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.

An outbreak of measles in northwest Texas grew to 146 cases on Friday, two days after health officials reported that a child had died after being hospitalized in Lubbock. Twenty people have been hospitalized for treatment amid the outbreak,

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