On 17 April 2007, while campaigning for re-election for his fourth term, Itoh was shot twice in the back at point-blank range by Tetsuya Shiroo while exiting a car in front of his campaign office outside Nagasaki Station. Itoh was taken to the Nagasaki University Hospital in a state of cardiopulmonary arrest and underwent four hours of emergency operations, but he died early the next morning due to blood loss. Itoh's death triggered a new mayoral election held on 22 April 2007. Itoh's son-in-law, , and a city official, , filed for candidacy in the election. Taue was elected as Itoh's successor.