About 13,000 people may have been exposed to the tainted steroid that has been linked to a growing outbreak of fungal meningitis, a spokesman for the Centers for Disease Control and Prevention said on Monday. The outbreak has killed 8 people and sickened 97 others in 23 states. More cases are expected.þþThe figure, the first estimate of how many people were injected with any of the 17,676 doses shipped around the country, is based on reports from state health departments and clinics that used the drug, methylprednisolone acetate. It was injected near the spine to ease back and neck pain, a treatment that about five million people in the United States undergo every year.þþThe company that made the drug, the New England Compounding Center in Framingham, Mass., has shut down, surrendered its license and recalled all its products, not just the steroid.þþThe disease centers said that the company began shipping potentially contaminated lots of the drug on May 21, and that people who had the treatment for back pain — called a lumbar epidural steroid injection — after that date should seek medical attention if they develop symptoms like severe or worsening headache, fever, stiff neck, dizziness, weakness, sensitivity to light or loss of balance.þþIt is not known if all the vials of medicine in the implicated lots were contaminated with the disease-causing fungus, or if everyone exposed to it will become ill. Curtis Allen, the spokesman for the disease centers, predicted that most exposed people would not become sick.þþBut fungal meningitis can be severe and can cause strokes, and early treatment might save a patient’s life. Health officials say people who may have been exposed must be tracked down immediately so that those with symptoms can be treated as soon as possible. The treatment consists of an antifungal drug, either voriconazole or amphotericin B, and sometimes both. Months of treatment are needed. Because the drugs can have serious side effects, including kidney problems, they are given only to people who have symptoms, and are not used as a preventive measure in those who are not ill.þþThis type of meningitis is not contagious. Despite the treatment, some patients are in critical condition, doctors said.þþDr. John Jernigan, a medical epidemiologist at the disease centers, said, “This is a very rare form of meningitis and there is not a great deal of clinical experience with it.”þþState health departments and pain clinics around the country have been trying to reach patients who received the steroid made by the New England center to warn them of the risk. Tennessee received a “disproportionate” share of the tainted medicine. One pain clinic, at St. Thomas Hospital in Nashville, received 2,000 vials. The clinic, the Outpatient Neurosurgery Center, closed on Sept. 20. Statewide, more than 1,000 patients are at risk, the state health commissioner, Dr. John Dreyzehner, said on Monday. He said that public health nurses had worked all weekend and had gone knocking on doors to track down the last 66 of the 1,000.þþDr. Dreyzehner said that public health nurses would be in touch with patients once a week or more until they felt sure that the risk had passed. So far, the incubation period for the disease seems to be between a few days and a month. The first shipments reached Tennessee on June 27, and the treatments were halted on Sept. 18. That means some people are still in the incubation period and could become sick in the coming weeks.þþNoting that early treatment is essential, Dr. William Schaffner, an infectious disease expert at Vanderbilt University, questioned whether officials had acted as quickly as possible to protect public health. For instance, even though worried doctors and patients around the country were eager to know which product was implicated in the outbreak, officials waited several days to release the name of the New England Compounding Center, saying that to name the company could have compromised their investigation.þþ“Wouldn’t it have been in the public health interest to have released the name of the pharmacy earlier?” Dr. Schaffner asked.þþIn addition, officials have said that inspectors from the Massachusetts Department of Public Health entered the New England center on Wednesday, Sept. 26. But federal inspectors from the Food and Drug Administration did not go there until the following Monday.þþ“What happened?” Dr. Schaffner asked. “It’s not a crime scene but I would have wanted to take control of that building as quickly as possible.”
Source: NY Times
