Texas health officials say the number of people with measles has increased to 146 in rural West Texas outbreak that led this week to the death of a school-aged child who was not vaccinated.

The measles outbreak in Texas has reached nearly 150 cases, according to a Friday morning update from the state health department. The agency said 146 cases have been identified since late January. Twenty of those patients have been hospitalized, and one school-age, unvaccinated child has died.

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