The number of deaths from fungal meningitis linked to potentially contaminated steroid injections has risen to 20 and the outbreak has reached a 16th state, New York, the Centers for Disease Control and Prevention said on Thursday.

The deadly outbreak of the rare disease showed no signs of abating, as nine new cases of meningitis were reported, bringing the national total to 254, plus three peripheral infections in joints.

Michigan reported its fourth death from meningitis. New cases also were reported in Indiana, New Hampshire, New Jersey, Ohio and Tennessee.

The outbreak stems from medications shipped by the New England Compounding Center in Massachusetts. The company faces multiple federal and state investigations and lawsuits over the tainted medications.

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