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Fungal meningitis outbreak hits US

9th October 2012

A pharmacy based in Massachusetts has issued a recall of all its products and closed its doors in the wake of an outbreak of fungal meningitis that has been linked to its steroid injections.

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Calling the move a precautionary measure, the Framingham-based New England Compounding Center (NECC) said it was proceeding out of "an abundance of caution" because of the risk of contamination, although it said there was no evidence so far that any of its other products had been contaminated.

NECC has also surrendered its pharmacy licence to the Massachusetts Board of Pharmacy and ceased trading following the outbreak.

The US Food and Drug Administration has already warned healthcare providers to avoid using any of the pharmacy's products.

According to the US Centers for Disease Control and Prevention, 91 people across nine states have been infected with the rare, fungal form of meningitis. At least seven people have died.

Health officials have been notifying anyone who may have received an injection with the contaminated steroid, although cases have only been reported so far in Florida, Indiana, Maryland, Michigan, Minnesota, North Carolina, Ohio, Tennessee and Virginia.

It is thought that hundreds, possibly thousands, of people may have received the jab, which is offered as a treatment for back pain, between July and September.

CDC has said it expects the number of confirmed cases in the outbreak to rise further, although the fungal form of meningitis is not as easily passed between humans as its viral and bacterial counterparts.

So far, all of the confirmed cases of fungal meningitis have been linked back to injections of methylprednisolone acetate, which was made and placed in syringes without preservatives by the New England Compounding Center pharmacy. All batches of the jab have now been recalled, after being given to patients at 75 clinics in 23 states.

However, the FDA and CDC have both warned healthcare providers to scour their dispensaries for any products made by the pharmacy and not to use them on patients until told it is safe to do so.

It is unclear whether patients who had the same tainted steroids injected in a place other than the spine are at risk of developing the disease.

Spinal steroid injections are a common treatment for back pain the United States.

According to CDC medical officer Benjamin Park, early detection of and intervention in suspected cases could cut the number of casualties.

It is possible that if patients are identified and begin to take antifungal therapy early, that some of the "unfortunate consequences" might be averted, Park told a news conference.

The symptoms of fungal meningitis initially present as similar to influenza, including fever, headache, nausea, weakness and confusion.

However, headaches can be severe and get worse over time. Park said some patients may only experience mild symptoms, making the disease hard to diagnose.

Those experiencing even mild symptoms following an injection should seek testing immediately, Park said.

The disease is detected by tests on the spinal fluid, which determine whether the fungus, Aspergillus, is present.

Patients need intravenous infusions of antifungal agents in hospital, and may need several months of treatment.


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