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US - CDC reports 63 dead, 749 infected with fungal meningitis in 20 states (Update Aug 5, 2013)

Re: US - 19 dead, 247 sick from suspected fungal meningitis as outbreak worsens

Re: US - 19 dead, 247 sick from suspected fungal meningitis as outbreak worsens

A case report of one of the index cases is available online from Annals of Internal Medicine.

"Fatal Exserohilum Meningitis and Central Nervous System Vasculitis after Cervical Epidural Methylprednisolone Injection"

Thanks Catbird.

Conclusion: The current case shows the aggressive, angioinvasive nature of Exserohilum species with an incubation time that is seemingly shorter than that of Exophiala, albeit to date unknown, and illustrates the need for rapid recognition and treatment (5) of this possible procedural complication in an effort to limit morbidity and mortality.

It appears prophylactic treatment is indicated.
 
Re: US - 19 dead, 247 sick from suspected fungal meningitis as outbreak worsens

Re: US - 19 dead, 247 sick from suspected fungal meningitis as outbreak worsens

considering that there may not be enough meds in existence to treat the 14,000 (many many more?) prophylactically (in the way they think is needed) it might be a good time to drill down into how the recommended drugs are manufactured, who makes them, and what the lag time is to bring manufacturing up to a scale that addresses the needs - and i wonder if these drug makers will get the same sort of emergency dispensation (i cant remember the term) that flu vax makers get with regards to liability exposure from their vax lots created during a pandemic (like H1N1 vax campaign)
 
Re: US - 19 dead, 247 sick from suspected fungal meningitis as outbreak worsens

Re: US - 19 dead, 247 sick from suspected fungal meningitis as outbreak worsens

There was a question at one of the CDC conference calls asking if the US government was going to break into its strategic stockpile for this event and the speakers did not know.

If the appropriate drugs, which are referenced here on the latest CDC Interim Treatment Guidance, exist in the strategic stockpile they should be used for this outbreak. It is inhumane not to do so.
 
Re: US - 19 dead, 247 sick from suspected fungal meningitis as outbreak worsens

Re: US - 19 dead, 247 sick from suspected fungal meningitis as outbreak worsens

yes i remember that stockpile question. It wasnt really answered - was deferred. if its the same one - that was asked before the prophylaxis recommendation. I do not know (anyone?) if there would be much call for these sorts of meds in a stockpile. It would not be an intuitive one to include in such large quantities as this could never have been anticipated (in terms of this scale though i would not be shocked to find that there have been whistleblowers on just this issue)
 
Re: US - 19 dead, 247 sick from suspected fungal meningitis as outbreak worsens

Re: US - 19 dead, 247 sick from suspected fungal meningitis as outbreak worsens

I think whatever list we might find may not be accurate because I am sure the government would not want an accurate inventory listing quantities, locations, etc. made public. I always assumed antibiotics, anti-virals, radiation sickness medications would be on that list. I never considered anti-fungals. :confused:
 
Re: US - 19 dead, 247 sick from suspected fungal meningitis as outbreak worsens

Re: US - 19 dead, 247 sick from suspected fungal meningitis as outbreak worsens

http://www.cdc.gov/phpr/stockpile/stockpile.htm

"The SNS is a national repository of antibiotics, chemical antidotes, antitoxins, life-support medications, IV administration, airway maintenance supplies, and medical/surgical items.
...
If the incident requires additional pharmaceuticals and/or medical supplies, follow-on vendor managed inventory (VMI) supplies will be shipped to arrive within 24 to 36 hours. If the agent is well defined, VMI can be tailored to provide pharmaceuticals, supplies and/or products specific to the suspected or confirmed agent(s). In this case, the VMI could act as the first option for immediate response from the SNS Program."

Am going to a training in a few weeks where we will be discussing the stockpile - might be able to ask about this then.
 
Re: US - 19 dead, 247 sick from suspected fungal meningitis as outbreak worsens

Re: US - 19 dead, 247 sick from suspected fungal meningitis as outbreak worsens

Thanks Catbird.

