The measles outbreak in Texas has reached 400 cases, the state announced Friday, an increase of more than 20 percent since the last update on Tuesday. 

Officials have said the numbers are likely an undercount.

Nearly all of the cases are in unvaccinated individuals or in individuals whose vaccination status is unknown, according to the Texas Department of State Health Services. At least 41 people have been hospitalized so far. 

An unvaccinated, but otherwise healthy child, died of measles in February, becoming the first measles fatality in the U.S. in a decade.  

Just two cases have occurred in people fully vaccinated, according to the data.  

The outbreak has also been spreading beyond Texas. The New Mexico Department of Health reported 44 cases on Friday, while Oklahoma reported seven confirmed and two suspected cases.  

Friday’s updates come after the Trump administration abruptly canceled more than $11 billion in COVID-era public health grants, a move that state and local health departments said could harm Texas’s measles response. 

Departments are already operating on thin margins and need to balance sometimes competing public health priorities. Due to the loss, some health departments are already starting to cancel contracts and lay off workers.  

Grants were used for information modernization, as well as to hire people to help with vaccinations, testing and disease tracking.

Philip Huang, director of Dallas County Health and Human Services, said grant money was going to be used to help equip a new lab that is being built. The new equipment would have expanded the lab’s testing capacity for COVID-19, as well as other pathogens, like measles.