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> 30+ dead from meningitis outbreak which includes Indiana
Southsider2k12
post Oct 9 2012, 08:09 AM
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http://www.examiner.com/article/indiana-me...eroid-injection

QUOTE
A state health official says Indiana now has 11 cases of fungal meningitis linked to a tainted back pain medication.

State Department of Health spokesman Ken Severson said Monday the latest total is up from eight known cases previously. There have been no Indiana deaths.

Indiana's cases involve patients at six Indiana health facilities in cities including Evansville, Fort Wayne, Elkhart, South Bend, Terre Haute and Columbus that received a recalled steroid produced by a specialty pharmacy in Massachusetts, The New England Compounding Center (NECC). NECC has recalled "three lots" consisting of a total of 17,676 single-dose vials of the steroid, preservative-free methylprednisolone acetate, according to Massachusetts health officials.

Eight other states received the tainted steroid and have reported fungal meningitis cases, making the national number 105. At least eight have died. The latest fatality reported Monday was in Tennessee.

The company has recalled the steroid which was sent to clinics in 23 states. The government last week urged doctors not to use any of the company's products.

Who is at risk for fungal meningitis linked to NECC?

The outbreak of fungal meningitis has been tied to steroid shots used to treat back pain. Patients who were given preservative-free methylprednisolone acetate in a spinal block or epidural may be at risk. As of right now, the CDC estimates that more than 1400 patients received contaminated shots. Contact your hospital if you have been given this anti-inflammatory within the last two months.

What is fungal meningitis?

Meningitis is an inflammation of the protective membranes covering the brain and spinal cord. It is usually caused by an infection, frequently with bacteria or a virus, but it can also be caused by less common pathogens like fungi.

Fungal meningitis is very rare and, unlike viral and bacterial meningitis, it is not contagious.

Symptoms of fungal meningitis are similar to symptoms from other forms of meningitis, but they often appear more gradually and can be very mild at first.
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Southsider2k12
post Oct 9 2012, 08:13 AM
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http://www.usatoday.com/story/news/nation/...-grows/1618031/

QUOTE
7:44PM EST October 7. 2012 - The number of people sickened by a nationwide meningitis outbreak has risen to at least 91 patients in nine states, with seven deaths, health officials said Sunday, and potentially hundreds more could be affected.

Tennessee, Virginia, Maryland, Florida, North Carolina and Indiana had previously reported cases. This weekend, Michigan, Minnesota and Ohio joined the list. Tennessee has been hardest hit, with 32 cases and three deaths.

The outbreak of fungal meningitis has been tied to steroid shots used to treat back pain. The steroid was custom-made by a specialty pharmacy in Framingham, Mass., New England Compounding Center, and recalled Sept. 26.

The Centers for Disease Control and Prevention website lists the names of about 75 clinics in 23 states that received the injections. Nearly 17,700 vials of the steroids were shipped.

The CDC said Sunday that "Clinicians should actively contact patients" who received potentially contaminated injections starting May 21, 2012.

"All patients who may have received these medications need to be tracked down
immediately," said Benjamin Park, medical officer, at the CDC's mycotic diseases
branch. "It is possible that if patients with infection are identified soon and
put on appropriate anti-fungal therapy, lives may be saved."

The pharmacy on Saturday announced a voluntary recall of all of its products
as a precautionary measure. It said there is no indication that any other products have been contaminated. The pharmacy has voluntarily shut down. The Food and Drug Administration had previously told health professionals not to use any products distributed by the center.

This type of meningitis is not contagious and can't be spread from person to person, Park said.

Meningitis is an inflammation of the lining of the brain and spinal cord. Infected patients have developed a variety of symptoms, which have set in one to four weeks after their injections. These include fever, a new or worsening headache, nausea and problems similar to those seen in a stroke.

CDC officials said that anyone who had an epidural injection since May 21 should contact a doctor if they have these symptoms, and also if they have a stiff
neck, sensitivity to light, slurred speech or newly developed weakness in any
part of the body.



Health inspectors found fungus in at least one sealed vial of the steroid at
the company's facility, according to the Food and Drug Administration. At a press conference last week, officials said they found foreign material in other products as well, but had not yet had time to test what that material was.

The outbreak is already interrupting medical care for some patients.
Anders Cohen, chief of neurosurgery and spine surgery at the Brooklyn
Hospital Center in New York, said he advises patients in pain to wait until the
CDC's investigation is completed before getting steroid injections.

Steroid injections are an "extremely common" treatment for lower back pain,
such as sciatica caused by a herniated disk, said William Blau, a professor of
anesthesiology at the University of North Carolina's School of Medicine. "I'm
guessing there are hundreds or thousands every day," he said.

