A second unvaccinated Mennonite child has died from measles complications as the viral outbreak continues to grow in Texas and spreads to surrounding states.

The Texas State Department of State Health Services said in a news release that the child died April 3 in a Lubbock hospital from measles pulmonary failure and had no reported underlying conditions.

U.S. Health and Human Services Secretary Robert F. Kennedy Jr. attended the April 6 funeral services at Reinlander Mennonite Church in Seminole. The Associated Press reported he met with families of both the 6- and 8-year-old children who died.

Kennedy is an anti-vaccine advocate who has resisted urging widespread vaccinations, but on April 6 he noted in a lengthy social media post that vaccinations are “the most effective way to prevent the spread of measles.”

Texas has recorded nearly 500 cases of measles as the virus has spread to 22 states, but the true number of measles cases is likely much higher as many go unreported. Health officials traced the outbreak to the Low German Mennonite community in the area around Seminole. It has since been connected to cases across the border in Mexico.

By late March, measles cases in Kansas doubled in less than a week to 23 cases in what health officials said was “a possible link” to the Texas cases. Cases are clustered in Grant, Morton and Stevens counties, which are also home to several Low German Mennonite congregations and have similarly low vaccination rates to Gaines County in Texas.

A measles outbreak among unvaccinated children in Ontario has grown to more than 660 cases, with about 100 added every week. Officials traced the cases to a conservative Mennonite gathering in New Brunswick. The Canadian Press reported Dr. Kieren Moore said the “vast majority” of Ontario cases are in Mennonite, Amish and other Anabaptist communities.