Steep federal funding cuts have forced public health officials in one of Texas’ most populous counties — Dallas — to cancel dozens of vaccination clinics and lay off 21 workers on the front lines of combatting the state’s growing measles outbreak.

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,

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 outbreak has expanded beyond West Texas and the Panhandle with confirmed cases in Erath County, southwest of Fort Worth, and Brown County, between Abilene and Killeen. Lamar County in far northeast Texas has 10 cases. Officials say 42 people have been hospitalized.

The Texas health department reported 422 cases of measles in the state on Tuesday, an increase from 400 in its previous count on March 28.

The number of measles cases in Texas has grown to 422 infections as of Tuesday, including the closest known case to Fort Worth so far.

Measles cases in the U.S., which have soared to nearly 500 infections this year, have created concerns for parents with children who are too young to be vaccinated.

The Texas health department said on Friday that the number of measles cases in the state rose 20% since its last report three days ago, as experts warn they expect the outbreak to further spread in coming weeks.

When Texas officials first discovered measles cases this year, they were among the Mennonite population. Now, officials say cases are spreading to other communities.