Conclusion: The current case shows the aggressive, angioinvasive nature of Exserohilum species with an incubation time that is seemingly shorter than that of Exophiala, albeit to date unknown, and illustrates the need for rapid recognition and treatment (5) of this possible procedural complication in an effort to limit morbidity and mortality.

It appears prophylactic treatment is indicated.


When reading that case history, I was really struck by how fast the progression and how deep the penetration was, especially in someone with no history of being immuno-compromised.
 
Re: US - 19 dead, 247 sick from suspected fungal meningitis as outbreak worsens

Re: US - 19 dead, 247 sick from suspected fungal meningitis as outbreak worsens

in the last conference call I caught, a caller asked if the FDA / CDC had any concerns about NECC inhalational products. they didnt have any answer to that.

Should inhaled meds be found to be infected with aspergillus and we start seeing patients with pulmonary aspergillosis the following paper would be of interest.

http://www.aspergillus.org.uk/secure/articles/pdfs7/19615460.pdf

"The innate immune response to Aspergillus fumigatus
Viviane Balloy and Michel Chignard

V. Balloy, M. Chignard / Microbes and Infection 11 (2009) 919e927

Abstract
Despite the development of new treatments, the mortality due to invasive pulmonary aspergillosis remains above 50%, reaching 95% in certain
situations. The battle against Aspergillus fumigatus involves several components of the pulmonary innate immune system: cells, mediators, and
natural antifungal molecules involved in the recognition and elimination of the fungus, thereby preventing colonization of the respiratory system.
With the 10,000e15,000 l of air we inhale each day, the lungs are constantly exposed to a wide range of microorganisms, such as
A. fumigatus. This fungus is ubiquitous in the environment and can release large numbers of spores able, due to their small size, to penetrate the
respiratory tract. The spores of A. fumigatus, like any other pathogen, are then confronted with the innate immune system, a constitutive defense
system that is permanently active and tightly regulated. The various elements of the pulmonary innate immune systemdphysical and cellular
barriers and soluble mediatorsdare involved in the recognition and elimination of pathogens, thereby preventing colonization of the respiratory
system. Consequently, the presence of spores in immunocompetent hosts is completely innocuous, because these spores are normally eliminated.
However, changes in one of the components of the defense system may lead to the development of pulmonary infections. Thus, in immunocompromised
individuals, the spores are able to develop and cause pulmonary mycoses. These mycoses, known as aspergillosis, are highly
variable, with the range of presentations extending from an allergy-type illness, allergic bronchopulmonary aspergilloses, to a very serious
generalized and frequently fatal infection: invasive pulmonary aspergillosis (IPA)."
 
Re: US - 19 dead, 247 sick from suspected fungal meningitis as outbreak worsens

Re: US - 19 dead, 247 sick from suspected fungal meningitis as outbreak worsens

CDC update as of 2 pm Oct. 18th (NOTE: As of 2 pm, there are no updates to case definitions, clinician or patient guidance.):


Multistate Fungal Meningitis Outbreak Investigation


  • Status: Ongoing Investigation
  • Infection: Fungal
  • Facility Type: Outpatient Setting
  • Case Count: 257
  • States: 16
  • Deaths: 20


Current Situation

October 18, 2012 3:00 PM EDT

CDC Responds to Multistate Fungal Meningitis Outbreak


The Centers for Disease Control and Prevention (CDC) with state and local health departments and the Food and Drug Administration (FDA) are investigating a multistate meningitis outbreak of fungal infections among patients who have received a steroid injection of a potentially contaminated product into the spinal area. Several patients suffered strokes that are believed to have resulted from their infection. The investigation also includes fungal infections associated with injections in a peripheral joint space, such as a knee, shoulder or ankle.

CDC and public health officials are referring any patients who have symptoms that suggest possible meningitis or a possible peripheral joint infection to their physicians who can evaluate them further. Those patients injected in peripheral joints only are not believed to be at risk for fungal meningitis but could be at risk for joint infection.

