Virginia and Maryland both released updates Tuesday in the number of meningitis cases reported across the area, with 24 total cases in Virginia and five in Maryland.
Those numbers include two fatalities.
The outbreak has been linked to a steroid produced by a specialty pharmacy in Massachusetts. The patients developed meningitis after receiving injections of the steroid, which has now been recalled.
The Virginia Department of Health confirmed Tuesday it has had 24 cases, 21 of which are in southwest Virginia. One of those patients died.
The other three cases are in West Virginia, in patients who received injections in Virginia.
Health officials in the Commonwealth said they expect these numbers to continue to grow. They said they're most concerned for patients who received injections on or after Aug. 8.
The Virginia Department of Health is reaching out a second time to all 689 patients who were exposed to the contaminated drug to make sure they are being monitored by their doctor.
All 689 people who received injections in Virginia received the contaminated medication. However, not all of them were injected in the spine. Some received the injections in their knees, necks or other joints. All 24 known cases of meningitis occurred in people who were injected in the spine.
In Maryland, health officials say they have identified two more cases, bringing their total up to five. One person has died.
Last week, the state released a list of seven clinics that received drugs linked to the meningitis outbreak. Those clinics began contacting patients when the list was released.
Nationwide, the Centers for Disease Control and Prevention says more than 100 people across nine states have become ill, and eight people have died.