A fourth person in Pennsylvania has died of measles, the state health department confirmed Tuesday. The latest death was in an unvaccinated 18-year-old resident of Mifflin County.

In the announcement, the state health department also confirmed a county coroner's report over the weekend of the death of an unvaccinated 40-year-old woman in Jefferson County. The state had previously reported two deaths in Lancaster County; both were infants—a newborn boy and a 6-week-old girl, both too young to be vaccinated.

According to the Mifflin County coroner, Andrea L. Alcalde, the 18-year-old's cause of death was determined to be acute disseminated encephalomyelitis (ADEM), which is a rare but known severe complication of measles. The condition is characterized by a rapidly progressing autoimmune disorder in which aberrant inflammation from an infection strips away the protective coverings of nerve cells in the brain and spinal cord. Before measles vaccines were widely used, ADEM was commonly associated with measles, though other viral infections can also spur its development.

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US Health Secretary Robert F. Kennedy Jr. will deliver a keynote address at an anti-vaccine conference being held in Washington, DC, later this week and hosted by the anti-vaccine organization he once led, Children's Health Defense (CHD). The organization announced Monday that Kennedy had signed on to the event.

Kennedy will appear alongside other high-profile figures in the anti-vaccine world, including Andrew Wakefield, the disgraced former doctor who was stripped of his medical license over a fraudulent, now-retracted study that falsely claimed a link between autism and the measles, mumps, and rubella (MMR) vaccine. An investigation by a medical board found that Wakefield had mistreated vulnerable children and that his actions amounted to serious professional misconduct.

Despite being ostracized from the medical community, Wakefield has become an enduring figure in the anti-vaccine community. His dangerous falsehood that vaccines cause autism has also endured—with significant help from CHD and Kennedy, who have embraced and widely promoted the erroneous link.

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