There have been four measles cases reported in the Dallas-Fort Worth area this year: one in Collin County, one in Denton County and two in Rockwall County. State authorities have not officially tied any of those cases to the outbreak that began in Gaines County, and all four appear in the state public health department’s list of “other 2025″ cases.

The Texas Department of State Health Services (DSHS) confirmed 20 more cases of measles since the last update on Tuesday. That brings the total number of cases in the West Texas outbreak since late January to 683. The DSHS added that 89 people have been hospitalized with measles since the outbreak began.

The Texas health department reported 663 cases of measles in the state on Tuesday, an increase of 17 cases since April 25, as the U.S. battles one of its worst outbreaks of the childhood disease. Cases in Gaines County,