Steroids decrease inflammation, which can ease pain. Injections are a mainstay of pain management, used for decades. They're a good alternative to narcotics for people with chronic pain, because they are very safe, effective and pose no risk of addiction, said David Zvara, chair of anesthesiology at UNC-Chapel Hill.

The risk of complications is a fraction of 1%, Blau said. "We give about three
injections a day, and we're just one clinic," said Blau, who added that people with
long-term pain may need two or three injections a year.

Steroid injections "dramatically and immediately decrease inflammation around irritated nerve roots," Zvara said. "Getting an injection like this hastens the healing process and can mean the difference between several lost days of work with back pain and returning to normal functioning within a day or two for many people."

Pain specialists can help people decide if an injection is the best therapy, Zvara said. "In most cases, an irritated nerve root will heal on its own over several days or weeks, he said. "The steroid injection hastens this process dramatically. For some, back pain can be debilitating resulting in lost work and suffering. Seeing a physician and potentially receiving a steroid injection in conjunction with other analgesics and muscle relaxants can be enormously beneficial. Importantly, patients must determine if the back pain is due to a surgical problem such as a herniated disc or a tumor as the steroid injection may reduce some of the discomfort, but it will not reverse the underlying cause."

Epidural steroid injections are administered somewhat like the epidural pain
relievers given to many women in labor, injected at the base of the spine near
the spinal fluid, Blau said. Women in labor, however, receive continuous pain
relief through a catheter, rather than a one-time steroid shot.

In some ways, epidurals have advantages over taking steroid pills. Because
they're shot directly into the spinal area, they tend to cause fewer side
effects than oral medications, which circulate throughout the body. Some of the
main side effects from long-term steroid use are immune suppression and a
worsening of osteoporosis, which can increase the risk of bone fractures, Blau
said.

The tainted steroids "are such a potential health hazard for patients because
the medication is site specific, delivered to the spinal canal, and nerves in
the spinal cord," Cohen said. Patients who choose to skip epidural medications
for now "can ask their physicians about other alternatives such as oral pain
medications. I've received calls from several patients, including one who came
into the office to check his lot number. I advise patients to call their
physicians to make sure their lots are cleared."

Cohen said the outbreak highlights stress in the pharmaceutical industry,
which sometimes can't produce enough of certain medications.

Companies that can't keep up with demand may turn to compounding pharmacies, which make their own medications from basic ingredients.

"Due to the high demand of certain medications, pharmaceutical companies are
outsourcing production, which sometimes leads to problems, because compounders are not under the same stringent regulatory guidelines as the pharmaceutical companies," Cohen said.

The fungus blamed for the outbreak, Aspergillus, is very common and found in leaf
mold, according to William Schaffner, an infectious disease expert at the Vanderbilt
University School of Medicine in Nashville. The fungus floats in the air, indoors and outdoors — and only very rarely makes people sick.

People inhale Aspergillus fungus spores all the time without any problem.
It's nearly impossible to avoid, because it is found in such places as decaying
leaves, trees, grain, soil, household dust, heating ducts and building
materials.

It's being blamed for meningitis that occurred after a steroid contaminated
with it was injected into the spinal column of some patients. That provides a
rapid way for the fungus to cause a serious infection. It's not clear how the
fungus got into the medication.

Usually, after somebody inhales Aspergillus spores, they're destroyed by the
body. But people with cystic fibrosis or asthma may have problems with it,
wheezing and coughing. A more severe infection can arise in people with weakened
immune systems, like those with HIV, the virus that causes AIDS; those who've had
transplant surgery; or patients getting chemotherapy for cancer. This invasive
infection can cause fever, chest pain and shortness of breath.

It's hard to tell exactly how common Aspergillus infections are, but one
study suggests it may affect just one or two people per 100,000 every year.

Contributing: The Associated Press and The (Nashville) Tennessean
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Ang
post Oct 9 2012, 08:42 AM
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Scary stuff......obviously this isn't so "safe" as the article stated.

This just adds to the reasons why I am reluctant to take medication. If I have pain, I just deal with it, or treat it with heat/ice.


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post Oct 9 2012, 10:28 AM
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QUOTE(Ang @ Oct 9 2012, 08:42 AM) *

Scary stuff......obviously this isn't so "safe" as the article stated.

This just adds to the reasons why I am reluctant to take medication. If I have pain, I just deal with it, or treat it with heat/ice.


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Southsider2k12
post Oct 10 2012, 08:41 AM
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http://tribstar.com/latest/x1149582703/CDC...tied-to-steroid

QUOTE

October 10, 2012
CDC: 12 Indiana meningitis cases tied to steroid
No confirmed cases among local patients who received shot

Associated Press

INDIANAPOLIS — Federal health officials say Indiana now has 12 cases of fungal meningitis linked to a tainted back pain medication.

The Centers for Disease Control and Prevention reported Tuesday on its website that another case had been added to the 11 known previously. There have been no Indiana deaths.

