A measles outbreak in rural West Texas has doubled in size to 48 cases, the Texas Department of State Health Services said on Friday.

“At this time, 48 cases have been identified with symptom onset within the last three weeks. Thirteen of the patients have been hospitalized. All of the cases are unvaccinated or their vaccination status is unknown. Due to the highly contagious nature of this disease, additional cases are likely to occur in Gaines County and the surrounding communities,” the DSHS said. The outbreak is the most severe Texas has seen in 30 years.

Texas Department of State Health Services spokesperson Lara Anton said the cases have been concentrated in a “close-knit, under vaccinated” Mennonite community. The outbreak is in a sparsely populated swath of rural Texas, near the New Mexico border, and has spread from its epicenter in Gaines County to include single-digit cases in Lynn, Terry, and Yoakum counties.

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