The deadly meningitis outbreak tied to steroid injections from potentially tainted medications spread to a 19th state on Monday with the first case reported in Rhode Island, the Centers for Disease Control and Prevention said.
Only four of the 23 states that received some of the medication have not reported cases of fungal meningitis, which has killed 25 people nationwide.
The four states that have not reported at least one case of meningitis are California, Nevada, West Virginia and Connecticut, the CDC said.
The total number of meningitis cases including the expansion to Rhode Island reached 347 nationwide on Monday, the CDC said, up 10 from the last report on Saturday.
There also are seven reported cases of infections after the tainted steroid was injected into a joint such as a knee, hip, shoulder or elbow, bringing the total number of infections to 354.
The steroid was supplied by New England Compounding Center of Massachusetts, which faces multiple investigations. Health authorities have said its facility near Boston failed to make medications in sterile conditions.