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.

A child who wasn’t vaccinated died in a measles outbreak in rural West Texas, officials there said Wednesday, the first U.S. death from the highly contagious respiratory disease since 2015.