As many as 13,000 people received contaminated steroid shots that are suspected in a national meningitis outbreak, according to health officials.

Eleven people have now died and another 119 are sick. Tennessee has the highest number of cases, followed by Michigan, Virginia, Indiana, Florida, Maryland, Minnesota, North Carolina, and Ohio.

The contaminated steroid shots were given to relieve back, knee, and shoulder pain.

Health officials in affected states are tracking down patients who may have received the shots.

"Local health department teams in many areas of the state worked tirelessly over the weekend making personal contact with approximately 66 at risk patients who we previously have not been able to verify," Dr. John Dreyzehner, health commissioner for Nashville, Tenn., said.

The source of the tainted shots is a New England specialty pharmacy that mixes its own medicines and is not subject to FDA standards.

The steroid medication was contaminated by a fungus that goes from the spinal fluid to the brain and causes meningitis, a serious inflammation of the meninges, the thin membranous covering of the brain and spinal cord.

Symptoms of meningitis include headache, fever, and slurred speech.

The steroid shots were delivered to 76 clinics nationwide.