What is the Probability of Someone with Active Measles Dying from Something Unrelated to Their Measles

Factual Questions
1

The title question relates to a current political controversy, but it is nonetheless a factual question.

It is blazingly obvious to me that the probability is quite low in the United States today. But I think a much better, supported, answer to the question must be possible other than to say “quite low.”

Most of the numbers needed to reason this out are in this article:

Coroner says baby with measles in Pennsylvania died of a ruptured spleen

The population of Pennsylvania is 13 million.

This next link is irrelevant to the factual question, but I think I have to include just to show why I am interested:

RFK Jr. says Shapiro’s office may have fabricated measles deaths

I also think that the fact a baby with measles died of a ruptured spleen (spleen problems being associated with measles) is irrelevant to the answer of the thread title question, much as it does illuminate that one case.

Just to hint at my incomplete thoughts here: If measles was extremely common – say, one percent of Pennsylvanians currently had the illness – it would then be plausible – even certain – that people in such a large group often died of something other than measles. It is because measles are still on the rare side that measles victims having died of something else is unlikely. Am I thinking correctly? And, regardless, can we put defensible numbers on the probability?

2

Two of the known complications of measles are pneumonia and encephalitis. Both can be fatal, especially in young children.

I’ve never heard of a ruptured spleen being directly associated with measles.

3

Enlarged spleen was common, perhaps typical, in measles before the vaccine:

1927 Journal Article

Enlarged spleen is risk factor for ruptured spleen:

Mayo Clinic, current guidance

4

I don’t know the numbers, but for the question in the title, you’d want the time that an active measles case remains active, and then the probability of a person of the appropriate population dying in that timespan.

Though in this case, it might be more appropriate to ask for the probability of a non-measles patient to die specifically of a ruptured spleen, in that time interval.

5

Deaths due to measles are commonly the result of “something else” - namely pneumonia or encephalitis caused by other organisms that take hold once the child is weakened by measles, i.e. through immune system damage.

Splenic rupture secondary to splenomegaly due to measles is certainly a possibility, one that only the infant’s medical caregivers and a competent pathologist can attest to - not the coroner’s office or the governor.

By confidently asserting that both deaths were due to measles without also supplying the public with solid backing evidence, Pennsylvania health officials and Gov. Shapiro opened the door to antivax conspiracy theorists and fabulists, who are all over social media promoting their garbage.. These are the same people who assert without merit that large numbers of pandemic deaths were wrongly attributed to Covid.

Big failure by Pennsylvania officials here.

This is a good article; hopefully the gift link applies.

6

Web search indicates that symptoms start about two weeks after exposure and continue for, on average, maybe another two weeks.

As for the probability of a person dying of a ruptured spleen during a two week period, web search says the range of possibilities is large because those who die with a ruptured spleen mostly have multiple traumas, such as from a terrible auto accident. I of course have no idea whether the baby who died from a ruptured spleen had measles as the only risk factor, or if the baby also had trauma. That’s one reason I do not want to focus on a particular case. While the medical literature strongly implies that measles increases spleen rupture risk, we do not know enough to generalize, and all the facts about any particular case are unlikely to be revealed to the public.

As for the probability of death in general for Americans who are aged matched to measles patients, , I do not have that. If I did, I could answer the thread question myself. AI numbers that I double-checked told me there are 344 deaths per million Americans over a two week period. but this is of course tremendously higher that what it would be if we age adjusted for the measles population, due to that population skewing young. For one thing, boomers like myself are almost all immune to measles due to having gotten this extremely contagious disease before a vaccine was available. But I do not know how to put numbers to that.

7

I read your X link and it doesn’t go far enough.

