The Wisconsin Department of Health Services said on Thursday an infant had died in connection with the ongoing measles outbreak in the state. The coroner listed measles as the immediate cause of death, the department said, declining to release further details to protect the family’s privacy. The death comes as the United States faces its highest number of measles cases in decades, fueled by outbreaks in several states and declining childhood vaccination rates in some communities. Wisconsin had reported 431 cases across 13 counties as of Nov. 3, with nine people hospitalized for severe symptoms. “This is the largest number of measles cases we’ve seen in Wisconsin in more than 35 years,” state epidemiologist Ryan Westergaard said in a media call. “The 431 cases we’ve identified are almost certainly an underestimate. Not everyone who becomes infected gets tested or comes to the attention of public health,” he added. State health officials said they have worked with local and tribal health departments to respond to the outbreak through case tracking, testing and vaccination efforts. The Department of Health and Human Services said the National Center for Health Statistics verifies when a death occurred and whether measles was listed as the underlying cause. Once verified, the death will be reflected on the CDC’s website, the agency said. On Wednesday, Pennsylvania health officials reported the state’s sixth measles-associated death this year. While New York state reported its first measles-associated child death earlier this week. However, the CDC has recorded four measles-related deaths this year but did not name the states where they occurred. The gap in numbers follows a policy shift under U.S. Health Secretary Robert F. Kennedy Jr., with the CDC switching to the National Center for Health Statistics’ mortality data to track measles deaths, replacing its earlier reliance on state health departments’ figures. The CDC is also working with the Council of State and Territorial Epidemiologists to develop a standardized case definition for measles deaths to promote consistent classification and reporting across jurisdictions, HHS said. Reporting by Siddhi Mahatole in Bengaluru; Editing by Shailesh Kuber