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

Declining vaccination rates, decreasing trust in government and a political unwillingness to endorse vaccines is shaping Texas’ measles response.

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,