  • CDC and FDA have confirmed the presence of a fungus known as Exserohilum rostratum in unopened medication vials of preservative-free methylprednisolone acetate (80mg/ml) from one of the three implicated lots from NECC (Lot #08102012@51, BUD 2/6/2013). The laboratory confirmation further links steroid injections from these lots from NECC to the multistate outbreak of fungal meningitis and joint infections. Testing on the other two implicated lots of methylprednisolone acetate and other NECC injectable medications continues.
  • As of October 17, 2012, a total of 47 patients have laboratory-confirmed fungal meningitis. This form of fungal meningitis is not contagious. CDC?s laboratory has confirmed Exserohilum rostratum in clinical specimens for all but two patients of these patients. Of the other two patients, one has been found to be infected with Aspergillus fumigatus and one with Cladosporium. These fungi are common in the environment but rarely cause meningitis.
  • CDC continues to work with states to determine if there may be other fungal infections caused by exposure to NECC products beyond the three lots of preservative-free methylprednisolone acetate (80mg/ml) from NECC that were recalled on September 26, 2012. CDC does not have firm evidence that fungal infections have been caused by exposure to other NECC products.
  • CDC and state health departments estimate that approximately 14,000 patients may have received injections with medication from the three implicated lots of methylprednisolone and nearly 97% have now been contacted for further follow-up.
  • Patients and clinicians need to remain vigilant for onset of symptoms because fungal infections can be slow to develop. In this outbreak symptoms typically have appeared 1 to 4 weeks following injection, but it?s important to know that longer and shorter periods of time between injection and onset of symptoms have been reported. Therefore, patients and physicians need to closely watch for symptoms for at least several months following the injection. See updated Patient Guidance for more information, and contact your physician if you are concerned you may have become ill from your injection.
  • Information about the investigation and guidance for clinicians, including interim treatment guidelines, is available at http://www.cdc.gov/hai/outbreaks/meningitis.html. CDC recommendations are subject to change as more information becomes available.
 
Re: US - 19 dead, 247 sick from suspected fungal meningitis as outbreak worsens

Re: US - 19 dead, 247 sick from suspected fungal meningitis as outbreak worsens

CDC update as of 2 pm Oct. 19th: (NOTE: As of 6:30 there are no updates to case definitions, clinician or patient guidance.)


Status: Ongoing Investigation
Infection: Fungal
Facility Type: Outpatient Setting
  • Case Count: 271
  • States: 16
  • Deaths: 21
 
Re: US - 19 dead, 247 sick from suspected fungal meningitis as outbreak worsens

Re: US - 19 dead, 247 sick from suspected fungal meningitis as outbreak worsens

CDC update for Oct. 20th ((NOTE: As of 5 pm there are no updates to case definitions, clinician or patient guidance.):




  • Status: Ongoing Investigation
  • Infection: Fungal
  • Facility Type: Outpatient Setting
  • Case Count: 284
  • States: 16
  • Deaths: 23
 
Re: US - 23 dead, 284 sick from suspected fungal meningitis as outbreak worsens

Re: US - 23 dead, 284 sick from suspected fungal meningitis as outbreak worsens

The case number is only up by 1 today - with a new case being reported in Indiana.

CDC Update for Oct. 21st (NOTE: As of 3 pm there are no updates to case definitions, clinician or patient guidance.):


  • Status: Ongoing Investigation
  • Infection: Fungal
  • Facility Type: Outpatient Setting
  • Case Count: 285
  • States: 16
  • Deaths: 23
 
Re: US - 23 dead, 285 sick from suspected fungal meningitis as outbreak worsens

Re: US - 23 dead, 285 sick from suspected fungal meningitis as outbreak worsens

Meningitis outbreak: Tracing steroid path in body proves difficult

Spinal dura may have been pierced in some fatal cases

<?xml:namespace prefix = fb ns = "http://www.facebook.com/2008/fbml" /><fb:like class="fb_edge_widget_with_comment fb_iframe_widget" width="429" action="recommend" show_faces="false" href="" fb-xfbml-state="rendered" send="false" font="" ref="artrectop"></fb:like>3:37 AM, Oct 22, 2012

...
Dr. Michael Baden, a high-profile forensic physician in New York, said it was possible that in at least some of the fatal cases the person administering the epidural steroid may inadvertently have pierced the spinal dura, the protective coating around the spinal canal.

If that occurred, the fatal fungus would have a direct path to the victim?s brain, he said.

