A 39-year-old unvaccinated woman in Franklin County, Pennsylvania, has become the sixth person to die of the highly infectious virus amid a state outbreak that has stricken over a thousand people since it began in April.

The woman died on Saturday, October 10. She had several underlying health conditions and had recently tested positive for measles, according to an advisory posted on social media by Franklin County Coroner Jordan Conner. The advisory noted that the woman's death meets the definition of a measles death set by the state's health department.

In an emailed statement to The Washington Post, the coroner's office said the primary cause of death was listed as "probable acute cardiac event due to possible complications of the measles."

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Over the weekend, the World Health Organization released a disease outbreak report on the events surrounding the death of a Russian infectious disease researcher earlier this month, highlighting that Russia has yet to report a confirmed cause of death. With that "key uncertainty," the United Nations health agency said it remains impossible to assess the risk of the event or whether the public health measures Russia took were adequate to prevent spread of the unknown disease.

The WHO reported that, so far, it has seen no evidence of ongoing transmission of the mystery disease. "However, confidence in the assessment remains limited by the absence of a confirmed etiological diagnosis, and the remaining uncertainty regarding the source and mode of exposure," the agency wrote in its report.

The agency laid out the order of events as information trickled out from Russian authorities, noting that it only became aware of the death via media reports on October 2. The WHO subsequently made contact with Russian authorities and requested information on October 3, 6, 7, and 8.

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Roughly 200 people are under medical observation, several hospitals are under quarantine, and dozens are in isolation in Russia following the unexplained death of an infectious disease researcher at the Irkutsk Anti-Plague Research Institute of Siberia, in the town of Shelekhov, according to early reports of the situation on Sunday and Monday.

Researcher Darya Shipilova reportedly died last week from pneumonia of "unknown" cause, according to Rospotrebnadzor, a Russian public health agency.

Unconfirmed information regarding her death has swirled. Some reports have claimed she accidentally broke a test tube containing the plague pathogen, Yersinia pestis, on September 25. She subsequently fell ill, was admitted to a hospital September 29 with severe pneumonia and died overnight between October 1 and October 2.  The head of the Russian region that neighbors Irkutsk, Alexey Tsydenov, initially reported that she had died of plague but later altered his statement to say she "possibly" died of the disease.

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COVID-19 made the weaknesses in our pandemic preparedness at national and global levels painfully clear. But a new study highlights that even at the first, local steps of an outbreak with pandemic-potential, we are worryingly underprepared.

Health officials in New York set up a regional test of healthcare facilities to identify and respond to a patient with a mystery infection that could pose a pandemic-level threat. But things didn't go well. Overall, responses were slow, appropriate use of personal protective equipment was spotty, and only 60 percent of facilities passed the basics of the test—an overall failing grade.

"These drills identified needs for health care workers and health care facility staff member training to achieve earlier identification, masking, and isolation of potentially infectious febrile patients," the officials wrote in the study, which was published in the Morbidity and Mortality Weekly Report.

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A fifth, unvaccinated person has died of measles in Pennsylvania, the state's health department announced Wednesday.

The department identified the deceased as a resident of Lancaster County, which is the epicenter of a raging outbreak that began in late April. The updated case count as of Wednesday is 943 across 39 counties, including 119 cases reported in just the last seven days. At least 176 people have been hospitalized.

Lancaster County has reported 381 cases and three of the five deaths in the outbreak. The previous two deaths were both in infants too young to be vaccinated. That includes a newborn boy and a 6-week-old baby girl. So far, no other information has been released about the county's third death announced today.

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