The Claim in Context
The death of a child under any circumstance is a tragedy. Understanding and accurately reporting the cause of death is important, because it helps both identify preventable causes of death like infectious diseases and monitor trends that can inform efforts to protect children and families from experiencing similar losses.
Some commentators and public figures have questioned whether diseases such as measles should be considered contributing factors to a person’s death. These discussions often center on the distinction between someone who "died with" a disease and someone who "died of" or “died from” it, causing undue confusion and downplaying the role of these diseases in cases of death.
These debates may stem from misunderstandings about how death certificates document the sequence of events that led to a person’s death and distinguish between immediate and underlying causes. False and misleading claims that infectious diseases are not contributing factors in death can undermine confidence in vaccines. When immunization rates drop below the threshold needed for community immunity, children and other vulnerable populations are at risk of serious illnesses.
Key Facts
- Death certificates typically document both the immediate cause of death and the underlying cause of death. The underlying cause is the disease or condition that began the chain of events leading to death. There may be multiple intermediate medical issues that stem from an underlying cause.
- A child can die from complications caused by an infectious disease even if that disease is not the final condition listed on the death certificate.
- Diseases such as measles, influenza and COVID-19 can weaken the body, damage organs, or increase susceptibility to severe secondary infections or organ failure that may ultimately cause death.
- For example, measles can lead to severe pneumonia or encephalitis; influenza and COVID-19 can cause pneumonia, respiratory failure, or other serious complications; chronic hepatitis B infection can lead to liver failure; and infection with viruses such as hepatitis B and HPV can also cause deadly cancers.
- Public health mortality statistics generally rely on the underlying cause of death because it provides the clearest picture of what ultimately led to a person's death and helps identify disease trends.
- Inaccurate or incomplete death certification can make it harder to understand the true impact of diseases and may result in undercounting or misclassifying deaths.
- States use different systems for determining the cause of death that is documented on death certificates. Some states rely on coroners, who are often elected officials who may not be physicians. Other states use medical examiners, who are physicians with specialized training. Some places use a combination of both coroners and medical examiners.
Evidence Snapshot
Death is commonly the result of a sequence of events rather than a single isolated medical condition. In many cases, the condition listed as the immediate cause of death is not the disease that started that sequence, but rather a consequence of it. For example, a person who contracts influenza may develop pneumonia as a complication of that infection. Their death certificate may list pneumonia or respiratory failure as the immediate cause of death, but the underlying cause was influenza. Understanding these distinctions helps to inform important public health and policy decisions.
Experts Say
“The death of a child is always a tragedy. Because some children are too young to be vaccinated, their immune systems are still developing, and their airways and lungs are small, they are more susceptible to contracting infectious diseases that can cause serious illnesses. Diseases like measles and whooping cough can lead to pneumonia, respiratory failure and death. In these circumstances, understanding the cause of death and important underlying conditions paints a fuller picture so that we can prevent similar tragedies from occurring.”
— Dr. James. D. Campbell, FAAP, chair, Committee on Infectious Diseases, American Academy of Pediatrics
Why It Matters
Words matter when discussing death. Confusion surrounding the difference between an immediate cause of death and an underlying cause of death can create misunderstandings about how diseases affect people and communities.
Understanding all of the factors that contributed to a child’s death helps ensure that mortality data accurately reflects the burden of disease, supports medical research, and helps families better understand health risks when making decisions for themselves and their children. Clinicians, researchers and public health officials need reliable data to guide approaches to prevent, diagnose and treat diseases.
Clear and accurate discussions about causes of death strengthen public understanding and help keep conversations focused on evidence rather than misunderstanding or oversimplification.
Resources for Further Information
Last Updated
09/14/2026
Source
American Academy of Pediatrics