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New Hampshire - DHHS confirms 13 cases associated with national fungal meningitis outbreak

Pathfinder

Pathfinder

Editor, Senior Moderator
Some N.H. PainCare patients have meningitis symptoms

By Oliver Jenkins
ojenkins@fosters.com
Thursday, October 11, 2012

SOMERSWORTH ? A handful of PainCare patients are currently experiencing meningitis-related symptoms and one person has been hospitalized in relation to a widespread fungal meningitis outbreak, PainCare's owner and CEO Michael O'Connell said Wednesday.

However, New Hampshire is still reporting no confirmed cases in an outbreak that has sickened well over one hundred people ? killing 12 ? across a number of states.

O'Connell said cultures from several patients currently experiencing symptoms were sent to a University of Massachusetts laboratory for further testing. The results of these tests won't be known for an additional one to two weeks.

?We've notified, educated, and invited patients who may be experiencing symptoms to come in for an assessment and evaluation,? O'Connell said. ?Some additional patients may be sent to the hospital for cultures or blood samples ? we're being extra safe and taking extra precautions.?
...
On Tuesday, the Department of Health and Human Services said up to 742 patients across New Hampshire were identified as having been possibly exposed to the recalled product, which are linked to three PainCare clinics throughout the state.

Last Thursday, the DHHS announced Somersworth and Merrimack PainCare clinics had received shipments of the tainted medication before these health risks were uncovered. More recently, it was announced on Tuesday that Paincare's Newington location was also linked to the tainted steroid.

The company quickly pulled the product from shelves after learning of these health risks.

O'Connell said his staff is fully devoted to tracking down patients who may be exposed to the medication.
...

Full text:
http://www.fosters.com/apps/pbcs.dll/article?AID=/20121011/GJNEWS_01/121019724
 
Re: New Hampshire - A report that some PainCare patients have meningitis symptoms

Re: New Hampshire - A report that some PainCare patients have meningitis symptoms

This is the latest information from the New Hampshire Dept. of Health and Human Services, Division of Public Health Services, dated Oct. 10th.

New Hampshire Health Alert Network
Health.Alert@nh.gov

Status: Actual
Message Type: Alert
Severity: Severe
Sensitive: Not Sensitive
Message Identifier: NH-HAN #20121010 Fungal Meningitis Update #2
Delivery Time: 12 hours
Acknowledgement: No
Originating Agency: NH Department of Health and Human Services, Division of Public Health Services

DATE: October 10, 2012 TIME: 1300 EDT


TO: Physicians, Physician Assistants, Nurses, Infection Control Practitioners, Infectious Disease Specialists, Hospital Emergency Departments, Hospital CEOs, Laboratory Response Network, Manchester Health Department, Nashua Health Department, NHHA, NH School Nurses, Pharmacists, Community Health Centers, DHHS Outbreak Team, DPHS Investigation Team, Ambulatory Surgical Centers, Public Health Network, and DPHS Management Team


FROM: Sharon Alroy-Preis MD, State Epidemiologist


SUBJECT: Fungal Meningitis Outbreak Following Epidural Steroid Injection Update #2


New Hampshire DHHS, Division of Public Health Service (NH DPHS) recommends:
  • Awareness of conference call hosted by CDC to provide clinical guidance to clinicians regarding the multi-state fungal meningitis today, 10.10.2012, at 2pm 1-888-790-6180, passcode: COCA
  • Discontinue use of all products distributed by the New England Compounding Center (NECC) of Massachusetts. All products manufactured by NECC since January 2012 have been recalled.
  • Consideration of fungal etiology in any patient with CNS symptoms (meningitis, brain abscess or stroke), with recent (since 5/21/12) epidural NECC medication injection (especially methylprednisolone), even if symptoms are subtle.
  • Consideration of fungal etiology in septic arthritis s/p NECC product injection to a peripheral joint.
  • Consideration of fungal etiology in osteomyelitis s/p injection to a peripheral or sacroiliac joint or epidural injection.
  • Timely reporting to NH DPHS of any suspect cases that may be related to this outbreak.
  • Please refer to previous HANs (10/4/12, 10/6/12) for previous specific information on this outbreak.


National Outbreak Update:
The national case count as of October 9, 2012, related to this outbreak is 119 cases in 10 states and 11 deaths. So far both Aspergillus spp.and Exserohilum spp. have been isolated in patients from CSF, in addition to P. acnes of unknown significance, so other fungal and bacterial organisms may still be involved. All products manufactured by NECC since January 2012 have been recalled.


CDC is hosting a conference call for providers at 2pm today and the details are above.
We encourage any interested provider or facility to join the call on this urgent and time-sensitive topic.

Additional information from CDC on this outbreak (including national epidemiology, case definitions, diagnostic and therapy recommendations from national experts) is available at the following link: http://www.cdc.gov/HAI/outbreaks/meningitis.html. Updated case definitions will be posted on the CDC website later today.


