LANSING – The Michigan Department of Community Health (MDCH) is coordinating with the Centers for Disease Control and Prevention (CDC) and Food and Drug Administration (FDA) on a multi-state investigation of cases of fungal meningitis among patients who received epidural steroid injections. Michigan currently has 22 confirmed cases associated with this outbreak; 21 cases of meningitis, including two deaths, and one infection of a joint associated with this outbreak. As of Oct. 8, 105 cases and eight deaths have been reported from nine states.
As this is a developing investigation, the number of cases is expected to increase. The age range of current identified cases is 38-89 years old. Of the two deaths, both were females ages 56 and 67. Locations of residence have yet to be reported. All cases are linked to the four facilities in Michigan that received a potentially contaminated product, suspected to be the cause of the outbreak.
Interim data show that infected patients received an injection with one of three lots of preservative-free methylprednisolone acetate prepared by the New England Compounding Center (NECC), located in Framingham, Mass.
The four Michigan facilities that received shipments of these recalled lots are working with MDCH to notify patients who may have received this product between May and October and may 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
As of Oct. 8, most of the patients who received an epidural injection have been notified. The CDC has expanded the notification process to include patients with injections in other sites, such as injections for joint pain. Notification of these patients is ongoing.
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. On Oct. 6, NECC expanded their recall to all products produced by the company even though there is no indication at this time of any contamination in other NECC products. A full list of recalled products is available at www.neccrx.com.
These fungal infections are not transmitted person-to-person. Infected patients have become ill approximately one to four weeks following their injection with a variety of symptoms including fever, new or worsening headache, neck stiffness, sensitivity to light, new weakness or numbness, increasing pain, redness or swelling at injection site. Some patients’ symptoms were very mild in nature.
Any individual who received a steroid injection at one of the four Michigan facilities and is experiencing the symptoms described above 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 the Michigan investigation can be found under “Spotlight” on www.michigan.gov/emergingdiseases. For more information about the multistate investigation by the CDC, visit www.cdc.gov/hai/outbreaks/meningitis.html.