Indiana’s cases involve patients at six Indiana health facilities that received a recalled steroid produced by a specialty pharmacy in Massachusetts.

Wabash Valley Surgery Center in Terre Haute was one of those six facilities, and so far, no one who received the drug at that facility has presented with symptoms.

“We have nobody in Terre Haute who has contracted meningitis,” Union Hospital spokesperson Kim Perkins said this morning.

The number of cases nationwide continues to climb. CDC reported Tuesay that 119 cases have been confirmed nationwide in the outbreak that has claimed 11 lives.

The disease is not contagious.
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Southsider2k12
post Oct 11 2012, 07:47 AM
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http://www.wdrb.com/story/19792946/cdc-15-...tied-to-steroid

QUOTE

CDC: 15 Indiana meningitis cases tied to steroid
Posted: Oct 11, 2012 7:51 AM CDT Updated: Oct 11, 2012 7:54 AM CDT


INDIANAPOLIS (AP) -- Federal health officials say the number of Indiana cases of fungal meningitis linked to a tainted back pain medication has risen to 15.

The Centers for Disease Control and Prevention on Wednesday added three more confirmed cases to the 12 previously known. It says the number of people nationwide sickened by the outbreak now has reached 137 cases, including 12 deaths.

No deaths from the outbreak have been reported in Indiana.

Indiana's cases involve patients at six Indiana health facilities that received a recalled steroid produced by a specialty pharmacy in Massachusetts. The clinics are in Elkhart, Evansville, Fort Wayne, South Bend, Terre Haute and Columbus.

Indiana health officials have said about 1,500 people in the state are known to have received injections of the drug.
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Southsider2k12
post Oct 11 2012, 07:50 AM
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A good FAQ from the CDC for anyone who might be looking for information in these cases...

http://www.cdc.gov/HAI/outbreaks/patients/...k-patients.html

QUOTE
Frequently Asked Questions For Patients: Multistate Meningitis Outbreak Investigation

October 10, 2012 12:45 PM EDT
About the Outbreak

Background
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 an epidural steroid injection with a potentially contaminated product. Several of these patients also suffered strokes that are believed to have resulted from their infection.

Physician Consulting with PatientHow many cases have been reported?
Updates about the investigation, including case counts, are available at http://www.cdc.gov/hai/outbreaks/meningitis.html.

Is the source of the outbreak known?
CDC is investigating medications and products that are associated with this outbreak of meningitis. At this point, the original source of the outbreak has not been determined. However, injectable steroid medication has been linked to the outbreak. The lotsExternal Web Site Icon of medication that were given to patients have been recalled by the manufacturer.
The type of epidural medication given to patients affected by this outbreak is not the same type of medication as that given to women during childbirth.

What states received the implicated product?
California, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Maryland, Michigan, Minnesota, Nevada, New Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Virginia, and West Virginia.
The names of the facilities that have received medication from one of these lots are available at http://www.cdc.gov/hai/outbreaks/meningiti...lities-map.html.

Are patients who did not receive an injection at risk?
No. Fungal meningitis is not transmitted from person to person. These infections are associated with a potentially contaminated medication that is injected into the body.

What should patients do?

Find out if you received a potentially contaminated medication. If patients are concerned about which product was used in their procedure, they should first contact the physician who performed their procedure.

The facilities who received one of the lots recalled on September 26, 2012, are actively contacting patients to find out if they are feeling well. The list of facilities that received medication from one of these three lots is available at http://www.cdc.gov/hai/outbreaks/meningiti...lities-map.html.

If you have received a potentially contaminated medication, seek medical attention if you have symptoms. It is important to note that infected patients have had very mild symptoms that are only slightly worse than usual. For example, many infected patients have had slight weakness, slightly worsened back pain, or even a mild headache. Patients have had symptoms generally starting from 1 to 4 weeks after their injection.

Patients who have had an epidural steroid injection since May 21, 2012, and have any of the following symptoms, should talk to their doctor as soon as possible:

New or worsening headache
Fever
Sensitivity to light
Stiff neck
New weakness or numbness in any part of your body
Slurred speech
Increased pain, redness or swelling at your injection site

I was contacted because I received an epidural injection with one of the potentially contaminated steroid medications approximately 4 weeks ago but I feel fine. Do I still need to be concerned?
Patients with infections have typically developed symptoms within 1-4 weeks after their injection. However, shorter and longer timeframes between injection and onset of symptoms have been reported. The timeframe is still being investigated. Patients should watch vigilantly for symptoms if they were injected with potentially contaminated steroids and see a doctor if they have any of the following symptoms, even if they have been previously evaluated: fever, new headache or headache that is getting worse, stiff neck, sensitivity to bright light, new weakness or numbness in any part of your body, slurred speech, new or worsening back pain, redness, or warmth or swelling at your injection sight. CDC will provide updated guidance as more information becomes available.