NH Specific Information:

In New Hampshire, 3 sites used the currently implicated product (Methylprednisolone Acetate of 3 lots) in Pain Care LLC: Merrimack, Somersworth and Newington locations. Total exposed so far: 742 patients: 214 patients post epidural injections and 528 post other site injections. New Hampshire does not yet have confirmed cases associated with this outbreak although investigation of symptomatic patients who have been exposed is ongoing.

You can refer to NH DHHS website for NH specific information:
http://www.dhhs.state.nh.us/dphs/cdcs/fungal-meningitis.htm

Please contact the NH DPHS Infectious Disease Investigation and Surveillance Sections at 603-271-4496 (after hours 1-800-852-3345, x5300) to report any suspect or confirmed cases.

This outbreak is rapidly evolving and NH DPHS will continue to provide updates as new information is learned.


For any questions regarding the contents of this message, please contact NH DHHS Infectious Disease Investigation and Surveillance Sections at 603-271-4496.
After hours or toll free (In NH) at 800-852-3345, ext. 4496 or 603-271-5300 and ask for the public health professional on call.
 
Last edited:
Re: New Hampshire - A report that some PainCare patients have meningitis symptoms

Re: New Hampshire - A report that some PainCare patients have meningitis symptoms

The cases are now confirmed.

New Hampshire reports 4 cases of fungal meningitis; first in New England linked to tainted steroids


"New Hampshire disease trackers reported Saturday that four adults in the state are infected with fungal meningitis, the first New England cases in a nationwide outbreak linked to contaminated steroids produced by a Framingham drug company.

Three men and one woman, between the ages of 40 and 60, are receiving treatment, according to a statement from the New Hampshire Department of Health and Human Services.

Only one clinic in New Hampshire is believed to have received the tainted shots, according to state health authorities. That medication was distributed to Pain Care LLC?s Somersworth, Merrimack, and Newington locations. Pain Care, LLC has identified 741 patients who may have been exposed to the recalled product."
 
Re: New Hampshire - Confirms 4 fungal meningitis cases

Re: New Hampshire - Confirms 4 fungal meningitis cases

DHHS Confirms First Cases in NH Associated with National Fungal Meningitis Outbreak <!-- InstanceEndEditable -->

Communicable Disease Control and Surveillance <!-- InstanceEndEditable -->

Publish Date:
<!-- InstanceBeginEditable name="Publish Date" -->October 13, 2012 <!-- InstanceEndEditable -->

<!-- InstanceBeginEditable name="Content" -->Concord, NH ? The New Hampshire Department of Health and Human Services (DHHS), Division of Public Health Services (DPHS) is today announcing four cases related to the national outbreak of fungal meningitis associated with steroid medication produced by New England Compounding Center (NECC) of Framingham, Massachusetts. The cases under investigation include three males and one female, all between 40 and 60 years of age. All cases are under care and are being monitored.

The medication believed to be linked to the illnesses here in New Hampshire and nationwide are three lots of methylprednisolone acetate used for injections for pain management. To date, nationally there have been 197 cases, including 14 deaths in 15 states.

NECC has voluntarily recalled all products it produced since January of 2012. However, all cases so far have resulted after injections with products from the original three lots.

?This has been a very difficult time for patients and healthcare providers affected by this outbreak,? said New Hampshire?s Public Health Director Dr. Jos? Montero. ?Our thoughts are with these patients and their families as they deal with the complicated circumstances surrounding this unfortunate incident.?

In New Hampshire the medication believed to be related to this outbreak was only distributed to Pain Care LLC?s Somersworth, Merrimack, and Newington locations. Pain Care, LLC has identified 741 patients who may have been exposed to the recalled product. DPHS is working with Pain Care, LLC to ensure that all patients potentially exposed are notified.

Patients diagnosed with this infection as part of this outbreak may present with fungal meningitis, epidural abscess, stroke or joint symptoms associated with the injected medication. The investigation remains active and information on cases continues to be gathered to understand the extent of this outbreak.

There are many different types of meningitis, a general term for an infection or inflammatory process involving the lining of the brain and central nervous system. The cases under investigation have no relation to the much more common forms of bacterial or viral meningitis. This particular form of meningitis cannot be passed from person to person, but can be very serious, even fatal.

Symptoms to be aware of include: headache, fever, nausea, stiff neck and sensitivity to light and in this type of meningitis symptoms may be or have been mild in some cases. The CDC is recommending that patients who feel ill with the above symptoms or have weakness or numbness in any part of the body or slurred speech after receiving this medication should contact their healthcare provider. Also patients who received injection of the medication to joints should report to their provider if they have local symptoms including increased pain, redness or warmth at the site of the injection.

