What to know about the dispute between RFK Jr. and Gov. Shapiro over 'measles-associated deaths'

This article originally appeared on PolitiFact.

After Pennsylvania health officials announced the first U.S. "measles-associated deaths" in 2026, U.S. Health Secretary Robert F. Kennedy Jr. called the deaths possibly "fabricated."

READ MORE: Measles deaths reported in Pennsylvania spark feud among politicians and health officials

What followed was a back-and-forth between Kennedy, Pennsylvania Gov. Josh Shapiro, state health officials, a county commissioner and a coroner that centers on whether one patient's measles infection directly caused the patient's death. The state public health department described the deaths as "measles-associated." The county coroner said, for at least one of the people who died, a baby, measles was not determined to be the cause of death.

As we learned with COVID-19, an underlying infection can contribute to a person's death without being listed as the sole cause of death. Even if measles is not listed as the cause, it doesn't mean the virus wasn't a factor.

It's not unusual for a coroner and public health department to describe deaths differently, Dr. Amesh Adalja, an infectious disease specialist at the University of Pittsburgh Medical Center told PolitiFact. A coroner's job is to establish the specific chain of events that caused death — some things are listed as direct causes, others as conditions that may have contributed.

READ MORE: There are already more U.S. measles cases this year than in all of 2025

And state health departments use terms such as "measles-associated death" to track outbreaks in real time, not to assign cause to individual deaths. Having a measles infection when you die counts as a "measles-associated death" in Pennsylvania.

So the coroner's office's finding and the state's description of the deaths are not necessarily in disagreement. But many people took "measles-associated" to mean it was the cause of death. When the coroner said differently, Adalja said, "the gap looked to a reasonable observer like either incompetence or concealment."

The infectious disease doctors we spoke to said this lack of clarity and the absence of details about the specific cases has allowed misinformation and conspiracies to fill the gap.

Shapiro announced the deaths amid a record-breaking surge of U.S. measles cases — over 2,900 so far this year — and falling vaccination rates among children. Pennsylvania counted more than 490 cases this year as of Aug. 31, a number Dr. Paul Offit, an infectious disease doctor at Children's Hospital of Philadelphia, said is almost certainly an undercount. Cases are expected to rise into the colder months and as school is in full swing.

Although Pennsylvania reported two deaths, health officials have shared only that one one was a newborn. We have no identifying information about the other person who died.

Here's a timeline of how federal public health officials went from offering Pennsylvanians their condolences to questioning whether the deaths occurred.

Aug. 25

Deaths announced. Pennsylvania's Department of Health confirms "two measles-associated deaths in Pennsylvania." The health department said both were Lancaster County residents and neither were vaccinated against measles. Lancaster County has the most recorded measles cases in the state so far this year — 227 cases.

Shapiro holds a press conference. At a Lancaster hospital, Shapiro appears alongside the state's Health Secretary Dr. Debra Bogen, and expresses his condolences to the families. He announces the state plans to open more pop-up vaccination clinics to respond to the outbreak and encourages residents to get the measles, mumps and rubella vaccine. He says he received a call from Kennedy but declined the secretary's offer of federal staff assistance, saying the state health department could manage it. "I was very, very blunt with him and I made very clear that his actions and the rhetoric that is coming from this administration are having a negative impact on communities across America," Shapiro says.

CDC extends condolences. After the press conference, the CDC's official X account posts, "HHS and CDC extend their condolences to the families and communities affected by two measles-associated deaths in Lancaster County, Pennsylvania." It says CDC is "working closely with state and local health departments" and encourages people to be vaccinated against measles.

Lancaster County Commissioner raises questions. Commissioner Josh Parsons posts on X, "The Coroner's office indicates that it currently has ZERO reported cases where measles is the immediate cause of death," and says such deaths are required by law to be reported to the coroner's office. "They have one case where a person died WITH measles, but not FROM measles. Measles was definitely NOT the cause of death in that case."

