Tuesday, January 16, 2018

CDC officials race clock against rare meningitis

WASHINGTON — Federal health officials have tracked down 12,000 of the roughly 14,000 people who may have received contaminated steroid shots in the nation's deadly outbreak of rare fungal meningitis.

Health officials warned Thursday that patients will need to keep watch for symptoms of the infection for months.

"We know that we are not out of the woods yet," Dr. J. Todd Weber of the Centers for Disease Control and Prevention said as the death toll reached 14, including a second victim in Florida.

Two men, ages 83 and 70, have died in Marion County, and state health officials say Florida now has seven cases of the illness.

The 83-year-old man had been injected with the contaminated steroid at the Marion Pain Management Center in Ocala, Florida Surgeon General and Secretary of Health John Armstrong said at a news conference Thursday.

Three pain clinics in Marion County — the Florida Pain Clinic, the Surgery Center of Ocala and the Marion Pain Management Center — unknowingly received the tainted medication. A 48-year-old man in Marion County is the latest Florida patient to be diagnosed with the illness.

Armstrong says officials have identified 735 of the 775 people in Florida who received contaminated injections.

"We're still discovering what we're up against," said Dr. Benjamin Park, who is leading the CDC investigation in Atlanta.

Dr. John Jernigan, a CDC epidemiologist, has assembled a team of the world's leading experts in fungal infections. They spent Tuesday clarifying which patients are in the gravest danger. Many of those afflicted with the disease are elderly, he said.

The bad news is that new cases are emerging virtually every day. Patients may not feel symptoms for up to a month after the steroid injections, which officials believe were administered between May and September.

"We expect to hear about more deaths," Park said.

Of the 170 people sickened in the outbreak, all but one have the fungal form of meningitis after receiving suspect steroid shots for back pain, the CDC said. The other case is an ankle infection discovered in Michigan; steroid shots also can be given to treat aching knees, shoulders or other joints.

Fungus has been found in at least 50 vials of an injectable steroid medication made at a specialty compounding pharmacy in Massachusetts, investigators said. Health authorities haven't yet said how they think the medication was contaminated, but they have ruled out other suspects — other products used in administering the shots — and the focus continues to be on that pharmacy, the New England Compounding Center.

Health officials are hurriedly trying to determine the best way to treat this kind of illness, and have settled on two very strong anti-fungal medications. Consulting with experts, they're making a best guess as to the dosage and length of time patients will have to be treated.

"This is new territory," Weber said.

The fungus behind the outbreaks was initially identified as Aspergillus, but as more testing of patients has been completed, it has become clear that another fungus — a kind of black mold called Exserohilum — is the primary cause. As of Wednesday, CDC's fungal disease laboratory confirmed Exserohilum in 10 people with meningitis and Aspergillus in just one.

Exserohilum is common in dirt and grasses, but this is the first time it has been identified as the cause of meningitis, said Weber of the CDC.

Fungal meningitis is not contagious like the more common forms.

Symptoms of meningitis include severe headache, nausea, dizziness and fever. The CDC said many of the cases have been mild. Symptoms have been appearing between one and four weeks after patients got the shots, but CDC officials on Thursday warned at least one illness occurred 42 days after a shot.

The fungus is difficult to grow in lab analyses, and health officials on Thursday issued an unusual piece of advice to doctors: If a patient who got the injection starts to develop meningitis symptoms, he or she should be treated, even if testing is negative for the fungus.

The CDC emergency operations center has marshaled more than 100 workers to gather information from health agencies in the affected states, hone treatment options and help local health workers contact the thousands who may have been infected. In the CDC's labs, workers are extracting DNA from samples of spinal fluid and running tests to determine who is infected.

Compounding pharmacies traditionally supply products that aren't commercially available, unlike the steroid at issue in the outbreak. And Dr. Madeleine Biondolillo of the Massachusetts Department of Public Health said it appears the company violated state law governing those pharmacies, which aren't supposed to do large-scale production like a drug manufacturer.

Company officials earlier this week declined comment except to say they were cooperating with the investigation.

Information from the Associated Press, Atlanta Journal-Constitution and Ocala Star-Banner was used in this report.

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