That also could explain why some victims died much more quickly than others, Baden said. Health officials with the U.S. Centers for Disease Control and Prevention have said that while some patients became ill with fungal meningitis within a week, others did not show symptoms for six weeks.

But Baden and others say that determining whether that protective coating was breached could be difficult.

?Any perforation of the dura will heal after a few days,? he said. ?The chances of finding that puncture are remote.?

He said it also was possible that the fungus could penetrate the dura even if there were no puncture.
...
Dr. Cyril Wecht, a Pittsburgh pathologist, said piercing the dura ?is something that should not happen.?

But he added that he would not be surprised if it did happen in some of the meningitis cases being studied by state and federal health experts.
...

Full text:
http://www.tennessean.com/article/2...sey=tab|topnews|text|FRONTPAGE&nclick_check=1
 
Re: US - 23 dead, 285 sick from suspected fungal meningitis as outbreak worsens

Re: US - 23 dead, 285 sick from suspected fungal meningitis as outbreak worsens

?Worried Sick?: Meningitis Risk Haunts 14,000</NYT_HEADLINE>

By DENISE GRADY
Published: October 21, 2012
...

As early as Monday, health officials may be able to offer doctors a method to estimate a patient?s risk and help decide how aggressive the follow-up should be, Dr. Marion Kainer of the Tennessee Health Department said on Friday during a telephone conference.

In Tennessee, which has had more cases and deaths (69 cases and 9 deaths as of Saturday) than any other state, the State Health Department has found that one lot (06292012@26) infected more patients than others, and that the older the medicine when it was given and the higher the dose, the more likely a patient was to get sick. But Dr. Kainer emphasized that another lot (08102012@51), more of which went to other states, also appeared to be heavily contaminated and risky. She said researchers thought older medicine was riskier because the fungus was multiplying in the vials and making them more dangerous.

The earlier treatment begins, the better. Doctors do not want to wait until patients become seriously ill ? but they say they must also avoid treating people who are not infected, because the drugs have severe side effects.
Yet doctors responding to the outbreak say it can be extremely difficult to determine whether symptoms are getting worse in people who were probably already suffering from chronic pain.

The stress of knowing that they have been exposed to a potentially deadly infection is also making matters more difficult. During the teleconference, one doctor said, ?To be real honest, I believe I would have symptoms if I had been told I was given this medication.?
...

Full text:
http://www.nytimes.com/2012/10/22/health/meningitis-risk-haunts-14000-people.html?ref=health&_r=0
 
Re: US - 23 dead, 285 sick from suspected fungal meningitis as outbreak worsens

Re: US - 23 dead, 285 sick from suspected fungal meningitis as outbreak worsens

I still can't find out any clear information about whether or not this stuff was exported. It's seem plausible, given that drugs seem to come from all over the world, that some lots were sent to out countries like Canada and Mexico. But a call to CDC sent me to Tennessee - both useless - and then to FDA which won't even take calls from outside the US. Of course, Health Canada has not responded yet to emails.

Anyone know more about how the world of drug shipments work?

J.
 
Re: US - 23 dead, 285 sick from suspected fungal meningitis as outbreak worsens

Re: US - 23 dead, 285 sick from suspected fungal meningitis as outbreak worsens

Interesting question.

No products from NECC should be used. The company has recalled all products.

I called the FDA and The Office of Drug Information has a recording that says their office is closed. :confused:

To be on the safe side any public health authority could issue a nationwide advisory citing USA FDA info and the above recall notice.
 
Re: US - 23 dead, 285 sick from suspected fungal meningitis as outbreak worsens

Re: US - 23 dead, 285 sick from suspected fungal meningitis as outbreak worsens

Interesting question.

No products from NECC should be used. The company has recalled all products.

Canada assigns a unique identifier to each drug: "drug identification number" or DIN.

With that unique key, insurers of any type can search "backwards": look at each payment transaction for that DIN to identify the cohort of purchasors, and perhaps the patient, Dr., and pharmacy

Drs. can find out what drugs a patient has taken, but that's a "forward" analysis: going from the individual to gain the set of drugs taken by that person.