Aug. 26

Kennedy questions the cause of death. Speaking at an event in Tampa, Florida, Kennedy is asked about the Pennsylvania death reports. "They cannot find any measles deaths in Lancaster County," Kennedy says, referencing what he said were a county commissioner's comments. "The press is all covering this as if those measles deaths actually happened, but nobody is doing a little bit of critical inquiry to find out. We're trying to figure out who those deaths were and whether they actually happened."

Pennsylvania Health department attempts to clarify. On Facebook, the state health department says 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." The post also says "not all deaths are referred to a coroner under Pennsylvania law," but confirms that an infant death with a positive measles case was under review by the Lancaster County Coroner's office.

Kennedy suggests the deaths may be 'fabricated." In an evening X post, Kennedy says Shapiro showed "giddy delight in announcing two measles deaths," and said it was a "replay of the Democrats' COVID playbook." During the COVID-19 pandemic, social media users falsely said COVID-19 death counts were being inflated by adding those who died "with, not from" the virus. Kennedy calls the state's announcement of measles deaths "premature" and suggests the deaths may have been "fabricated by one of the Governor's hopeful staffers," citing the Lancaster County Coroner's office's lack of publicly released information about both cases.

Top Pennsylvania health official responds. Bogen issues a statement on X saying the health department's epidemiology team "thoroughly investigated and verified both individuals tested positive for measles. The information was not reported to the public until the results of the epidemiological investigations were confirmed." The post also clarified the legal requirements. "Under state law, PA (health department) is not required to report deaths to coroners."

Lancaster County coroner says the cause of infant death was a ruptured spleen. Dr. Stephen Diamantoni, a Lancaster County Republican elected as coroner who's held the office since 2008, tells multiple media outlets over several days that the forensic pathologist who performed the autopsy did not specify measles as the cause of death. He says the cause of death was identified as a ruptured spleen, although the baby had a measles infection in the lungs, acquired before birth from the mother. Measles can cause the spleen to be enlarged and susceptible to rupture, but the forensic pathologist did not find evidence of that, Diamantoni says.

Aug. 27

Diamantoni says in an interview that measles was on the infant's death certificate as a contributing condition. But Diamantoni says he still does not believe measles contributed to the child's death.

CDC changes its public position. After initially offering condolences, the CDC X account responds to Kennedy's allegation of "fabricated" deaths: "We appreciate Secretary Kennedy's efforts to clarify conflicting information from Pennsylvania officials about whether the two reported deaths were caused by measles. CDC is working to determine what actually occurred." The post said the governor's office had not provided "relevant" information about the outbreak and had declined offers of assistance. The post echoes Kennedy's reference to misleading concerns around COVID-19 case inflation.

State health department calls the CDC post "inaccurate." In a reply to the CDC's post, the Pennsylvania health department says it is "in regular contact with CDC professional staff regarding measles cases and other public health programs."

Aug. 29

Kennedy doubles down. In an interview on FOX News' "Saturday in America with Kayleigh McEnaney," Kennedy refers to the deaths as "so-called 'measles deaths,'" and said, "The governor has not been able to point to any child that died from measles in Lancaster County."

Aug. 30

CDC not counting Pennsylvania deaths. As a part of the CDC's regular updates to its measles dashboard, the agency specifically declines to include the Pennsylvania deaths in its death count: "This week's measles outbreaks update will not include the two measles-associated deaths reported by the Pennsylvania Department of Health on August 25 while CDC reviews additional information regarding the circumstances and causes of death," the agency's statement says. "At this time, available information does not establish whether measles caused or contributed to the deaths or whether the individuals died from other causes while infected with measles."

The Atlantic publishes an interview with an Amish Lancaster couple. The couple, who did not want their real names used, said their newborn son died soon after being born and the circumstances of their son's death seemed to match the details of the case that had made national news, though they had not been aware there was controversy. The mother, who was called Anna in the article, had become extremely ill and dehydrated after her other children became sick. "They assumed that Anna's severe case of measles contributed to their loss," the article said. "That's what the midwife told them as well."