A measles outbreak that began in South Carolina at the start of October is showing no signs of slowing as officials on Tuesday reported 27 new cases since Friday. Those cases bring the outbreak total to 111.

The southern state’s outbreak now rivals outbreaks ongoing in Utah and Arizona, which have tallied 115 and 176 cases, respectively. The outbreaks are threatening to cost the country its measles elimination status, which was earned in 2000 after vaccination efforts stopped the virus from spreading continuously. If the current transmission of the virus isn’t halted by January, the virus will have circulated for 12 consecutive months, marking it once again as an endemic disease in the US.

In an update on Tuesday, South Carolina’s health department suggested the spread is far from over. Of the state’s 27 new cases, 16 were linked to exposure at a church, the Way of Truth Church in Inman. And amid the new cases, new exposures were identified at Inman Intermediate School. That’s on top of exposures announced Friday at four other schools in the region, which led to well over 100 students being quarantined.

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ByHeart announced on Thursday that its own testing identified the bacterium that causes botulism in its baby formula, which is linked to an ongoing infant botulism outbreak that has doubled since last week.

As of November 19, there have been 31 cases across 15 states—up from 15 cases in 12 states reported last week. All 31 cases so far have been hospitalized. No deaths have been reported.

The outbreak was announced on November 8, and ByHeart was, at first, unusually aggressive in deflecting blame for linked illnesses.

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