Pennsylvania announced its first measles deaths in 35 years on Aug. 25 — two unvaccinated Lancaster County residents, one a newborn. The next day, HHS Secretary Robert F. Kennedy Jr. accused the state of possibly fabricating the deaths. Then on Aug. 27, Lancaster County Coroner Dr. Stephen Diamantoni gave his own answer. He said the newborn died of a ruptured spleen, not measles — but the measles virus was still found in the infant's tissue. That finding didn't end the fight. It became the new thing everyone's fighting over.

1. Kennedy and Local Officials (HHS Secretary Robert F. Kennedy Jr., Lancaster County Commissioner Josh Parsons)

Kennedy and his allies say the coroner just proved their point.

Kennedy called it fabrication before the coroner said a word. On Wednesday — a day before the spleen finding went public — Kennedy posted that "the announcement appears to have been premature, and the deaths may even have been altogether fabricated by one of the Governor's hopeful staffers." He argued state law requires measles deaths to go through the coroner, and said "the Lancaster County Coroner says that it has no record of any measles deaths."

Kennedy's camp calls the finding vindication. A day later, Diamantoni put a specific medical cause on the newborn's death — a ruptured spleen, not measles. To Kennedy and his allies, a real medical cause of death is stronger proof than the earlier paperwork fight ever was.

A local official is amplifying it. Lancaster County Commissioner Josh Parsons posted that state officials had presented "false information" about the first death, quoting the coroner's ruptured-spleen finding directly. He also said there's "zero information" on the second reported death.

2. Gov. Shapiro and the PA Health Department (Gov. Josh Shapiro, PA Health Secretary Dr. Debra Bogen)

The cause-of-death finding doesn't change what "measles-associated" has always meant.

State officials never claimed measles alone killed the infant. Health Secretary Dr. Debra Bogen said, "I have thoroughly reviewed the case investigation information and sadly can confirm that there were two recent measles-associated deaths in Lancaster County." The health department counts a death as "measles-associated" whenever there's lab or epidemiologic evidence of measles. That's true even while a coroner is still reviewing the immediate cause of death.

Gov. Shapiro says Kennedy is the one doing damage. He said Kennedy's rhetoric is "having a negative impact on communities across... Pennsylvania" and that "there's real-life consequences to spreading misinformation." He's separately called Kennedy's post "inaccurate and misleading."

3. Public Health Experts (Dr. Paul Offit, Children's Hospital of Philadelphia)

Focusing on the death certificate misses the bigger outbreak.

Measles put the baby at risk either way. Dr. Paul Offit, a vaccine expert at Children's Hospital of Philadelphia, said, "These patients would not have died were it not for measles." He means that even if a spleen injury was the direct cause, measles is still why the baby was vulnerable in the first place.

The outbreak is real, and it's getting worse. Pennsylvania has confirmed 424 measles cases this year, 94 of them in the past week alone. That makes it the state's largest outbreak since 1992, with 73 people hospitalized. In Lancaster County, kindergarten MMR vaccination has fallen from 95.5% in 2017 to 87.6% last year. That's below the roughly 95% level doctors say herd immunity requires.

Where This Lands

The coroner's finding was specific. He found a ruptured spleen — measles was present, but wasn't the direct cause. Kennedy and Commissioner Parsons read that finding as proof the state overstated its case. Shapiro's administration says its "measles-associated" label was accurate on its own terms and never claimed otherwise. Public health researchers like Offit say the cause-of-death argument is a distraction. Pennsylvania is in its worst measles outbreak in over three decades, and vaccination rates in the outbreak's epicenter keep falling.

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