Pediatrics professor devastates Lancaster County coroner — by using medical science

Dr. Paul Offit, Professor of Pediatrics at Children's Hospital of Philadelphia

Lancaster County in Pennsylvania is now the epicenter of the worst measles outbreak in the United States in the past three+ decades. In August, two children died from measles-related illnesses in Lancaster County, but the county coroner — who is a general practitioner and has no pediatric background — argued that measles did not cause the death of the one of the children after the state and medical experts argued that it had.

The coroner’s decision and the followup caused such a controversy that his personal practice in Lancaster did away with its website. He is an elected Republican and is aligned with a county commissioner who denied that measles had anything to do with a newborn child’s death.

This reeks of politics making medical decisions.

While the cause of death of the child was indeed a ruptured spleen, the question is what caused such a rare occurrence to transpire and what effect measles had in the death.

A professor of pediatrics carefully took apart the coroner’s diagnosis that measles was not a factor by using his education and medical science.

“Making sense of Lancaster County’s controversial coroner”

Dr. Paul Offit is a distinguished pediatrics professional and is an “internationally recognized expert in the fields of virology and immunology. He is currently the Maurice R. Hilleman Professor of Vaccinology at the Perelman School of Medicine at the University of Pennsylvania.

In short, he has an accomplished pediatrics resume and is well-versed in the problems caused by the measles outbreak in the United States. He is also a professor of pediatrics at the Children’s Hospital of Philadelphia.

Dr. Offit was so outraged by the action of the Lancaster County Coroner, Dr. Stephen Diamantoni, that he wrote a Substack article explaining why he believes that the coroner’s conclusion is medically inaccurate. He did not have access to the coroner’s medical details, but he took apart the analysis that the man gave publicly for the death. The coroner focused on the conclusion that the child died from a ruptured spleen, but Dr. Offit emphasized that deaths of an infant from a ruptured spleen are rare, as the National Institute of Health has explained.

Dr. Stephen Diamantoni

Argument

Let’s begin his analysis with looking at the end of his Substack article, the conclusion:

What do we know? We know that this infant was infected with measles while in the womb; we know that the infant died of splenic rupture; we know that measles infections can increase splenic fragility leading to rupture; and we know that splenic rupture is extraordinarily rare in newborns. It’s understandable that Dr. Diamantoni is cautious about determining why this child died of splenic rupture given its rarity.

Nonetheless, if Dr. Diamantoni is going to claim that measles wasn’t the precipitating cause of this child’s death, he is going to have to do a much better job of explaining why it wasn’t.

Dr. Paul Offit, “Making sense of Lancaster County’s controversial coroner,” https://substack.com/@pauloffit, August 2026

Dr. Offit presented his argument in a systematic way, point by point, arguing that

Diamantoni’s conclusion that measles was not a factor in the child’s death was way off base.

He pointed out that right-wing anti-vaxxers had been arguing that measles did not cause the death, and the national secretary of ”health,” who has never taken a medical course in his life, said that that state of Pennsylvania had “fabricated” the cause of the deaths,

Anti-vaccine activists’ claims were supported by a Lancaster County coroner named Dr. Stephen Diamantoni, a board-certified family medicine practitioner, who said that “measles didn’t contribute to the newborn’s death.” Dr. Diamantoni said that he had detected “measles virus in the infant’s lung tissue,” and that the baby had died from a “traumatic rupture” of the spleen.

Because measles virus can cause enlargement of the spleen and thinning of the splenic capsule, it is plausible that the child’s splenic rupture occurred during the birth process, which can be traumatic. Nonetheless, the coroner stated that because “there was no swelling or enlargement of the spleen, whatsoever,” that “measles was not the cause of death.”

Dr. Diamantoni is in a tough spot. Splenic ruptures are extremely rare in neonates.

Dr. Paul Offit, https://substack.com/@pauloffit, August 2026.

