Report details start of steroid meningitis outbreak
More federal oversight needed to prevent repeat occurrences, expert says.
(HealthDay)—The first reports of serious fungal infections from tainted steroid injections for back pain came in September from Tennessee and quickly became a national health crisis.
As of Monday, 30 people had died and 419 had been sickened in 19 states during the outbreak of fungal meningitis, with Tennessee and Michigan hit the hardest, according to U.S. health officials.
"Tennessee really got inundated with this," said Dr. Marc Siegel, an associate professor of medicine at NYU Langone Medical Center in New York City.
Now, a report published online Nov. 6 in the New England Journal of Medicine explains how the outbreak began and gives details on 66 cases in Tennessee. The state is now reporting a total of 78 cases of infection and 13 deaths.
This is rare fungal infection, Siegel said. "What's important about this report is that it documents an unusual way of transmitting this fungus," he explained.
The crisis started when a Tennessee doctor reported a single case of fungal meningitis to the state Department of Health on Sept. 18, and the agency began an investigation. Two days later two more cases were identified in Tennessee and authorities notified the U.S. Centers for Disease Control and Prevention.
By Sept. 25 there were eight cases of meningitis, which is inflammation of the lining surrounding the brain and spinal cord. All of the patients had been injected with a steroid compound in hopes of relieving neck or back pain.
Investigators quickly linked the outbreak to contaminated products made by a single company, the New England Compounding Center in Framingham, Mass. The company began a recall of its products and eventually it was shut down.
When the Tennessee Department of Health compiled data on the cases, it found that the age of patients ranged from 23 to 91, and it generally took about 18 days from the steroid injection until symptoms appeared.
Symptoms included headache, new or worsening back pain, nausea, stiff neck and neurological symptoms, such as sleep problems and sensitivity to light, the report said.
The investigators were able to trace the tainted products to specific lots of a steroid, preservative-free methylprednisolone acetate. Patients particularly at risk were those whose injections came from older vials or those who were given high doses or multiple injections, the investigators found.
Among these 66 patients, eight died—seven from strokes, the report said.
Effective collaboration between public health officials and physicians were essential to this investigation, the authors said. "An aggressive public health response to a single report of an unusual infection resulted in the identification of a multistate outbreak of fungal infections and the rapid recall of the implicated product involved," they concluded.
According to the CDC, as many as 14,000 people were exposed to the contaminated steroids.
While praising the Tennessee Department of Health and the CDC for their swift action, Siegel said the lesson from this outbreak is the need for more oversight of compounding pharmacies like the New England Compounding Center.
These pharmacies combine, mix or alter ingredients to create drugs to meet the specific needs of individual patients, according to the U.S. Food and Drug Administration. Such customized drugs are frequently required to fill special needs, such as a smaller dose or removal of an ingredient that might trigger an allergy in a patient.
Currently, these pharmacies are regulated by each state's Board of Pharmacy. The FDA has limited regulatory power over these companies, Siegel noted. Several members of Congress have called for greater FDA oversight of compounding pharmacies in the wake of the outbreak.
"This is a situation where something is made in one state but administered in another state. This is a federal problem," Siegel said. "This is not supposed to happen. This loophole needs to be closed."
"From the point of manufacture to the point of injecting a person's body, the amount of surveillance should not diminish," he added.
More information: To learn more about fungal meningitis, visit the U.S. Centers for Disease Control and Prevention.
Journal reference: New England Journal of Medicine
Copyright © 2012 HealthDay. All rights reserved.
- US clinics rush to warn of tainted steroid; 5 dead Oct 05, 2012 | not rated yet | 0
- US: Avoid drugs from company tied to meningitis (Update) Oct 04, 2012 | not rated yet | 0
- US tainted drug outbreak rises to 185 cases Oct 12, 2012 | not rated yet | 0
- Meningitis outbreak toll now 23 dead, 297 sickened: CDC Oct 22, 2012 | not rated yet | 0
- Official: pharmacy tied to meningitis outbreak may have broken state law Oct 12, 2012 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Classical and Quantum Mechanics via Lie algebras
Apr 15, 2011 I'd like to open a discussion thread for version 2 of the draft of my book ''Classical and Quantum Mechanics via Lie algebras'', available online at http://lanl.arxiv.org/abs/0810.1019 , and for the...
- More from Physics Forums - Independent Research
More news stories
(HealthDay)—Few randomized clinical trials have been done to assess clinical prediction rules for patients with lower back pain, and the trials that have been done are of low quality and do not provide ...
Diseases, Conditions, Syndromes 15 hours ago | not rated yet | 0 |
A new, highly sensitive blood test that quickly detects even the lowest levels of malaria parasites in the body could make a dramatic difference in efforts to tackle the disease in the UK and across the world, according to ...
Diseases, Conditions, Syndromes 20 hours ago | not rated yet | 0
(AP)—The World Health Organization says a yellow fever booster vaccination given 10 years after the initial shot isn't necessary.
Diseases, Conditions, Syndromes 20 hours ago | not rated yet | 0
(AP)—Twenty-three youths have died in the past nine days at initiation ceremonies that include circumcisions and survival tests, South African police said Friday.
Diseases, Conditions, Syndromes 21 hours ago | 5 / 5 (1) | 3
The United States government public health agency, the CDC, pledges "To base all public health decisions on the highest quality scientific data, openly and objectively derived." But Peter Doshi, a postdoctoral fellow at Johns ...
Diseases, Conditions, Syndromes May 16, 2013 | not rated yet | 0
Big names in medicine are set to give an upbeat assessment of the war on AIDS on Tuesday, 30 years after French researchers identified the virus that causes the disease.
4 hours ago | not rated yet | 0
For combat veterans suffering from post-traumatic stress disorder, 'fear circuitry' in the brain never rests
Chronic trauma can inflict lasting damage to brain regions associated with fear and anxiety. Previous imaging studies of people with post-traumatic stress disorder, or PTSD, have shown that these brain regions can over-or ...
5 hours ago | not rated yet | 0 |
(Medical Xpress)—What if the quality of your work depends more on your focus on the piano keys or canvas or laptop than your musical or painting or computing skills? If target users can be convinced, they ...
17 hours ago | 3.7 / 5 (3) | 0 |
The neural machinery underlying our olfactory sense continues to be an enigma for neuroscience. A recent review in Neuron seeks to expand traditional ideas about how neurons in the olfactory bulb might encode information about ...
16 hours ago | not rated yet | 0 |
In 2008 researchers from the University of Southern Denmark showed that the drug thioridazine, which has previously been used to treat schizophrenia, is also a powerful weapon against antibiotic-resistant bacteria such as ...
14 hours ago | 3.7 / 5 (3) | 0 |
Treatment for alcohol use disorders works best if the patient actively understands and incorporates the interventions provided in the clinic. Multiple factors can influence both the type and degree of neurocognitive abnormalities ...
14 hours ago | not rated yet | 0 |