The FDA list doesn't have any such number, just the generic name of the drug. Aside from the fact that numerous manufacturers make the same product, matching databases is next to impossible without the unique key.

So another angle is to ask if any of the NECC products were in the country in the first place.

J.
 
Re: US - 23 dead, 285 sick from suspected fungal meningitis as outbreak worsens

Re: US - 23 dead, 285 sick from suspected fungal meningitis as outbreak worsens

I will start sending out emails. I am not sure who has that information now. The FDA raided NECC. Groan. What a mess.....
 
Re: US - 23 dead, 285 sick from suspected fungal meningitis as outbreak worsens

Re: US - 23 dead, 285 sick from suspected fungal meningitis as outbreak worsens

This just came out.

Update on Fungal Meningitis

FDA provides NECC Customer List

[10-22-2012] On October 4, 2012, FDA advised medical professionals that all products produced by New England Compounding Center (NECC) should be retained, secured, and withheld from use. On October 6, NECC announced a voluntary recall of all its products currently in circulation that were compounded at and distributed from its Framingham, Massachusetts facility. A complete list of all NECC products subject to this recall can be accessed here [HTML | PDF]. On October 15, 2012, FDA further advised healthcare providers to follow-up with patients who were administered any NECC injectable product on or after May 21, 2012, including an ophthalmic drug that is injectable or used in conjunction with eye surgery, or a cardioplegic solution purchased from or produced by NECC.

Today, FDA is making available two lists of customers (consignees) who received products that were shipped on or after May 21, 2012 from New England Compounding Center’s Framingham, MA facility. The first list includes customer names and addresses, organized by state. The second list contains the same basic information as the first list, but is organized alphabetically by customer name and also includes the specific products shipped, the quantities of product shipped, and the shipping date. The lists were prepared based on information provided by NECC, and FDA cannot vouch for the completeness or accuracy of the lists. Products shipped by NECC may be missing from the list and facility information may be incomplete. Nevertheless, this is the best information we have available, at this time, to help inform facilities and healthcare providers of NECC products shipped to their facilities since May 21, 2012.
FDA is reiterating and updating its previous recommendation that follow-up with patients be done when the following three conditions are met:

  • The medication was an injectable product purchased from or produced by NECC, including an ophthalmic drug that is injectable or used in conjunction with eye surgery, or a cardioplegic solution,
  • The medication was shipped by NECC on or after May 21, 2012, and
  • The medication was administered to patients on or after May 21, 2012.
Since the May 21, 2012 date is the date the first of three lots of methylprednisolone acetate implicated in the current outbreak was produced, products produced and shipped by NECC on or after May 21, 2012 are believed at this time to be of greatest risk of contamination. Now that we have shipping information available, we are updating FDA’s recommendation to health care providers so that they can focus their attention on following up with the patients who are believed to be at greatest risk of receiving a contaminated product.

Advice to NECC Customers

Customers identified on these lists should check their stocks to identify whether they have any products from the New England Compounding Center (NECC), and they should immediately isolate any identified product from their drug supplies. All NECC products are subject to voluntary recall. Customers with product on hand should contact NECC at 1-800-994-6322 or via fax at 508-820-1616 to obtain instructions on how to return products to NECC.

Advice to Patients

Patients who believe they received an injection or other product that was shipped by NECC on or after May 21, 2012 should remain vigilant for the signs and symptoms of infection, and contact their health care provider if they are concerned. The meningitis outbreak has occurred in patients who received injections near the spine (back or neck). The signs and symptoms of meningitis include fever, headache, stiff neck, nausea and vomiting, photophobia (sensitivity to light) and altered mental status. Symptoms for infections following other types of injections at other body sites may vary, and are not limited to meningitis. Other possible infections at other parts of the body (e.g., peripheral joints) may include fever; swelling, increasing pain, redness, warmth at an injection site; visual changes, pain, redness or discharge from the eye; chest pain, or drainage from the surgical site (infection within the chest). Patients should contact their healthcare provider if they have any of these signs or symptoms.
Patients who received an NECC product prior to May 21, 2012 and who have not experienced symptoms of infection to date are at less risk of infection because of the amount of time that has elapsed since that date. FDA is not recommending these patients follow-up with their healthcare providers unless they are experiencing symptoms of infection.