I was contacted because I received a joint injection with one of the potentially contaminated steroid medications approximately 4 weeks ago but I feel fine. Do I still need to be concerned?
As of October, infections from steroid injections into joints other than the spine (e.g., knee, hip) have not been reported. However, the investigation is ongoing and joint infections may take longer to develop than meningitis. The timeframe is still being investigated. Patients should watch vigilantly for symptoms if they were injected with potentially contaminated steroids and see a doctor if they have any of the following symptoms: fever, increased pain, redness, warmth, or swelling in the joint that received the injection or at the injection site. CDC will provide updated guidance as more information becomes available.

Are other medications from the New England Compounding Center located in Framingham, Massachusetts associated with infections?
To date, CDC has not received reports of infections linked to other products from the New England Compounding Center. However, out of an abundance of caution, CDC recommends that patients cease use of any product produced by the New England Compounding Center until further information is available. A list of products produced by the New England Compounding Center can be found through the FDA website at http://www.fda.gov/Drugs/DrugSafety/ucm322734.htm

If patients have taken or used medications from New England Compounding Center, and they are worried that they are ill because of use of one of these products, they should seek medical attention. Again, CDC has not received any reports of infection linked to other products from New England Compounding Center.

What is a compounding pharmacy? Why are these medications compounded when they are also commercially available?
Compounding pharmacies create special formulations of medications in order to fit patients’ healthcare needs. For example, they may change the dose or change the formulation of a medication from a solid to a liquid.

Where can I find updates and additional information on this outbreak?
For complete information and updates on this outbreak, visit www.cdc.gov/hai/outbreaks/meningitis.html.
About Fungal Meningitis

What is meningitis?
Meningitis is swelling of the protective membranes, or meninges, covering the brain and spinal cord. The swelling is usually caused by an infection with a bacteria or virus, but meningitis can also be caused by a fungus. Meningitis caused by a fungus is called fungal meningitis. The severity of illness and the treatment for meningitis differ depending on the cause, so knowing the specific cause of meningitis is important.

What is fungal meningitis?
Fungal meningitis occurs when the protective membranes covering the brain and spinal cord are infected with a fungus. Fungal meningitis is rare and usually caused by the spread of a fungus through blood to the spinal cord.

Is fungal meningitis common after epidural injections?
Epidural injections are generally very safe procedures, and complications are rare. Fungal meningitis is an extremely rare cause of meningitis overall, including after epidural injections. The type of epidural medication given to patients affected by this outbreak is not the same type of medication as that given to women during childbirth.

What are the symptoms of fungal meningitis?
Symptoms of fungal meningitis are similar to symptoms of other forms of meningitis; however, they often appear more gradually and can be very mild at first. In addition to typical meningitis symptoms, like headache, fever, nausea, and stiffness of the neck, people with fungal meningitis may also experience confusion, dizziness, and discomfort from bright lights. Patients might just have one or two of these symptoms.
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Southsider2k12
post Oct 11 2012, 01:29 PM
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Reuters
2 minutes ago
FLASH: CDC says 14,000 people may have received drugs linked to meningitis outbreak, patients face possible health risk for next "several months"
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Southsider2k12
post Oct 15 2012, 08:32 AM
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http://www.wane.com/dpp/news/indiana/anoth...s-case-reported

QUOTE
Another Indiana meningitis case reported

Updated: Sunday, 14 Oct 2012, 8:06 PM EDT
Published : Sunday, 14 Oct 2012, 8:06 PM EDT

INDIANAPOLIS (AP) - Indiana now has 28 cases of fungal meningitis linked to injections of a steroid used to treat back pain.

The Centers for Disease Control and Prevention reported the new case on Sunday. It previously had said Indiana had 27 cases, including two deaths. Nationwide, there's more than 200 cases in 14 states and 15 deaths.

Family members of an 89-year-old southern Michigan woman who received two shots at a northern Indiana clinic said last week that they believed she was Indiana's first death. Little is known about Indiana's second death, which the CDC reported Saturday.

Indiana's cases involve patients at six health facilities that received a steroid recalled by a Massachusetts specialty pharmacy. Those clinics are in Elkhart, Evansville, Fort Wayne, South Bend, Terre Haute and Columbus.

Fort Wayne Physical Medicine ( FWPM) said its patients were not given methylprednisolone acetate by epidural injection, but instead through the joints. A spokesperson explained to NewsChannel 15 that in order to be sickened by the fungus, one would have to receive the contaminated medicine through the spine.
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Southsider2k12
post Oct 15 2012, 08:36 AM
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http://www.nwitimes.com/news/national/at-c...204611fbf2.html

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ATLANTA | Scattered across the carefully landscaped main campus of the Centers for Disease Control and Prevention are the staff on the front lines fighting a rare outbreak of fungal meningitis: A scientist in a white lab coat peers through a microscope at fungi on a glass slide. In another room, another researcher uses what looks like a long, pointed eye dropper to suck up DNA samples that will be tested for the suspect fungus.