The case by case approach is hopelessly impractical, which is why I started this factual thread. The county coroner is a Republican elected in a partisan contest, and the parents of kids who died unvaccinated are hardly likely to agree to an autopsy by a pathologist who would almost surely be associated with a pro-vaccine institution (Penn Medicine/University of Pennsylvania and/or Philadelphia medical examiner office). Maybe if the coroner was strongly advising an autopsy at Lancaster General, which is a Penn Medicine affiliate, they would agree, but he will not because of politics. That’s the problem, not that he is Family Medicine board certified.

I believe the solid backing evidence can only come from population analysis. Those who are bad at math will be unable to follow the analysis, but we cannot help that.

8

I stand corrected, thank you!

9

Do people ever die of “spontaneous spleen rupture”? I would think if a baby dies of a spleen rupture, there would be some cause of the spleen rupture recorded (e.g. the car accident if applicable).

If a baby had measles, and while having measles had a spleen rupture with no other likely cause, and measles can cause spleen ruptures (even as a rare symptom), I’m inclined to think that the measles caused the spleen rupture.

10

Probably I’m interpreting the question too literally. But I would think that any cause of death whose probability increases for someone who has measles is, for precisely this reason, “related to measles”. So by definition, the probability of someone with measles to die of something unrelated to measles is exactly the same as the probability for anyone else to die of anything other than measles.

11

Deaths are counted as neonatal (0-27 days) and postnatal (28-365 days). About 20,000 deaths occur in that span, about 60% neonatal. That gives us a national population of 12,000.

Pennsylvania has about 6 infant (up to 1 year) deaths per 1,000 live births. Live births are a rounded 130,000 per year. That’s a rounded 800 infant deaths, and 500 neonatal deaths.

We don’t know the ages of the dead babies, but it would appear that with that small of a universe having an overlap with measles is unlikely.

Going further than that is tricky. We would have to know how many of those deaths were due to congenital causes, how many due to infections or diseases of any kind, and how many were due to other causes like trauma. We would also have to know how many had traces of virus found in an autopsy, since the disease seems not to have been apparent. And I don’t think we know how many babies overall have traces of the virus without symptoms.

A further complication is that babies who die neonatal are probably so sick that they are hospitalized and have less exposure to the measles.

Vaccination is irrelevant, since the MMR vaccine usually isn’t given in the first year.

Historical data is probably valueless, since a sizable number of measles deaths haven’t occurred in decades, when medical intervention was less powerful than today.

We’re missing so much data that “unlikely” is unlikely to be superseded by a more specific number.

12

Yes, the more I think about this, the harder it gets to see how the specific probability I am asking for can be obtained.

My thinking is that measles remains rare enough for it to be an enormous unlikely coincidence for someone to die of something unrelated to measles at the same time they were experiencing measles symptoms. But there are so many factors that it may be hopeless to address this in a nonpartisan manner.

There is high risk, at least where measles is already circulating, that children returning to school (this week and next) will increase the contagion, and thus number of cases, so greatly that there will eventually be some small number of children who coincidentally die of something totally unrelated while having mild measles.

13

We could have a separate thread discussing why electing coroners is a bad idea (politics should not come into play), compounded by having coroners who are untrained in forensic pathology.

Is There Any Justification for Politicizing the Cause of Death? Measles and Beyond
Is There Any Justification for Politicizing the Cause of Death? Measles and Beyond
14

The latest measles death in Lancaster county definitely occurred in an infant dying of a congenital cause.

15

Sort of, and? Children with that condition generally die within the first six months or so of respiratory infections.

In that case proper format is the respiratory infection as the proximate cause of death. With an underlying/contributing condition of congenital microcephaly.

In this specific case the child was an individual with a disease that would at some point result in a respiratory infection that would kill them but was not actively currently “dying of a congenital cause.”

I suppose you’d be of the mind to not count a death from Covid in an 86 year old as Covid because they were going to die from something soon enough if it wasn’t Covid?

