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.

Update: The Texas measles outbreak has grown to 146 cases, with the first child fatality reported. Residents are urged to get vaccinated.