Not far away in another building is the emergency operations center, which is essentially the war room. There's a low hum of voices as employees work the phones, talking to health officials, doctors and patients who received potentially contaminated pain injections believed to be at the root of the outbreak. Workers sit at rows of computers, gathering data, advising doctors and reaching out to thousands of people who may have been exposed. Overall, dozens of people are working day and night to bring the outbreak under control. Nearly 200 people in more than a dozen states have been sickened, including 15 who have died.

There is a sense of urgency — people are dying, and lives could be saved if those who are sickened get treated in time. But it's not a race against a fast-spreading illness like avian flu or SARS — or even the fictional virus the CDC fails to unravel in the popular TV series "The Walking Dead." Unlike those outbreaks, this strain of meningitis isn't contagious and doesn't spread between people. It is likely isolated to the contaminated steroid, produced by the New England Compounding Center in Framingham, Mass.

"This is a very unusual infection," said Dr. John Jernigan, a CDC medical epidemiologist who is leading the clinical investigation team for the outbreak response. "So, treatment recommendations, diagnostic recommendations are all going to be new, and we're learning as we go on this one."

Meningitis, an inflammation of the membranes surrounding the brain and spinal cord, is not uncommon. But it is usually caused by bacteria, and it is very unusual to see it in patients with normal immune systems, Jernigan said. This strain is caused by a fungus that is common in dirt and grasses — people routinely come into contact with it without getting sick — but it has never before been identified as the cause of meningitis.

By Friday morning, officials believed they had reached about 90 percent of those who were potentially affected, Jernigan said. They planned to continue trying to reach every person to see if they've had problems and to warn them to be on the lookout for symptoms, which can include severe headache, nausea, dizziness and fever. The CDC says many of the cases have been mild, but some people had strokes.

A meeting is held each morning to review overnight developments and plot a course of action for the day, and another at the end of the day summarizes the day's developments and looks ahead to the next day. Maps on big screens in the front of the emergency operations center track the states where the tainted medications were sent and the tally of cases reported in affected states.

A few steps away in the joint information center, another team works to keep the information about the outbreak on the CDC's website up to date and disseminate information via the media and other outlets.

In another building on the campus tucked away in the northeast corner of Atlanta, in a part of the CDC that specializes in fungal infections, about 15 scientists in the reference and research labs are logging 12 hours or more a day and working through weekends to test samples coming in from around the country.

Because the lab scientists had never worked with this particular fungus in cerebrospinal fluid before, they had to quickly develop new tests to detect it before they could start analyzing the hundreds of samples — cerebrospinal fluid samples, cultures and bits of tissue — sent in from around the country, research lab team leader Ana Litvintseva said.

Dressed in a white coat Friday, Shawn Lockhart, the fungal reference lab team leader, peered through a microscope as images of what looked like red pea pods appeared on a computer screen next to him. Many other closely related fungi look similar, but a tiny dot at the end of a pod told him he was looking at the fungus believed to be at the root of the outbreak.

Normally, the reference lab works on difficult samples sent in from state health departments, while the research lab works on research projects. But the scale of this outbreak means those projects are mostly being shelved at the moment.

"The scale is much, much bigger than we would normally work with," said research lab team leader Ana Litvintseva said. "We are working every weekend and people are here 12 to 13 hours at a time and we're testing samples nonstop."
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Southsider2k12
post Oct 18 2012, 02:31 PM
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http://www.wsbt.com/news/wsbt-ind-agency-s...0,5876245.story

QUOTE
Ind. agency: State has 34 fungal meningitis cases
Associated Press

4:22 p.m. EDT, October 18, 2012

INDIANAPOLIS (AP) — Indiana has two more cases of fungal meningitis linked to injections of a recalled back pain steroid, bringing the state's total to 34.

The Indiana State Department of Health reported the new cases Wednesday. Two Indiana patients have died.

The state agency has released no details about the two deaths or the clinics they're linked to. Its policy is to withhold details about where the Indiana cases are located.

Relatives of 89-year-old Pauline Burema of Cassopolis, Mich., have said they believe she contracted the disease after receiving an injection at the OSMC Outpatient Surgery Center in Elkhart. Burema died Oct. 10, and the family has been awaiting autopsy results on the cause. A granddaughter has said the clinic has told its patients it had at least eight cases.
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Southsider2k12
post Oct 25 2012, 11:43 AM
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http://www.indystar.com/article/20121024/L...dyssey=nav|head

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A third person linked to Indiana has died of fungal meningitis after receiving a contamined steroid shot for chronic back pain and 41 people here have been sickened, state health officials announced today.

