The cause of the accident between the truck and the Durbin & Greenbrier Railroad train on a trip at the peak of the fall season wasn't immediately known.
Two passenger cars overturned in the accident at 1:30 p.m. Friday along U.S. Route 250 about 160 miles east of Charleston near Cheat Mountain, said emergency services director Shawn Dunbrack of Pocahontas County.
Randolph County emergency services director Jim Wise said at least three people were critically hurt. He said 21 people were taken to a hospital in Elkins by ambulances and 45 others were transported there by bus with lesser injuries. There were no immediate details on the death and nature of the injuries.
Hospital spokeswoman Tracy Fath said at least eight ambulances arrived at the hospital. She didn't immediately know the patients' conditions. Medical personnel also were tending to those on the bus.
"Some wished to have medical care. Some declined to have medical care," Fath said. "Our staff is on the bus trying to (assess) which ones will want to be seen."
Dunbrack said the train involved was operated by the Durbin & Greenbrier Railroad. The railroad's Cheat Mountain Salamander runs Tuesdays through Saturdays in October on a 6.5-hour trip. The railroad said there were three passenger cars Friday on the 88-mile roundtrip that left Elkins on a route taking passengers to elevations of more than 4,000 feet.
"Our thoughts and prayers are with all those involved and the emergency responders working the tragic accident in Randolph County this afternoon," Gov. Earl Ray Tomblin said in a statement.