In the Hunter there were 78 new cases recorded in the 24 hours to 8pm on Tuesday.
None of the state's four deaths, announced earlier on Wednesday, were in the region's hospitals.
NSW Health said two people were from south western Sydney and two from western Sydney, the only two health districts with higher daily cases than the Hunter in the latest figures.
"Two people were not vaccinated and two people had received two doses of a COVID-19 vaccine," the health service said.
The remaining two cases had underlying health conditions.
Hunter New England Health said 38 of the new cases were infectious in the community, and 54 cases linked.
There are 19 active cases in the region's hospitals, four in intensive care.
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Nine of the fresh cases came from Cessnock while Bellbird, Cliftleigh, Greta and Kearsley had two cases each.
Cases were also detected in Aberdare, Abermain, Ellalong, Paxton and Stanford Merthyr.
Lake Macquarie added three in Edgeworth, two in Warners Bay and Windale and individual cases at Belmont North, Booragul, Macquarie Hills, Teralba, Toronto, Highfields and West Wallsend.
Birmingham Gardens added five, while elsewhere in Newcastle there were four cases in Mayfield, two in Wallsend and one apiece for New Lambton Heights, Shortland and Waratah.
Port Stephens had four in Raymond Terrace and one case each in Wallalong, Williamtown and Bobs Farm.
Three of Maitland's seven cases stemmed from Rutherford, with two in Millers Forest and one each in Bolwarra Heights and Telarah.
Tamworth added cases in Tamworth South and Calala, while Midcoast Council had six cases in Taree as well as four others in Cundletown, and one each for Forster and Wingham.
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