Nationwide, there have been 24 deaths and 317 cases in the outbreak linked to medicine distributed by a Massachusetts specialty pharmacy.

In addition, the Food and Drug Administration has asked health care providers to contact any of their patients who had received products made by the New England Compounding Center. Nearly 1,300 sites across the country have purchased products from the facility since May 21.

So far, however, the only product implicated in the multi-state meningitis outbreak is the steroid shot. In Indiana, six clinics received medications from the contaminated lots and 1,502 people here were exposed through an epidural or joint injection, state health officials say.

While three people who received shots in Indiana have died, only two of those were residents of the state. The third had treatment here but resided across state lines.

Fungal meningitis symptoms include worsening headache, fever, neckache, confusion, and can lead to stroke or death. Symptoms typically appear one to four weeks after infection.
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post Oct 29 2012, 07:14 AM
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http://www.examiner.com/article/indiana-of...-telling-public

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According to a series of emails obtained Friday by the Associated Press, Indiana health officials knew a week before notifying the public that six clinics in the state received a tainted back pain medication linked to a nationwide outbreak of fungal meningitis.

The AP public records request resulted in the release of documents, including emails indicating that officials at the Indiana State Department of Health were racing to keep up with information as the disease rapidly spread.

As Amy Reel, a spokesman for the state health agency, told the Associated Press, "A lot of new information was coming in regularly over the weekend of September 29 and 30 from the Centers for Disease Control and Prevention as the situation began to take shape."

Randy Snyder, acute care director for the agency, wrote in an October 3 email to other state health officials, "This is a fast breaking and fluid situation."

On the night of September 28, the emails reveal the CDC informed officials at the ISDH it was investigating a cluster of fungal meningitis cases in Tennessee and North Carolina that it suspected were connected with injections of a contaminated steroid. An attachment to the email identified the six Indiana health facilities known to have received the suspected medication from a Massachusetts specialty pharmacy, which has since recalled all its products and shut down.

The CDC email also urged state health agencies to contact those clinics receiving the contaminated steroid, and to monitor patients for signs of meningitis symptoms. The six Indiana clinics receiving the tainted steroid are located in Elkhart, Evansville, Fort Wayne, South Bend, Terre Haute and Columbus.

On Saturday, September 29, Snyder sent an email stating that he had received no reports of meningitis cases. That same morning, state epidemiologist Pam Pontones sent an email to CDC intelligence officer Rachel Smith that said, "We'll focus on contacting the facilities on the list first."

"We'll contact the patients," Kristi Williams, pharmacy director at Union Hospital in Terre Haute, told state health officials in an email the following Monday. That same day, October 1, Snyder said in an email that the state health department had contacted by phone and email all six of the health facilities that received the tainted lots of medication. The agency also distributed a "script" for the clinics to read from when notifying patients who may have been exposed.

Reel said Indiana and other states didn't receive data defining how to recognize cases that would be considered part of the outbreak from the CDC until October 2, and the state agency immediately alerted physicians.

"It's critical physicians are made aware of signs and symptoms prior to any public announcement so they can be prepared to discuss those signs and symptoms and appropriately treat patients," said Reel.

According to documents obtained by the AP, health officials weren't aware of any meningitis cases in Indiana as of early morning on October 4. Shortly after noon, however, they knew that one case had been confirmed and two more were suspected in the Hoosier state.

As Pontones said in an email, "One case has been identified in Indiana, and we probably have at least two more."

That same day, the ISHD informed the six clinics that the state epidemiologist would be contacting them for a list of the patients who had received the tainted medication, and to find out how many patients the clinics had already contacted.

In the same email, Snyder told the clinics that the agency intended to announce the outbreak to the public and planned to identify the facilities that had received the contaminated steroid.

Reel said the state health agencies coordinated the release of information with a CDC press conference on October 4, the same day the first Indiana case was confirmed.

As of today, the CDC meningitis website was reporting 44 cases and three deaths connected with Indiana.
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post Oct 29 2012, 07:15 AM
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http://articles.chicagotribune.com/2012-10...break-new-cases

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Six new cases reported in meningitis outbreak
October 28, 2012|Reuters

(Reuters) - Six new cases of fungal meningitis have been reported in an outbreak tied to contaminated steroid injections that has led to 25 deaths in the United States, the Centers for Disease Control and Prevention said on Saturday.

The CDC reported three new cases in Florida, two in Ohio and one in Indiana, raising the total number of meningitis cases attributed to the tainted steroid to 337 in 18 states. This type of meningitis cannot be spread person-to-person.

There also are seven reported cases of infections after the tainted steroid was injected into a joint such as a knee, hip, shoulder or elbow.

The steroid was supplied by New England Compounding Center of Massachusetts, which now faces multiple investigations. Health authorities have said its facility near Boston failed to make medications in sterile conditions.