For more information visit the CDC website at www.cdc.gov/hai the DHHS website at www.dhhs.nh.gov or call the DPHS Bureau of Infectious Disease Control at 603-271-4496.

http://www.dhhs.state.nh.us/media/pr/10132012nhmeningitis.htm
 
Re: New Hampshire - DHHS confirms 6 cases associated with national fungal meningitis outbreak

Re: New Hampshire - DHHS confirms 6 cases associated with national fungal meningitis outbreak

DHHS Announces Additional Cases Related to the National Fungal Meningitis Outbreak <!-- InstanceEndEditable -->
<!-- InstanceBeginEditable name="Byline" --><!-- InstanceEndEditable -->

Contact:
<!-- InstanceBeginEditable name="Contact" -->Public Information Office
(603) 271-9388

<!-- InstanceEndEditable --><!-- InstanceBeginEditable name="issued by" -->Communicable Disease Control and Surveillance <!-- InstanceEndEditable -->
Publish Date:
<!-- InstanceBeginEditable name="Publish Date" -->October 16, 2012 <!-- InstanceEndEditable -->

Concord, NH ? The New Hampshire Department of Health and Human Services (DHHS), Division of Public Health Services (DPHS) is today announcing two additional cases related to the national outbreak of fungal meningitis associated with injection medications produced by New England Compounding Center (NECC) of Framingham, Massachusetts. This brings the number of cases in New Hampshire to six. These two new cases are under care and are not hospitalized.

The medication initially believed to be linked to the illnesses here in New Hampshire and nationwide are three lots of methylprednisolone acetate used for injections for pain management. Yesterday the Food and Drug Administration (FDA) announced that possible meningitis potentially associated with epidural injection of an additional NECC product, triamcinolone acetonide, has been identified through active surveillance and reported to them. Triamcinolone acetonide is a type of steroid injectable product made by NECC. Also, one transplant patient with Aspergillus fumigatus infection who was administered NECC cardioplegic solution during surgery has been reported. Cardioplegic solution is used to induce cardiac muscle paralysis during open heart surgery to prevent injury to the heart. The FDA is working with the Centers for Disease Control and Prevention (CDC) and the states affected to get information out to clinicians and patients about these new developments.

More...
http://www.dhhs.state.nh.us/media/pr/10162012meningitis.htm
 
Re: New Hampshire - DHHS confirms 6 cases associated with national fungal meningitis outbreak

Re: New Hampshire - DHHS confirms 6 cases associated with national fungal meningitis outbreak

Somersworth mayor gets precautionary meningitis treatment

Tuesday, October 16, 2012

SOMERSWORTH ? Mayor Matthew Spencer was recently hospitalized and treated for fungal meningitis as a precautionary measure, according to a press release he issued Tuesday morning.

Spencer, who has a back injury, was among patients who might have received tainted medication during an injection he received in his spine at PainCare LCC in Somersworth....

?I have not been diagnosed with fungal meningitis. However, I have been treated as a precaution, due to the similarities of symptoms I have had since a recent steroid epidural injection that I received on September 19, 2012. I have been seeking treatment at PainCare LLC in Somersworth due to an injury incurred while serving in the United States Coast Guard,? the mayor continued.

Spencer did not receive the medication initially recalled during his last epidural injection, but did receive a medicine that was recently recalled and compounded at the same facility, New England Compounding Center (NECC) in Framingham, Mass.

?My current diagnosis is ?cerebral spinal fluid (CSF) abnormalities after an epidural steroid injection? and is included under the new CDC case guidelines of 'probable case,'? Spencer noted.

Spencer was treated for several days as an inpatient at Wentworth-Douglass Hospital in Dover. ?I am currently following through with home treatments and being monitored by doctors. I appreciate the care I received from the caring professionals at Wentworth-Douglass Hospital and support from PainCare LCC in Somersworth.
...

Full text:
http://www.fosters.com/apps/pbcs.dll/article?AID=/20121016/GJNEWS_01/121019293/-1/FOSNEWS
 
Re: New Hampshire - DHHS confirms 6 cases associated with national fungal meningitis outbreak

Re: New Hampshire - DHHS confirms 6 cases associated with national fungal meningitis outbreak

"2 more fungal meningitis cases in NH"

"Two more people in New Hampshire have been diagnosed with fungal meningitis related to a national outbreak bringing the number affected in the state to eight.

Nationally, 16 states have reported 257 cases of fungal meningitis to date, including 20 deaths.The victims in the outbreak had all received steroid shots made by a Massachusetts specialty pharmacy, mostly to treat back pain. In New Hampshire, the medication believed to be related to the outbreak was distributed to Pain Care LLC's locations in Somersworth, Merrimack and Newington.

The state Department of Health and Human Services said Thursday that the two new patients are a male and female, both of whom are receiving treatment."
 
Re: New Hampshire - DHHS confirms 8 cases associated with national fungal meningitis outbreak

Re: New Hampshire - DHHS confirms 8 cases associated with national fungal meningitis outbreak

MULTISTATE FUNGAL DISEASE OUTBREAK​

NEW HAMPSHIRE SUMMARY
October 2, 2012 to November 9, 2012

NUMBER OF CASES* ASSOCIATED WITH NECC PRODUCTS​


Cases with Meningitis: 9

Cases with Non-Meningitis Infections:4

Total: 13

Deaths: 0
 
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