A Pennsylvania coroner has announced the death of a 40-year-old woman associated with the state’s ongoing measles outbreak, making it the apparent third fatality linked to the outbreak in the state.

The first two victims were infants. One was born with a genetic disorder that left her vulnerable to infection, while the other died after a ruptured spleen following a measles infection.

The woman died on Saturday, according to reporting by WTAE in Pittsburgh.

“Many people associate measles with a childhood illness, but it can lead to severe complications in individuals of any age,” Jason Stiver, the Jefferson County chief deputy coroner and public relations officer, told WTAE.

Measles is among the most infectious diseases known to medicine. Hospitalization occurs in about one in five infected people who are unvaccinated, while one to three of every 1,000 infected children die from respiratory or neurologic complications.

“Measles is highly contagious and can result in serious respiratory illness, hospitalization, and in rare cases like this, death. We encourage residents to stay informed, follow guidance from public health officials, and take appropriate steps to protect themselves and their families,” Stiver said.

“While cases of severe illness remain uncommon, this tragedy highlights that measles should not be taken lightly,” he said.

The coroner’s office is reportedly working with Pennsylvania health officials on the case. The state health department’s latest measles update, released Friday, did not include the death.

As of last week, Pennsylvania had nearly 700 measles cases across 37 counties. The outbreak is heavily concentrated in Lancaster and Mifflin counties, which are home to large farming communities.

The Centers for Disease Control and Prevention (CDC) recently published data showing a steady decline in kindergarten vaccination rates, including rates for the measles, mumps and rubella (MMR) vaccine.

Experts attribute the decline to several factors, including the vaccine’s success—leaving few people with memories of an era when children regularly died from measles—and misinformation surrounding Robert F. Kennedy Jr., the US health secretary and longtime vaccine skeptic who has repeatedly claimed, without evidence, that vaccines cause autism.

Most recently, Kennedy reportedly asked the CDC to remove Pennsylvania’s two measles deaths from its tally. He later acknowledged in a social media post that the CDC “waited for the evidence”. Pennsylvania health officials have counted both deaths as measles-associated.

“The Lancaster County Coroner has now publicly stated that measles caused only the second infant’s death and has also publicly stated that the infant had Amish lethal microcephaly, a rare genetic condition in which infants typically live only about six months, received palliative care continuously from birth, and died at approximately two months of age,” Kennedy said. “The Coroner continues to state publicly that the first infant died from a lacerated spleen, not measles.”

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