(Reporting by David Bailey, Editing by Ellen Wulfhorst and Doina Chiacu)
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post Oct 29 2012, 08:04 AM
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INDIANAPOLIS – Attorney General Greg Zoeller’s office today filed an emergency petition asking the Indiana Board of Pharmacy to suspend the license of the Massachusetts pharmacy linked to the meningitis outbreak.

On Thursday, the Indiana State Department of Health (ISDH) confirmed 43 cases of fungal meningitis and three deaths stemming from a tainted steroid injection produced by the New England Compounding Center (NECC) based in Framingham, Mass. As a licensed non-resident pharmacy whose products are distributed and sold in Indiana, NECC is legally responsible for the “proper and safe storage and distribution of drugs and devices.”

“It is tragically clear that this out-of-state pharmacy presents an immediate danger to public health and safety,” Zoeller said. “Our office will use all available resources to ensure Indiana patients are protected from any more harm and to pursue a formal administrative action against the company’s ability to operate in our state.”

The Indiana Board of Pharmacy will consider the petition for summary suspension at its next meeting which begins at 8:30 a.m. on Nov. 5. The meeting will be held in Room W064 of the Indiana Professional Licensing Agency, Indiana Government Center South, 402 W. Washington St., in Indianapolis.

If the suspension is granted, the NECC could not operate in Indiana for 90 days which would give the Attorney General’s Office time to file a formal licensing complaint before the pharmacy board. Once an administrative complaint is filed, the board could then determine the appropriate disciplinary action.

According to ISDH, there are now 1,502 people in Indiana who have been exposed to the contaminated medication through an epidural or joint injection. Patients exposed in Indiana have been contacted by their healthcare provider.

“These are uncharted waters, but we are learning more about these infections every day,” said Joan Duwve, M.D., Chief Medical Officer at ISDH. “The State Health Department has been working diligently with the Centers for Disease Control and Prevention to assist Indiana medical providers with the screening, diagnosis, and treatment of infections related to use of these contaminated products. We will continue to do so until this outbreak is resolved.”

In September, the U.S. Centers for Disease Control and Prevention (CDC) in coordination with the Food and Drug Administration identified the NECC as the compounding pharmacy that produced the epidural steroid injections that caused the onset of meningitis in certain patients. Shortly after, NECC ceased production and initiated a recall of the drugs.

As of Oct. 25, the CDC had indentified 328 cases of fungal meningitis across 18 states stemming from NECC’s tainted steroid injections. The cause of contamination of the steroid injections is still under investigation.

In-state pharmacies, including those engaging in sterile compounding, are subject to inspection by the Board of Pharmacy’s Compliance Officers. The board’s administrative rules and inspections of sterile compounding facilities address, among other things: policies and procedures; engineering controls/physical requirements; personnel training; labeling and documentation/records and reports; and quality assurance measures.

Non-resident pharmacies registered in Indiana are required by Indiana Code to comply with the laws and rules of the state in which they are domiciled. In order to be registered as an Indiana non-resident pharmacy, an applicant must submit numerous documents and fulfill various duties, including verification of the pharmacy’s licensure in its home state. The Indiana Board of Pharmacy relies on other state boards of pharmacy to regulate licensees in their jurisdiction.
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post Nov 1 2012, 08:30 AM
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http://www.examiner.com/article/indiana-no...ngal-meningitis

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Health officials confirmed today that Indiana now has 48 cases of fungal meningitis tainted steroid injections for back pain. There have been three deaths linked to Indiana, and according to Elkhart County’s health officer, all three deaths are linked to a clinic in the northern Indiana County

The Centers for Disease Control and Prevention updated the count on its website Wednesday.

The Indiana State Department of Health has said six Indiana clinics received the tainted steroids, including the OSMC Outpatient Surgery Center in Elkhart. The tainted medication also went to clinics in Columbus, Evansville, Fort Wayne, South Bend and Terre Haute.

The tainted steroids have been traced to the New England Compounding Center of Framingham, Massachusetts. The specialty pharmacy has since recalled all its products and shut down.
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post Nov 1 2012, 11:58 AM
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From Zoellers office...

INDIANAPOLIS – The Massachusetts pharmacy linked to the meningitis outbreak agreed on Wednesday to an indefinite summary suspension of its license to do business in Indiana, according to Attorney General Greg Zoeller.

Last week, Zoeller’s office filed an emergency petition asking the Indiana Board of Pharmacy to suspend the license of the New England Compounding Center (NECC) which is based in Framingham, Mass. The Indiana Board of Pharmacy will consider and vote on the new agreement for indefinite summary suspension at its meeting Monday beginning at 8:30 a.m. The meeting will be held in Room W064 of the Indiana Professional Licensing Agency, Indiana Government Center South, 402 W. Washington St., in Indianapolis.

