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.

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.