Meningitis cases reported in Virginia, Maryland

NASHVILLE, Tenn. (AP) - Health officials say a rare meningitis outbreak has sickened 26 people in five states who received steroid injections for back pain. Four people have died.

Eighteen of the cases - and two deaths - are in Tennessee where a Nashville clinic received the largest shipment of the steroid suspected in the outbreak. A health official said the steroid came from a specialty pharmacy in Massachusetts.

According to the Centers for Disease Control and Prevention, the other cases are in Virginia, Maryland, Florida and North Carolina. Virginia and Maryland had one death each.

Health officials said Wednesday that more new cases are almost certain to appear in the coming days. Investigators have not ruled out contamination in other products.

In the Virginia case, Dr. David Trump said Wednesday the injections were administered at two medical facilities in southwest Virginia.

He said potentially several hundred people may have received the steroid injections.

Trump said the state Department of Health is working with the two Virginia medical facilities to identify patients who received the treatment, and he expects additional cases.

The two facilities are believed to be the only source of the recalled steroid in Virginia.