The West Texas measles outbreak grew again on Friday, with state health officials now reporting 146 cases of the infectious virus.
Hospitalizations were up by two, rising from 18 to 20.
There has been only one death associated with the outbreak: the first in the nation since 2015.
An unvaccinated child died Tuesday in Lubbock, although the facility that treated the child told The Associated Press they did not live in Lubbock County.
Of the 146 cases, 70 are children and teens between the ages of five and 17 years old. And, 46 are four years old and younger.
Measles, which can survive in the air for up to two hours, can cause serious illness and death.
“Due to the highly contagious nature of this disease, additional cases are likely to occur in the outbreak area and the surrounding communities,” the Texas Department of State Health Services said.
A spokesperson for the state health department told The Associated Press that cases in West Texas have been concentrated in a “close-knit, undervaccinated” Mennonite community.
While the majority of the cases - nearly 100 - have been reported in Gaines County, health authorities have sounded the alarm about potential exposures in San Marcos and San Antonio over Valentine’s Day weekend.
“There is a very good possibility that hundreds of thousands of folks have come in contact with (the person),” Metro Health Deputy Director Dr. Anita Kurian said, according to KSAT.
In addition to concerns about the nation’s response on a federal level, the actions of state government have come into question.
Mobile vaccination clinics have been opened in affected areas of the state, but Republican Governor Greg Abbott has yet to address the weeks-long outbreak in press conferences, according to The Texas Tribune. A request for comment from the governor was not immediately returned on Friday.
“Everybody is so sensitive to the vaccine topic due to COVID,” Ector County Judge Dustin Fawcett told the publication. “We need to be very careful about how we address this topic … Our job is to provide the resources, not to tell people what they need to do.”
Meanwhile, the cases have spread across multiple states throughout the continguous U.S. and Alaska.
Kentucky reported its own case in an adult resident who recently traveled internationally.
“Kentucky health officials are working to identify and contact individuals who may have been exposed to the virus. The resident attended a fitness center in Frankfort, Kentucky while infectious,” the Kentucky Department for Public Health said in a statement.
“Measles is one of the most contagious viruses in the world,” Commissioner Dr. Steven Stack said. “Fortunately, measles can be prevented with the measles, mumps and rubella (MMR) vaccine, which is safe and effective. Vaccines are an essential tool to keep children and adults safe and healthy.”
