Germany is at the start of a coronavirus epidemic, its health minister has warned.
Jens Spahn said some of the infection chains in the country are “no longer trackable”.
It comes as fears grow over the spread of coronavirus across Europe.
France has reported its second death, while the number of people in Italy with the virus continues to climb.
Spahn said: “We are at the beginning of a corona epidemic in Germany. The new cases in North Rhine-Westphalia and Baden-Wuerttemberg are a further sign of that.
“The infection chains are partially no longer trackable, and that is a new thing.
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"Large numbers of people have had contact with the patients, and that is a big change to the 16 patients we had until now where the chain could be traced back to the origin in China.”
Spahn suggested the country would need to change its strategy “to contain the virus and cut infection chains”.
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Meanwhile, Italy has reported the number of people with the virus has grown to 322, up 45% in 24 hours. Eleven people have died.
Austria, Croatia and Switzerland also reported their first cases linked to the outbreak in Italy, while Spain and France recorded new ones also involving people who had been to northern Italy.
The first positive test in South America has also been recorded, with a 61-year-old Brazilian man who had recently been to northern Italy.
Meanwhile, for the first time, the number of new cases officially reported outside China has exceeded new cases reported by Beijing.
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Reuters reported figures from the World Health Organization (WHO) showing there were 427 new cases reported in 37 countries on Tuesday, compared to 411 reported by Beijing.
In the UK, health secretary Matt Hancock told MPs on Wednesday that 7,132 people in the UK have so far been tested.
Of these, 13 have tested positive, of whom eight have been discharged from hospital.
He said the NHS is looking to extend home testing while a new public information campaign will be launched.
A number of schools in the UK have told staff and pupils to stay at home after returning from ski trips to northern Italy, where several towns in the Lombardy and Veneto regions remain on lockdown.
At least eight schools have closed despite national guidance urging them to stay open. Hancock urged schools not to close unless they had a confirmed case of the virus.
Additional reporting by PA.