In the neonate with the ruptured spleen and the OP:

The probability of a child experiencing a normal non traumatic delivery having a fatal spontaneous splenic rupture is essentially zero. Neonatal splenic rupture from all causes, not necessarily fatal, including associated with trauma and/or congenital infection is rare. OpenEvidence, a medical AI, cites less than 5 per million (the citation is behind a paywall.)

Best data is children of mothers exposed to measles at any point during pregnancy have perinatal mortality rates of 15%. That data from Africa and may be best compared to baseline in the community of 4%. So maybe best thought as roughly fourfold increased risk?

Perinatal death is less if the mother’s infection is early in pregnancy, extremely high if the infection was near delivery, like this mother’s was. Measles pneumonia, secondary bacterial pneumonia, disseminated infection, subacute sclerosising panencephalitis … all pretty common among perinatal infections in historic context.

FWIW the reasonable standard in this case would be for the spleen to be sent for tissue analysis (histpathology) which would very highly probably confirm that the spleen was effected by measles such as multinucleated giant cells, measles antigen verifiable by PCR, splenic capsule with thinning, and congestion, or subcapsular hemorrhage consistent with a pathologically fragile organ, so on.

If it is not being done then that is forensic negligence; more likely it is not yet released. Unfortunately in the current environment I think we do have to consider the possibility that it was done, showed those findings, and has been ordered to be not shared publicly. Unfortunately that is a real consideration.

Doubling back this statement gobsmacks me:

That is EXACTLY WHY vaccination rates in the community matter! Babies are highest risk of death as a consequence of measles and can only be protected by preventing exposure to it by high vaccination rates around them.

16

Maybe I didn’t make myself clear but I think you’re overreacting.

This latest death report seemed to be relevant to the OPs question about the overlap between measles deaths and deaths that would have occurred anyway. The Amish community in Pennsylvania appears to have higher instances of cases both of measles and congenital problems in infants. That would affect the probability of overlap in that location without it being a major factor elsewhere.

As for vaccination being irrelevant, that was solely to ward off comments about the deaths being caused by the vaccine. Obviously an increased prevalence of cases in the surrounding community raises the danger for the unvaccinated.

17

The point about examining splenic tissue from the infant that died after splenic compromise is a good one, as the spleen is an organ with characteristically high viral load in measles infection. Characteristic histologic changes can be confirmed by immunofluorescence studies and would lend weight to a finding of splenic rupture secondary to infection.

I’ve never seen such microscopic changes, since spleens are not typically biopsied, and deaths from measles are thankfully rare - at this point, anyway.

“They couldn’t have been vaccinated at that age” ranks with “The baby was going to die before long anyway” as common tropes employed by antivaxers in response to the Pennsylvania measles deaths.

The latter claim feeds into the eugenicist model of antivaccine ideology, in which the very young, immunosuppressed and elderly who are at particular risk of vaccine-preventable diseases are deemed unimportant/expendable, in contrast to healthy young purebloods with superb natural immune systems, as these people fancy themselves.

18

I had measles. My mother said she knew which birthday party I caught it at, and who from, as well.
By the time my brother came along, they had a shot for it.

19

[Moderating]
That’s an excellently on-topic post overall, @DSeid , but I want to point out that this:

is getting dangerously personal.

Also, this from @Jackmannii :

is also veering away from the factual and into the political.

20

Are there comments about that which need warding off? I have dealt with many vaccine refusers and conspiracy theorists … they make lots of crazy claims … the vaccine causing death is not on the list.

In terms of the OP, if a child with a disease dies of something the odds of that something being a consequence of the disease depends much on what that something is.

The car the family was in is hit my a drunk driver, killing the newborn baby? Not related.

The child is literally hit by lightning? Not related.

The child dies by a mechanism a ruptured spleen in the context the spleen enlargement is known with perinatal measles and congenital infections are among the known causes of the extremely rare event of neonatal splenic hemorrhage? Related presumptively.

Dies as a consequence of premature birth? Possibly. Measles during pregnancy can trigger premature birth. It would be hard to classify on an individual case.