A strain of chronic fungal meningitis has affected an estimated 137 people in 10 states nationwide, and Virginia is the third-most infected state. When news of the outbreak began to spread last week, Virginia had 11 reported cases. That number has since risen to 27. Twelve people nationwide have died from the infection so far, including one death in Virginia. The outbreak came from a contaminated sample of a steroid called methylprednisolone acetate, Virginia’s state epidemiologist David Trump said. The steroid is an anti-inflammatory agent used to treat patients with back pain. The contaminated steroid injection that caused the outbreak originated at the New England Compounding Center, according to the Centers for Disease Control and Prevention. The New England center has issued a recall of all its products distributed from its facility in Framingham, Mass. The potentially tainted injections were given in two Virginia clinics, both in the Roanoke region, Trump said. Nearly 700 people received the injection. Trump said he thinks the number of people infected in Virginia will continue to increase. In Tennessee, the hardest-hit state, 44 had been infected and six had died as of Wednesday. Michigan follows with 28 infections and three deaths reported so far. This meningitis outbreak is not directly communicable between individuals — only those who received the contaminated injections are at risk for fungal meningitis, Director of Student Health James Turner said. After the initial injection, it takes one to four weeks for symptoms to develop. Starting last Monday, Virginia’s Department of Epidemiology began contacting the two Roanoke clinics in question, Trump said. The clinics sent letters, emails and made phone calls to alert physicians and nurse practitioners across the state. Two subsequent notices were sent out to all Virginia physicians and nurse practitioners about the infection’s spread. “We have been working very closely with the major hospitals in the Roanoke area,” Trump said. The outbreak is not something students need to be worried about, because the only people infected are those who received contaminated injections in their spinal columns, Turner said. “It would be extremely rare that a young person would receive such an injection,” he said. Students who recently received spinal steroid injections, however, should contact a physician, Turner added. In contrast to the bacterial meningitis common among college students, fungal meningitis takes longer for symptoms to show and is less lethal.