Advice to Healthcare Professionals

FDA advises healthcare professionals to follow-up with patients who have been administered an injectable product shipped by NECC on or after May 21, 2012, including an ophthalmic drug that is injectable or used in conjunction with eye surgery, or a cardioplegic solution. FDA does not urge patient follow-up at this time for NECC products of lower risk such as topicals (for example, lotions, creams, eyedrops not used in conjunction with surgery) and suppositories, or for patients who may have received an NECC product in these categories before May 21, 2012. Patients who received an NECC product prior to May 21, 2012 and who have not experienced symptoms of infection to date are at less risk of infection because of the amount of time that has elapsed since that date. FDA is not recommending that healthcare providers follow-up with these patients unless they have reported symptoms of infection.
Health care professionals should retain and secure all remaining products purchased from NECC. All NECC products are subject to voluntary recall. Clinics or customers with product on hand should contact NECC at 1-800-994-6322 or via fax at 508-820-1616 to obtain instructions on how to return products to NECC.
Clinicians and patients are also requested to report any suspected adverse events following use of these products to FDA's MedWatch program at 1-800-332-1088 or www.fda.gov/medwatch.
Healthcare professionals and patients may dial FDA’s Drug Information Line at 855-543-DRUG (3784) and press * to get the most recent information regarding the meningitis recall and speak directly to a pharmacist.
If you have identified NECC customers who received product that do not appear on these lists, please contact FDA’s Drug Information Line to report this problem.
FDA continues its investigation and may issue additional public communications as appropriate.

-

Related Information




-




Contact FDA

1-800-332-1088
1-800-FDA-0178 Fax
Report a Serious Problem MedWatch Online
Regular Mail: Use postage-paid FDA Form 3500
Mail to: MedWatch 5600 Fishers Lane
Rockville, MD 20857

http://www.fda.gov/Drugs/DrugSafety/ucm322734.htm

Update on Fungal Meningitis

FDA provides NECC Customer List

[10-22-2012] On October 4, 2012, FDA advised medical professionals that all products produced by New England Compounding Center (NECC) should be retained, secured, and withheld from use. On October 6, NECC announced a voluntary recall of all its products currently in circulation that were compounded at and distributed from its Framingham, Massachusetts facility. A complete list of all NECC products subject to this recall can be accessed here [HTML | PDF]. On October 15, 2012, FDA further advised healthcare providers to follow-up with patients who were administered any NECC injectable product on or after May 21, 2012, including an ophthalmic drug that is injectable or used in conjunction with eye surgery, or a cardioplegic solution purchased from or produced by NECC.
Today, FDA is making available two lists of customers (consignees) who received products that were shipped on or after May 21, 2012 from New England Compounding Center’s Framingham, MA facility. The first list includes customer names and addresses, organized by state. The second list contains the same basic information as the first list, but is organized alphabetically by customer name and also includes the specific products shipped, the quantities of product shipped, and the shipping date. The lists were prepared based on information provided by NECC, and FDA cannot vouch for the completeness or accuracy of the lists. Products shipped by NECC may be missing from the list and facility information may be incomplete. Nevertheless, this is the best information we have available, at this time, to help inform facilities and healthcare providers of NECC products shipped to their facilities since May 21, 2012.
FDA is reiterating and updating its previous recommendation that follow-up with patients be done when the following three conditions are met:

  • The medication was an injectable product purchased from or produced by NECC, including an ophthalmic drug that is injectable or used in conjunction with eye surgery, or a cardioplegic solution,
  • The medication was shipped by NECC on or after May 21, 2012, and
  • The medication was administered to patients on or after May 21, 2012.
Since the May 21, 2012 date is the date the first of three lots of methylprednisolone acetate implicated in the current outbreak was produced, products produced and shipped by NECC on or after May 21, 2012 are believed at this time to be of greatest risk of contamination. Now that we have shipping information available, we are updating FDA’s recommendation to health care providers so that they can focus their attention on following up with the patients who are believed to be at greatest risk of receiving a contaminated product.
Advice to NECC Customers

