May 23, 2013
'US fungal meningitis outbreak could have been much worse'
As bad as the 2012 fungal meningitis outbreak has been, so far infecting 620 people in 19 states and killing 39 of them, it could have been a lot worse, US health officials said today.
Prior and much smaller fungal outbreaks involving tainted spinal injections were far more deadly, killing as many as 40 to 50 percent of those who had become infected," said Dr. Rachel Smith, an epidemic intelligence service officer at the Centers for Disease Control and Prevention.
"We were certainly concerned we could see that kind of mortality rate in this outbreak," said Smith, who wrote about the ongoing US outbreak of fungal meningitis and related infections in the New England Journal of Medicine.
Instead, the overall death rate linked to tainted steroid injections from a Massachusetts pharmacy has been about 6 percent.
Smith credits the quick, coordinated response by federal and state public health agencies, hospitals and doctors.
"We think it likely saved lives," Smith said in a telephone interview.
In late September, when the first cases of fungal meningitis surfaced in Tennessee, health officials considered the possibility that the outbreak might be confined to a single ambulatory surgical center in the state.
That was the case of an outbreak in Sri Lanka that followed the 2004 tsunami. Needles used for spinal injections had been stored in a damp closet and become contaminated.
But, when a similar case in North Carolina surfaced, it became clear that the infections - which caused serious swelling in tissues in the spine and brain stem - were likely linked to the steroid medication methylprednisolone acetate, made by New England Compounding Center or NECC in Framingham, Massachusetts.
Compounding pharmacies traditionally alter or recombine drugs to meet a patient's specific need, but in recent decades, some compounder such as NECC have developed big manufacturing operations that are not subject to the strict safety standards of other drug companies, and the U.S. Food and Drug Administration and others are urging stricter oversight.