The number of people with measles in Texas increased to 146 in an outbreak that led this week to the death of an unvaccinated school-aged child, health officials said Friday. The number of cases — Texas’ largest in nearly 30 years — increased by 22 since Tuesday.

Vaccine hesitancy has been rising for years in the United States. Doctors and parents in one rural county are confronting the consequences.

The latest update comes two days after the first death was reported in a school-aged child who lived in the outbreak area.