Michigan health officials have reported three more infections and one more death linked to contaminated steroids supplied by a Massachusetts pharmaceutical company.

The Michigan Department of Community Health says at least 249 people have been infected with illnesses including fungal meningitis that are part of a national disease outbreak. The steroids are used in injections to treat neck and back pain.

The department reports that at least 16 people have died in the outbreak.

As of last week, the department says there have been 68 cases of fungal meningitis, 155 epidural abscesses, one stroke and 25 peripheral joint infections in Michigan tied to the steroids.