An unvaccinated New Mexico man tested positive for measles after death, becoming what health officials say could be the second death reported in the ongoing outbreak that has infected over 160 people in at least nine states.

Gaines County is a vast, flat expanse far in the west of Texas: more than 1,500 square miles of sparsely populated farmland. And right now, this is the epicenter of a measles outbreak the likes of which this state hasn’t seen in more than 30 years.