A sixth death has been announced in Pennsylvania’s measles outbreak, as new figures show cases in the state have risen above 1,100.

The most recent fatality was reported in Franklin county on Monday in a statement posted to Facebook by its coroner. The victim was identified as a 39-year-old female who “had several underlying conditions, including a past diagnosis of measles with treatment”.

The coroner, James Conner, said it was the first measles-related death in the county “for many years” – and that the patient’s recent diagnosis met the definition of the Pennsylvania health department for inclusion.

Five other people have died after contracting measles since August in Pennsylvania, which state officials said on Monday had now recorded 1,137 cases and 219 hospitalizations. The outbreak began west of Philadelphia in April, with authorities blaming low vaccination rates.

The federal Centers for Disease Control and Prevention (CDC), however, continues to list deaths nationally at two amid a dispute between the Trump administration’s health secretary, Robert F Kennedy, and Pennsylvania’s governor, Josh Shapiro, over the methodology for classifying measles-related fatalities.

The CDC’s website, last updated on Friday, shows 4,080 confirmed measles infections across the US in 42 separate outbreaks, the highest figures in decades, and almost double the number of cases for the whole of 2025.

Earlier in October, New York’s governor, Kathy Hochul, declared an emergency because of rising case numbers in her state; while Ohio, South Carolina, Texas and Utah have also seen significant increases.

A spokesperson for the Pennsylvania health department told NBC News on Monday that it was aware of the Franklin county fatality – and was “conducting a thorough review of the reported death”.

The coroner’s office told the outlet through a spokesperson that the woman’s “primary cause of death was a probable acute cardiac event due to possible complications of the measles”. The coroner’s office spokesperson said the woman was not vaccinated.

Conner’s statement did not identify the woman to protect the privacy of the victim and relatives. “Families deserve the dignity to mourn in private,” that statement said.

“We strongly encourage our medical community, first responders, and the public to follow the precautions set forth by” Pennsylvania state guidelines.

Those state guidelines recommend two doses of the MMR (measles, mumps and rubella) vaccine, or a combined MMRV vaccine including varicella (chickenpox) protection for children 12 and older.

The CDC website recommends the same vaccinations, but Kennedy – a longtime vaccine skeptic – has offered mixed messages. In March 2025, he questioned the effectiveness of the measles vaccine, saying people should be able “to make that choice for themselves” about whether to take it.

And in September, he told anti-vaccine activists at a conference in Washington DC that they had “a strong and steadfast friend at the White House”, a month after telling US families in response to the rise in measles cases nationwide that parents “should get their children vaccinated”.

The Pennsylvania outbreak has seen 157 new cases over the last week, state figures showed, and one-third of the overall number of infections have come in those 18 or under. Fewer than 1% of cases occurred in those who are fully vaccinated.

The first two fatalities, reported in August, were infants, one whose mother had measles during her pregnancy, and the second a six-week-old who also had a rare genetic condition.

The other Pennsylvania victims were women aged 40 and 20, and an 18-year-old, all of whom had coexisting health conditions.