Point one

The professor’s first contention that the coroner was wrong focussed with the coroner’s expressed opinion that measles could not have been a factor because the size of the spleen was “normal,”

First, Dr. Diamantoni put a lot of emphasis on his finding of a normal-sized spleen, emphasizing it with the word “whatsoever.” To him, this meant that measles virus didn’t affect the spleen so couldn’t possibly be the cause of death. However, once a spleen is ruptured, it’s difficult to tell whether it was enlarged. For example, if you find a balloon on the ground that has burst, it’s hard to know how big it was before it burst.

What he is saying is that the coroner could not tell the size of the spleen once it ruptured. That is a rather simple medical truth that any pediatrician could understand.

Point 2

Dr. Offit then explained that the coroner could have discovered a cause other than measles for the rupture of the spleen, but for some unexplained reason, he did not,

Second, Dr. Diamantoni might have found that the spleen was vulnerable because the child had suffered from something other than measles that had caused splenic fragility before birth; specifically, infections like CMV and rubella, hemolytic disorders, or certain inborn errors of metabolism. If Dr. Diamantoni had found any of these other problems, then he could confidently say that measles wasn’t the cause. But if he hasn’t, the only obvious cause left would be measles.

So, what Dr. Offit is saying is that the coroner could have pointed to a reason for the fragile spleen that caused the rupture, and if so, that would have proved his contention..

However, he is not a pediatric specialist, but is a general practitioner who boasted on his website about his treating adult diseases like hypertension and heart disease.

Point 3

Now, the pediatric expert pointed out the scientific impossibility of the coroner’s conclusion, using pediatric knowledge to do so,

Third, Dr. Diamantoni is wrong to believe that a spleen must be quite enlarged to be fragile and at risk for rupture. Measles can cause only mild or moderate enlargement of the spleen but still be vulnerable to splenic rupture. Also, a fragile splenic capsule can be difficult to determine post-mortem. It would have been of value here to look at the remaining splenic tissue to determine the presence of cells typically found during measles infection, such as multi-nucleated lymphocytes. This would have further solidified the case for measles virus as the cause of the splenic fragility. Perhaps this was done; if so, it should be reported to the public.

In short, the coroner’s analysis is not scientifically solid based upon the sketchy information that he released to the public.

The coroner's narrative changes

He then challenged the coroner’s changing his story to the public,

On August 28, in response to several days of reporters trying to get a straight story from the coroner, Dr. Diamontoni issued another statement. Now, he no longer said that “measles was not the cause of death” but rather was a “contributing factor.” Dr. Diamontoni further explained that measles was listed under Part II of the infant’s death certificate, which reports “other conditions contributing to death but not resulting in the underlying cause.” He said that he made this change to offer “a broader view of the general health of the child.”

Dr. Diamontoni’s clarification only caused more confusion. The critical question is clear: Would this infant have died if he hadn’t been infected with measles?

The answer to that question is obvious from the analysis that he presented. The doctor did not have access to all of the data compiled by the coroner because is had not been released. What he is actually asking for is an investigation of the findings of the coroner so that medical professionals can make their own conclusions.

Here is some more biographical information about Dr. Offit,

Dr. Offit is an internationally recognized expert in the fields of virology and immunology, and was a member of the Advisory Committee on Immunization Practices to the Centers for Disease Control and Prevention. He is a member of the Food and Drug Administration Vaccines and Related Biological Products Advisory Committee, and a founding advisory board member of the Autism Science Foundation and the Foundation for Vaccine Research, a member of the Institute of Medicine and co-editor of the foremost vaccine text, Vaccines.

He is a recipient of many awards including the J. Edmund Bradley Prize for Excellence in Pediatrics from the University of Maryland Medical School, the Young Investigator Award in Vaccine Development from the Infectious Disease Society of America, a Research Career Development Award from the National Institutes of Health, and the Sabin Vaccine Institute Gold Medal.

I would take the word of that medical professional before that of a politician.