Three more patients have died after contracting fungal meningitis from potentially tainted steroid injections supplied by a Massachusetts company, the U.S. Centers for Disease Control and Prevention said on Tuesday, bringing the death toll from the outbreak to 28 nationwide.

Two of the new deaths were in Michigan, which now has reported seven fatalities, and one in Tennessee which has confirmed 11 deaths, the CDC said. The two states have been the hardest hit by the outbreak, first discovered in Tennessee late last month.

The number of cases of fungal meningitis reported across the United States rose to 356 on Tuesday, up nine from Monday, the CDC said. Nineteen of 23 states that received shipments of the steroid have reported cases.

There also are seven reported cases of infections after the steroid was injected into a joint such as a knee, hip, shoulder or elbow, bringing the total number of infections to 363.

The steroid was supplied by New England Compounding Center of Framingham, Massachusetts, which faces multiple investigations. Health authorities have said its facility near Boston failed to make medications in sterile conditions.