The death of a Florida teenager on a Carnival cruise ship earlier this month has been ruled a homicide, the latest development in a case that has drawn international attention and sparked intense speculation on social media.

Anna Kepner's cause of death was “mechanical asphyxia," according to a copy of her death certificate obtained by ABC News, which said the 18-year-old “was mechanically asphyxiated by other person(s)."

Mechanical asphyxia is when an object or physical force stops someone from breathing, according to Stephen Nelson, a chief medical examiner in Central Florida who is not involved in the case.

“In some way, shape or form, your airway has been cut off,” said Nelson, a former chair of Florida's Medical Examiners Commission.

A family vacation that ended in tragedy

A high

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