Pennsylvania Measles Death of Infant Sparks Coroner Dispute

A Pennsylvania measles death involving an infant is now in dispute, after the county coroner said the baby died of a ruptured spleen rather than measles, contradicting the state health department’s conclusion.

Coroner points to a different cause

A day after the Pennsylvania Health Department announced that one of two measles-associated deaths in the state was an infant, Lancaster County Coroner Dr. Stephen Diamantoni said he does not consider measles the cause of death. He said the baby died shortly after birth from an internal hemorrhage and “traumatic rupture” of the spleen, though he did find evidence of the measles virus in the infant’s lung tissue.

It remains unclear whether measles played a role. An infection can enlarge the spleen and raise the risk of rupture, but that can be hard to detect in an autopsy once a rupture has occurred. Diamantoni, a Republican who has held the elected post since 2008, said he found no evidence the infant’s spleen was enlarged. He said he is continuing to investigate the death, noting the baby was born at a birthing center assisted by a lay midwife who was not certified in midwifery.

State health officials stand by their finding

Health Secretary Dr. Debra Bogen said she remains confident in her department’s conclusion that the death was “measles-associated,” a term indicating laboratory or epidemiologic evidence of infection. “As a pediatrician with more than 30 years of caring for children, I have thoroughly reviewed the case investigation information and sadly can confirm that there were two recent measles-associated deaths in Lancaster County,” Bogen said in a statement. Gov. Josh Shapiro, a Democrat, nominated her for the role in 2023.

The department has not released details on the second death, though it said both people who died were unvaccinated. Newborns are not eligible for the MMR vaccine, which is recommended starting at 12 to 15 months, with a second dose at 4 to 6 years.

Vaccination rates have slipped in Lancaster County

MMR vaccination coverage among children in Lancaster County fell from 95.5% in 2017 to 87.6% last year, below the 95% threshold generally considered necessary for herd immunity. The two deaths mark the first associated with measles in the U.S. this year and the first in Pennsylvania in 35 years.

Cases climb across the state and nation

Pennsylvania’s Health Department has confirmed 424 measles cases this year, including 94 diagnosed in the past week, with 73 people hospitalized for complications. Nationwide, 2,777 measles cases have been confirmed this year, the most in 35 years.

Dr. Paul Offit, a pediatrician and director of the Vaccine Education Center at Children’s Hospital of Philadelphia, called two deaths out of 494 reported cases a “stunning” ratio, since measles has historically caused 1 to 2 deaths per 1,000 cases. “That’s 1 death per 200 people,” Offit said, suggesting the outbreak’s true scope may be worse than official numbers indicate. “This is much worse than people are saying.”