Third Meningitis Death Reported In Tennessee; Fifth In US
A sign on the door to the New England Compounding Center requests no soliciting at the Framingham, Mass. company, Wednesday Oct. 3, 2012.
Diana Reed (From Wayne Reed Christian Childcare Center website)
NASHVILLE, Tenn. (NewsChannel 5/AP) - A third patient has died in Tennessee in a growing outbreak of a rare form of meningitis. Five deaths have now been reported nationwide.
During a conference call Thursday, officials with the Centers for Disease Control said 35 cases of fungal meningitis have now been reported in six states. Twenty five of those cases were in Tennessee, with seven new cases reported in the last 24 hours, according to state health officials.
According to the Wayne Reed Christian Childcare Center, Diana Reed passed away Wednesday afternoon surrounded by her family. She was the wife of Wayne Reed, for whom the center was named.
Dr. Robert Latham, chief of medicine at Saint Thomas Hospital in Nashville, also said Thursday a patient died there late Wednesday or early Thursday, but did not confirm the identity of the victim.
Reed is one the patients in Tennessee who had received epidural steroid injections, mostly for back pain, a fairly typical treatment. Saint Thomas Outpatient Neurosurgery Center in Nashville received the largest shipment of the steroid. Investigators, though, said they are still trying to confirm the source of the infection.
On Thursday, an official with the Food and Drug Administration said tests found contamination in a sealed vial of the steroid at the New England Compounding Center in Massachusetts. Tests are under way to determine if it is the same fungus blamed in the outbreak.
The FDA has now warned doctors and hospitals not to use any product from NECC, although no other products from the pharmacy have been implicated in the outbreak.
The pharmacy issued a recall last week and has shut down operations. The steroid was sent to 75 facilities in 23 states.
Three cases have been reported in Virginia, two in Maryland, two in Florida and one in North Carolina. The other two deaths were reported in Virginia and Maryland, said officials at the Centers for Disease Control and Prevention.
The type of meningitis involved is not contagious like the more common forms. This type is caused by a fungus often found in leaf mold and which health officials suspect may have been in the steroid.
Additional cases are being evaluated, and it is "expected to be the norm for quite some time", said Tennessee Department of Health Commissioner John Dreyzehner on Thursday. He added that all patients believed to have received the injection have been contacted, but if they discover a change in symptoms, they should contact their physician.
Dreyzehner said the outbreak has no relation to any of the other reported meningitis cases in Tennessee, including recent viral and bacterial cases.
Meningitis is an inflammation of the lining of the brain and spinal cord. Symptoms include severe and worsening headache, nausea, dizziness and fever. Some of the patients also experienced slurred speech, and difficulty walking and urinating, Tennessee health officials said.
"Some are doing well and improving. Some are very ill — very, very seriously ill and may die," Tennessee health official Dr. David Reagan said of the state's patients.
The incubation period is estimated at anywhere from two to 28 days, so some people may not have fallen ill yet, Tennessee health officials said. At three clinics in Tennessee, officials are contacting the more than 900 people who received the steroid in the past three months.
Investigators also have been looking into the antiseptic and anesthetic used during the injections. Neither has been ruled out. However, the primary suspicion is on the steroid medication. Steroid shots are common for back pain, often given together with an anesthetic.
The Food and Drug Administration identified the maker of the steroid as New England Compounding Center, a specialty pharmacy in Framingham, Mass. Last week, the company issued a recall of three lots of the steroid — methylprednisolone acetate. In a statement, the company said it had voluntarily suspended operations and was working with regulators to identify the source of the infection.
The CDC said Thursday that NECC has ceased distribution of all their products.
Compounding pharmacies mix ingredients for customized medicines that generally aren't commercially available. They are regulated by states.
The outbreak was discovered about two weeks ago when Vanderbilt University's Dr. April Pettit was treating a patient who was not doing well for reasons doctors did not understand.
When the lab found the fungus in the patient's spinal fluid, Pettit began asking questions and learned the patient recently had steroid injections in his spine, according to Dr. William Schaffner, who chairs Vanderbilt's Department of Preventive Medicine.
"When it became clear that the infection-control practices at the clinic were up to par, the steroid medication became implicated," Schaffner said.
Federal officials did not release condition reports or details on all the patients in the five states. Fungal meningitis is treated with high-dose antifungal medications, usually given intravenously in a hospital.
At least 17 of the reported Tennessee cases were treated at the Saint Thomas Outpatient Neurosurgery Center in Nashville, although health officials would not confirm where the latest cases had been treated. It had 2,000 vials of the suspect lots, the largest number. That clinic voluntarily closed last month to deal with the investigation.
A hotline has been set up to answer questions from the public about the meningitis cases at 1-800-222-1222.