The Texas measles outbreak has surpassed 250 cases, with a new county added to the list, the state reported Friday. Health officials said 259 measles cases have been identified since late January, up from the 223 cases reported earlier this week.

Dozens of children have contracted measles in the state’s largest outbreak in 33 years. Online, some are blaming vaccines for the disease’s spread.

Despite an unvaccinated child’s death, local residents in West Texas say personal choice—not public-health policy—should guide their decisions.