October 7th, 2012

CDC: Meningitis Outbreak Spreads to 7 States

Published: October 05, 2012

The scope of the fungal meningitis outbreak is widening, with 12 more cases and an additional state reporting patients.

All told, the CDC said today, 47 people have been affected in seven states – up from the 25 cases in six states reported Thursday -- but the death toll is unchanged at five.

The rare form of meningitis has been linked to three lots of a steroid used to control back pain. The steroid, preservative-free methylprednisolone acetate, was manufactured by the New England Compounding Center in Framingham, Mass., and the three lots have now been recalled.

But the CDC and the FDA are now advising doctors – "out of an abundance of caution" -- to avoid all products made by the company and to retain and secure them until further notice.

The recalled lots of methylprednisolone acetate are:

Lot #05212012@68, BUD 11/17/2012
Lot #06292012@26, BUD 12/26/2012
Lot #08102012@51, BUD 2/6/2013

The hardest-hit state is Tennessee, which is reporting four new cases today – bringing its total to 29, with three deaths, according to John Dreyzehner, MD, the commission of the state's health department.

Virginia is now reporting six cases, up from four yesterday, and Indiana has three, up from one. Florida and Maryland are unchanged with two cases each, as is North Carolina with one.

The new entrant is Michigan, which is reporting four cases.

Aside from the three deaths in Tennessee, there has been one fatality in each of Virginia and Maryland.

The steroid is used in epidural injections aimed at relieving back pain and there seems little doubt at this point that it's the cause of the fungal meningitis.

There were "no significant lapses in processes" at the any of the clinics in Tennessee that used the steroid, Dreyzehner told reporters in a telephone press briefing today.

"The evidence indicates this is a product issue," he said.

FDA investigators reported finding "foreign matter" in an unopened vial of the substance at the company's plant. Under the microscope that substance was found to be a fungus, and microbiological testing is now under way to determine the exact type, the agency said.

Symptoms of the fungal meningitis include fever, new or worsening headache, nausea, and new neurological deficit consistent with deep brain stroke, the CDC reported.

Some patients had symptoms that were "very mild in nature," the agency noted.

Cerebrospinal fluid obtained from patients typically shows an elevated white cell count (with a predominance of neutrophils), low glucose, and elevated protein.

The delay between the injection of the steroid and the appearance of symptoms has been between 1 and 4 weeks, the agency is reporting.

Officials have emphasized that the condition is not contagious, unlike viral or bacterial meningitis.