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Multistate Fungal Meningitis Outbreak

The Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) are currently coordinating a multistate investigation of fungal meningitis among patients who received a steroid injection with a potentially contaminated product.  In several patients, the meningitis was found to be caused by a fungus that is common in the environment but rarely causes meningitis. This form of meningitis is not contagious. At this point, the original source of the outbreak has not been determined.  However, injectable steroid medication has been linked to the outbreak.

Several cases of illness have been reported in Florida to date and a response is being coordinated between local public health departments, the eight Florida facilities in receipt of the recalled product and the state Florida Department of Health. 

All infected patients identified thus far have received preservative-free (PF) methylprednisolone acetate (80mg/ml) from among the lots voluntarily recalled by the New England Compounding Center in Framingham, Massachusetts.  The products were recalled on on September 26, 2012. These lots are:

• Methylprednisolone Acetate (PF) 80 mg/ml Injection, Lot #05212012@68, by use date (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

Map 1: Number of Outbreak-Associated Fungal Meningitis Cases by County
There are twenty-five cases, including five* deaths, among persons with linked to epidural steroid injections, as of December 6, 2012 at 1:21 PM (EST).

Total Number of Cases: 25
Count by County Marion: 18 Escambia: 7

Map 2: Map of Florida Healthcare Facilities which Received Implicated Lots** of Methylprednisolone Acetate (PF) Recalled from New England Compounding Center on September 27, 2012

List of Florida Health Care Facility which Received Any Products Recalled from the New England Compounding Center

Full list of all 257 Facilities that Received the NECC Products

Resources:

CDC Health Alert Network: Update (April 5, 2013)

Florida Health Alert Network: Surveillance Guidance for Physicians (November 21, 2012)

Florida Health Alert Network: Surveillance Guidance for Physicians (November 14, 2012)

CDC Health Alert Network (HAN): Contamination Identified in Additional Medical Products from New England Compounding Center (November 1, 2012)

CDC Health Alert Network (HAN): Voluntary Recall of All American Medical Products (November 1, 2012)

CDC Health Alert Network (HAN): Issuance of Guidance on Management of Asymptomatic Patients who Received Epidural or Paraspinal Injections with Contaminated Steroid Products (October 24, 2012)

Florida Health Alert Network: Guidance Document for Physicians (October 18, 2012)

CDC Health Alert Network (HAN): Multistate Outbreak of Fungal Meningitis and Joint Infections Associated with Contaminated Steroid Medications (October 17, 2012)

MMWR: Multistate Outbreak of Fungal Infection (October 12, 2012)

CDC Health Alert Network (HAN): Multistate Outbreak of Meningitis and Stroke Associated with Potentially Contaminated Steroid Medication (October 8, 2012)

Florida Health Alert Network: Guidance Document for Clinicians (October 7, 2012)

CDC Health Alert Network (HAN): Meningitis and Stroke Associated with Potentially Contaminated Product (October 4, 2012)

Interim Treatment Guidance for Central Nervous System and/or Parameningeal Infections Associated with Injection of Potentially Contaminated Steroid Products (CDC)

Frequently Asked Questions for Clinicians: Multistate Meningitis Outbreak Investigation (CDC)

Role of Antifungal Prophylaxis in Asymptomatic Patients (CDC)

Lumbar Puncture in Asymptomatic Patients (CDC)

CDC Website on Fungal Diseases

FDA Statement on Fungal Meningitis Outbreak

For up-to-date national information regarding the outbreak, visit the CDC Outbreak Investigation Page.

For a complete list of FDOH press releases, please visit the Florida Department of Health Online Newsroom.

For County Health Departments:

Florida Health Alert Network: Surveillance Guidance for CHDs (November 21, 2012)

Example Abnormal LP Results Data Collection Tool
 

Florida Health Alert Network: Surveillance Guidance for CHDs (November 7, 2012)

Florida Health Alert Network: Fungal Meningitis Reporting Guidance (October 30, 2012)

Meningitis Outbreak Following Epidural Steroid Injection CRF (October 29, 2012)

Florida Health Alert Network: Surveillance Guidance for CHDs (October 26, 2012)

CHD Specimen Submission Instructions for Cases Associated with Contaminated Injectable Product (October 25, 2012)

CDC Specimen Submission Form (October 12, 2012)

Case Definitions: Multi-state Outbreak Associated with Injection of Potentially Contaminated Steroid Product