BOSTON (CBS/AP) — A fifth person has died in a growing outbreak of a rare form of meningitis that has sickened about three dozen people in several states.

Dr. Robert Latham, chief of medicine at Saint Thomas Hospital in Nashville, said Thursday a patient died there late Wednesday or early Thursday, bringing the number of deaths in Tennessee to three.

WBZ NewsRadio 1030′s Lana Jones reports

Deaths have also been reported in Virginia and Maryland.

All received steroid injections used mostly for back pain that have been traced back to the New England Compounding Center, a specialty pharmacy in Framingham.

The pharmacy issued a recall last week of the possibly tainted steroid and has shut down operations.

The CDC said Thursday afternoon that the medication was shipped to 23 states, including New Hampshire, Rhode Island and Connecticut, but not Massachusetts.

New Hampshire public health officials are also working with the CDC after they found the same medication was distributed to Pain Care LLC, at the Somersworth and Merrimack locations. Pain Care has sent the product back to the manufacturer.

Pain Care LLC did not return phone calls from WBZ. However, state health director Dr. Jose Montero says the clinics are calling the 186 patients who were injected.

“The pain clinics are calling them since they are their patients, explaining to them what happened,” he said. “This is not the fault of the pain clinic. They got a product that was contaminated.”

Montero says he expects some of the New Hampshire patients to come down with symptoms.

“We have 186 people who received those medications so unfortunately yes, we have a high chance of finding cases that match this particular outbreak of meningitis.”

New England Compounding Center released a statement Thursday saying they are working with state and federal agencies in the investigation into the cause of the outbreak.

“As part of this process, NECC has initiated a series of recalls encompassing all methylprednisolone acetate products – as well as other injectable medications – distributed from our facility in Framingham, Massachusetts,” they said in a statement. “We also understand the FDA – as a precautionary measure – has suggested to medical professionals that they do not use any NECC products at this time, although there is no indication of any potential issues with other products. As previously announced, we have voluntarily suspended operations while we assist authorities in this investigation. The fatalities and illnesses confirmed today by the CDC and FDA are tragic. The thoughts and prayers of everyone employed by NECC are with those who have been affected.”

The type of meningitis is not contagious and health officials believe that more new cases are almost certain to appear in the coming days.

WBZ-TV’s Lauren Leamanczyk contributed to this report.