Three people have been gored at the annual bull running festival in Pamplona, Spain.

Officials say a Spaniard aged 43 and two Americans, aged 23 and 46, were injured during the San Fermin festival in the Navarre province in northern Spain.

The 46-year-old required surgery after being gored in the neck, AP reported.

At least two others were taken to hospital for injuries to the head sustained during the annual run, and a total of 48 people were treated by the Red Cross at the scene.

The annual bull running has claimed at least 16 lives since 1910, when records of the deaths first began.

Man gored in running of the bulls Show all 8 1 /8 Man gored in running of the bulls Man gored in running of the bulls Revellers run ahead of the bulls during the second day of the event in Pamplona AP Man gored in running of the bulls A runner finds himself in a steer's way during the first bull run of the famous running of the bulls Reuters Man gored in running of the bulls Several 'mozos' or runners are chased by bulls from the Torrestrella ranch EPA Man gored in running of the bulls Several 'mozos' or runners are chased by bulls EPA Man gored in running of the bulls A gigante (giant) passes down a street of Pamplona during the San Fermin procession Getty Images Man gored in running of the bulls Revellers run next to the fighting bulls AP Man gored in running of the bulls A calf, used as a game to amuse revellers, jumps into the arena after the running of the bulls AP Man gored in running of the bulls AP

The last person to die was Daniel Jimeno Romero, who died in 2009.

The festival sees daily bull runnings, with participants dressing up in mostly white and red and dashing down the 850 metre course.

Six bulls are released each day, and will be released until Sunday.