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The number of measles cases exceeded 500 in Texas on Tuesday, according to the state’s health department, which made the update days after a second Texas child died after contracting the highly contagious illness that has been confirmed in at least 20 states.

Texas confirmed 505 measles cases in 22 counties on Tuesday. About 70% of these cases were confirmed in children under the age of 18.

A second child in Texas has died from measles, one of the world’s most contagious illnesses, which was declared eliminated from the United States in 2000, several decades after the introduction of a highly effective vaccine.

The Texas Department of State Health Services said Tuesday that the number of measles cases in the outbreak that began in January has risen to 505 confirmed infections with 57 hospitalizations. Based on the most recent data,

Update: Texas faces a growing measles outbreak, with additional counties put on alert as cases rise to 505 with two school-aged fatalities; vaccination is urged

West Texas is in the middle of a still-growing measles outbreak with 481 cases Friday. The state expanded the number of counties in the outbreak area this week to 10. The highly contagious virus began to spread in late January and health officials say it has spread to New Mexico,