Steroid-related meningitis cases rise to 47

NEW YORK (AP) — A deadly meningitis outbreak rose to 47 cases in seven states Friday, as clinics scrambled to notify patients across the country that the shots they got for back pain may have been contaminated with a fungus.

The tally of deaths from the rare fungal meningitis remained at five. But a seventh state, Michigan, was added to the list with four cases, the Centers for Disease Control and Prevention said Friday.

Tennessee's cases now total 29; Virginia, six; Indiana, 3; two each in Maryland and Florida and one in North Carolina.

Looking for a source of the outbreak, investigators have focused on a steroid custom-made by a specialty pharmacy, New England Compounding Center in Framingham, Mass. Health inspectors found fungus in at least one sealed vial of the steroid at the company's facility this week.

The pharmacy recalled 17,676 single-dose vials of the steroid, methylprednisolone acetate. Shipments went to clinics in 23 states.

As a precaution, the Food and Drug Administration urged physicians not to use any of the company's products, and on Friday released a list of them.

The first known case in the meningitis outbreak was diagnosed about two weeks ago in Tennessee. Three of the five deaths are in Tennessee; the others in Virginia and Maryland.

Meningitis is an inflammation of the lining of the brain and spinal cord. Symptoms include severe headache, nausea, dizziness and fever.

The type of fungal meningitis involved is not contagious like the more common forms. It is caused by a fungus that's widespread but very rarely causes illness. It is treated with high-dose antifungal medications, usually given intravenously in a hospital.

Associated Press writers Travis Loller in Nashville, Jay Lindsay in Boston, Randall Chase in Wilmington, Del., and AP chief medical writer Marilynn Marchione in Milwaukee contributed to this story.

Online:

http://www.cdc.gov/meningitis/fungal.html

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TENNESSEE

NASHVILLE, Tenn. (AP) — Tennessee health officials report four more people have been sickened by an outbreak of fungal meningitis.

State Health Commissioner John Dreyzehner said in a press conference Friday that there are 29 cases in the state and three deaths.

The new cases raise the total to 39 people in six states who contracted the rare meningitis after receiving steroid injections for back pain. Five have died.

The commissioner repeated three times that "the evidence indicates this is a product issue." He said the clinics administering the shots had no way of knowing the injections were contaminated.

The Massachusetts pharmacy that supplied the steroid has recalled nearly 17,000 lots of the medical while federal officials have warned health care providers not to use any products from the New England Compounding Center.

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MICHIGAN

LANSING, Mich. (AP) — State health officials say a steroid medication suspected of causing a meningitis outbreak was shipped to four facilities in Michigan.

While no cases of the rare kind of meningitis linked to the outbreak in six states have been reported in Michigan, state Department of Community Health spokeswoman Angela Minicuci said Friday MDCH is working with the four clinics to reach out to patients "out of an abundance of caution."

According to Minicuci, the four facilities that received a shipment of the medication involved in the investigation are Michigan Neurosurgical Institute in Grand Blanc, Michigan Pain Specialists in Brighton, Neuromuscular & Rehabilitation in Traverse City and Southeast Michigan Surgical Hospital in Warren.

Nationwide, hundreds, and perhaps thousands, of people who got the shots between July and September could be at risk.

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INDIANA

INDIANAPOLIS (AP) — A second case of fungal meningitis that's been liked to injections of a recalled back-pain medication has been reported in Indiana.

OSMC Surgery Center CEO Don Hammond says test results received Friday morning confirmed that one of the Elkhart clinic's patients had contracted the rare illness that's tied to a widening U.S. outbreak that's killed five people.

Indiana State Department of Health spokesman Ken Severson says there are two confirmed cases but won't disclose the locations.

Six Indiana health facilities received batches of the medication that was recently recalled by a Massachusetts manufacturer. The affected clinics are in Evansville, Fort Wayne, Elkhart, South Bend, Terre Haute and Columbus.

More than 1,000 people in Indiana who received the injections are being notified.

The disease is not contagious but can be fatal.

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OHIO

COLUMBUS, Ohio (AP) — Officials say four health care facilities in Ohio received a recalled steroid injection suspected in a deadly outbreak of meningitis.

The Ohio Department of Health says the medication went to two facilities in Marion, one in Cincinnati and one in the Columbus suburb of Dublin. The department says the facilities are working to contact patients who received the steroid injection, which is often