectious disease experts, Adalja is extremely concerned about falling vaccination rates in Pennsylvania. CDC data show that non-medical vaccine exemptions in Pennsylvania have tripled since the 2016-17 academic year.
Adalja noted that the K-12 school year is starting now, which means large numbers of unvaccinated kids will be coming together, some of whom will be exposed to the measles virus, which can remain airborne for up to two hours.
“Every week spent on political oxygen instead of vaccination appointments leaves that pool exactly the size it is today,” wrote Adalja. “The biology is indifferent to all of it, and the biology is the only thing here that gets a vote.”
Given falling vaccination rates in Lancaster County and beyond, Steier said the country needs strong public health leadership.
“And we are not getting it,” she said.
Editor’s Note: This story was updated at 5:00 pm CT on August 27 after the Philadelphia Inquirer updated its story. The original version said the baby tested positive for measles antibodies.
