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October 05, 2012
LANSING - The Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA), and state health departments including the Michigan Department of Community Health (MDCH) are coordinating a multi-state investigation of cases of fungal meningitis and strokes among patients who received epidural steroid injections after July 1. Michigan currently has six confirmed cases of meningitis associated with this outbreak. As of Oct. 5, 49 cases and five deaths have been reported from six states.
As this is a developing investigation, the number of cases is expected to increase. The occurrence of cases in Michigan underscores the critical objective that every effort be made to assure patient and clinician awareness of this situation to facilitate earlier identification and treatment.
Fungal meningitis is not transmitted person-to-person. Infected patients have presented approximately one to four weeks following their injection with a variety of symptoms including fever, new or worsening headache, nausea, and other symptoms consistent with a stroke. Some of these patients' symptoms were very mild in nature.
A potentially contaminated product is suspected to be the cause of the outbreak. Interim data show that infected patients received injection with preservative-free methylprednisolone acetate (80mg/ml) prepared by the New England Compounding Center (NECC), located in Framingham, Mass. On Sept. 25, the NECC recalled three lots of product associated with known cases of fungal meningitis:
- Methylprednisolone Acetate (PF) 80 mg/ml Injection, Lot #05212012@68, BUD 11/17/2012
- Methylprednisolone Acetate (PF) 80 mg/ml Injection, Lot #06292012@26, BUD 12/26/2012
- Methylprednisolone Acetate (PF) 80 mg/ml Injection, Lot #08102012@51, BUD 2/6/2013
Four Michigan facilities received shipments of these recalled lots and are working with MDCH to identify and notify patients who may have received this product and be at risk for developing illness. The facilities are:
- Michigan Neurosurgical Institutes in Grand Blanc
- Michigan Pain Specialists in Brighton
- Neuromuscular and Rehabilitation in Traverse City
- Southeast Michigan Surgical Hospital in Warren
On Oct. 3, the NECC ceased all production and initiated a recall of all methylprednisolone acetate and other drug products prepared for injection into the membrane surrounding the brain or spinal cord. Although all cases detected to date occurred after injections with products from these three lots, out of an abundance of caution, the CDC and FDA recommend that healthcare professionals cease use of any product produced by the NECC until further information is available.
Any individual who received an epidural steroid injection or steroid injection into a joint at one of the four Michigan facilities and is experiencing symptoms consistent with fungal meningitis or a stroke should immediately contact their physician or seek medical attention. Physicians should notify the MDCH about any patients undergoing evaluation. Physicians may contact the MDCH Communicable Disease Division at (517) 335-8165 to report a suspect case or for any questions.
Additional information about this investigation can be found under "Spotlight" on www.michigan.gov/emergingdiseases. Physicians seeking guidance regarding diagnosis or treatment should visit http://www.cdc.gov/hai/outbreaks/meningitis.html.
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