Customers identified on these lists should check their stocks to identify whether they have any products from the New England Compounding Center (NECC), and they should immediately isolate any identified product from their drug supplies. All NECC products are subject to voluntary recall. Customers with product on hand should contact NECC at 1-800-994-6322 or via fax at 508-820-1616 to obtain instructions on how to return products to NECC.
Advice to Patients

Patients who believe they received an injection or other product that was shipped by NECC on or after May 21, 2012 should remain vigilant for the signs and symptoms of infection, and contact their health care provider if they are concerned. The meningitis outbreak has occurred in patients who received injections near the spine (back or neck). The signs and symptoms of meningitis include fever, headache, stiff neck, nausea and vomiting, photophobia (sensitivity to light) and altered mental status. Symptoms for infections following other types of injections at other body sites may vary, and are not limited to meningitis. Other possible infections at other parts of the body (e.g., peripheral joints) may include fever; swelling, increasing pain, redness, warmth at an injection site; visual changes, pain, redness or discharge from the eye; chest pain, or drainage from the surgical site (infection within the chest). Patients should contact their healthcare provider if they have any of these signs or symptoms.
Patients who received an NECC product prior to May 21, 2012 and who have not experienced symptoms of infection to date are at less risk of infection because of the amount of time that has elapsed since that date. FDA is not recommending these patients follow-up with their healthcare providers unless they are experiencing symptoms of infection.
Advice to Healthcare Professionals

FDA advises healthcare professionals to follow-up with patients who have been administered an injectable product shipped by NECC on or after May 21, 2012, including an ophthalmic drug that is injectable or used in conjunction with eye surgery, or a cardioplegic solution. FDA does not urge patient follow-up at this time for NECC products of lower risk such as topicals (for example, lotions, creams, eyedrops not used in conjunction with surgery) and suppositories, or for patients who may have received an NECC product in these categories before May 21, 2012. Patients who received an NECC product prior to May 21, 2012 and who have not experienced symptoms of infection to date are at less risk of infection because of the amount of time that has elapsed since that date. FDA is not recommending that healthcare providers follow-up with these patients unless they have reported symptoms of infection.
Health care professionals should retain and secure all remaining products purchased from NECC. All NECC products are subject to voluntary recall. Clinics or customers with product on hand should contact NECC at 1-800-994-6322 or via fax at 508-820-1616 to obtain instructions on how to return products to NECC.
Clinicians and patients are also requested to report any suspected adverse events following use of these products to FDA's MedWatch program at 1-800-332-1088 or www.fda.gov/medwatch.
Healthcare professionals and patients may dial FDA’s Drug Information Line at 855-543-DRUG (3784) and press * to get the most recent information regarding the meningitis recall and speak directly to a pharmacist.
If you have identified NECC customers who received product that do not appear on these lists, please contact FDA’s Drug Information Line to report this problem.
FDA continues its investigation and may issue additional public communications as appropriate.

-

Related Information




-




Contact FDA

1-800-332-1088
1-800-FDA-0178 Fax
Report a Serious Problem MedWatch Online
Regular Mail: Use postage-paid FDA Form 3500
Mail to: MedWatch 5600 Fishers Lane
Rockville, MD 20857
 
Re: US - 23 dead, 285 sick from suspected fungal meningitis as outbreak worsens

Re: US - 23 dead, 285 sick from suspected fungal meningitis as outbreak worsens

Number of U.S. meningitis cases from tainted injections nears 300
3:41 p.m. EDT, October 22, 2012


(Reuters) - The number of U.S. cases of meningitis from tainted injections of a steroid medication reached 294, up 12 from a day earlier, the Centers for Disease Control and Prevention (CDC) said on Monday.

There were three other cases of joint infections from the steroid medication that have not resulted in meningitis cases, bringing the national total of infections to 297, according to the CDC.

There were no new deaths reported, leaving the total number of fatalities at 23, the CDC said. The number of cases has continued to mount despite recall of the product by New England Compounding Center. Meningitis cases have been identified in 16 states and deaths in seven states.:tiphat:http://www.courant.com/health/sns-r...itis-casesbre89l1bx-20121022,0,3406602.story?
 
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