“The agreement by the New England Compounding Center to have their pharmacy license suspended is encouraging,” Zoeller said. “The tragic and fatal consequences of the company’s actions regarding the sterility of their drugs cannot be overlooked and our office will use all resources available to make sure they are held accountable.”


On Thursday, the Indiana State Department of Health (ISDH) confirmed 48 cases of fungal meningitis and three deaths in the state stemming from a tainted steroid injection produced by NECC. As a licensed non-resident pharmacy whose products are distributed and sold in Indiana, NECC is legally responsible for the “proper and safe storage and distribution of drugs and devices.”


If the board votes to accept the agreement, the company could not operate in Indiana and the Attorney General’s Office will move forward with filing a formal licensing complaint before the pharmacy board. Once an administrative complaint is filed, the board could then determine the appropriate disciplinary action.

According to ISDH, there are now 1,502 people in Indiana who have been exposed to the contaminated medication through an epidural or joint injection. Patients exposed in Indiana have been contacted by their healthcare provider.

In September, the U.S. Centers for Disease Control and Prevention (CDC) in coordination with the Food and Drug Administration identified the NECC as the compounding pharmacy that produced the epidural steroid injections that caused the onset of meningitis in certain patients. Shortly after, NECC ceased production and initiated a recall of the drugs.

As of Oct. 31, the CDC had indentified 377 cases of fungal meningitis and 28 deaths across 19 states stemming from NECC’s tainted steroid injections. The cause of contamination of the steroid injections is still under investigation.

In-state pharmacies, including those engaging in sterile compounding, are subject to inspection by the Board of Pharmacy’s Compliance Officers. The board’s administrative rules and inspections of sterile compounding facilities address, among other things: policies and procedures; engineering controls/physical requirements; personnel training; labeling and documentation/records and reports; and quality assurance measures.

Non-resident pharmacies registered in Indiana are required by Indiana Code to comply with the laws and rules of the state in which they are domiciled. In order to be registered as an Indiana non-resident pharmacy, an applicant must submit numerous documents and fulfill various duties, including verification of the pharmacy’s licensure in its home state. The Indiana Board of Pharmacy relies on other state boards of pharmacy to regulate licensees in their jurisdiction.



-30-
Contact Information:
Name: Erin Reece
Phone: 317.232.0168
Email: Erin.Reece@atg.in.gov
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post Nov 6 2012, 12:49 PM
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http://www.wsbt.com/news/wsbt-ind-reports-...,0,707044.story

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NDIANAPOLIS (AP) — Indiana health officials say four people have now died from fungal meningitis linked to injections of a recalled back pain medication.

State Department of Health spokesman Ken Severson also said Monday Indiana now has 51 cases of the rare disease.

Officials didn't say where the fourth death occurred. Severson says officials can't discuss individual cases due to privacy laws.

Elkhart County's health officer has said three deaths are linked to the northern Indiana county but told WSBT on Monday the 4th death was not from Elkhart County.

The state health agency has said six Indiana clinics received the tainted steroids, including the OSMC Outpatient Surgery Center in Elkhart. The tainted medication also went to clinics in Columbus, Evansville, Fort Wayne, South Bend and Terre Haute.

The tainted steroids have been traced to the New England Compounding Center of Framingham, Mass.
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post Nov 13 2012, 12:14 AM
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The Centers for Disease Control and Prevention has released the latest numbers of those affected by the preservative-free methylprednisolone injections that led to meningitis. To date, the meningitis outbreak has infected 438 people, and 32 have died. Since the release of a tainted steroid injection by NECC and Alaunus Pharmaceutical, some 419 cases of fungal meningitis have been confirmed by the Food and Drug Administration. Of those numbers, 30 people have died, including Daniel Rohrer, whose family has filed the first wrongful death suit against NECC and the pharmaceutical company. Due to the number of people exposed, the confirmed cases diagnosed and the number of complaints that have been filed in both state and federal courts, this matter may end up in a multi-district litigation and possibly even in a class-action lawsuit.
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post Nov 15 2012, 08:54 AM
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http://www.necn.com/11/14/12/Indiana-confi...cc21a9628d58d65

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Indiana confirms another fungal meningitis case
Nov 14, 2012 1:41pm

INDIANAPOLIS (AP) — Indiana has another case of fungal meningitis linked to injections of a recalled back pain medication.

State Department of Health spokesman Ken Severson said Friday that Indiana now has 53 cases of the illness that's killed four people in the state.

State officials say clinics in six Indiana cities received tainted steroids traced to the New England Compounding Center. The Framingham, Mass., company is linked to a multistate outbreak that's sickened 438 people in 19 states and caused 32 deaths.

The Indiana clinics that received tainted medication are located in South Bend, Elkhart, Columbus, Evansville, Fort Wayne and Terre Haute.

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