The Texas health department reported 422 cases of measles in the state on Tuesday, an increase from 400 on March 28, as the United States battles one of the largest outbreaks of the disease in the past decade.

The measles outbreak in Texas continues to spread, with 422 cases reported since January, an increase of 22 cases since Friday. Most cases are in West Texas, where one child has died. Dallas County Health and Human Services has cut 21 workers,

An unvaccinated adult who lives in Pueblo developed measles after visiting a part of Mexico that has an ongoing outbreak.

The number of cases continues to rise, and data from the CDC shows 97% of those infected are unvaccinated or whose vaccine status is unknown. In March alone, Texas reported 185 measles cases. Following behind Texas; New Mexico and Kansas have reported the next highest number of cases at 44 and 23, respectively.

The Texas measles outbreak continues to grow as health officials report 70 new cases in the state, with 400 total cases.

Kansas and Ohio health officials have confirmed several measles cases among mostly unvaccinated children and adults, as the total number of states reporting measles outbreaks reaches 18.