Maine patients watched for possible exposure to contaminated steroid, meningitis

Posted Oct. 18, 2012, at 7:24 p.m.
Dr. Sheila Pinette
Dr. Sheila Pinette

Health officials are monitoring 74 Maine residents who were treated in New Hampshire with injections linked to a national outbreak of fungal meningitis that has led to 20 deaths.

Maine has recorded no cases of fungal meningitis and none of the Maine patients treated in New Hampshire has shown signs of the disease, but physicians are taking a closer look at one individual, said Dr. Sheila Pinette, director of the Maine CDC.

“All of them are asymptomatic except for this one person who is being evaluated right now,” she said.

The potentially contaminated steroid medication was not distributed or used in Maine, though some health providers in New Hampshire received the drug and treated patients who live in Maine, according to the Maine Center for Disease Control and Prevention.

The deadly outbreak that has sickened more than 250 people has now spread to 16 states, with new cases reported in Indiana, New Jersey, Ohio, Tennessee and New Hampshire. Approximately 14,000 patients may have been injected with the potentially tainted steroid, methylprednisolone acetate, which was sold to hospitals and clinics in 23 states.

“We really believe in our state the risk is very, very low,” Pinette said.

The patients who face the highest risk of meningitis received spinal injections for back pain, while others received less risky shots in their knees and shoulders. The Maine patients are believed to have received both types of injections, Pinette said.

Meningitis is a potentially deadly inflammation of the lining around the brain and spinal cord. Fungal meningitis is a rare form of the condition that usually results from fungus spreading through blood to the spinal cord. It is not contagious.

About 97 percent of the affected patients have been contacted by health officials, according to the U.S. Centers for Disease Control and Prevention.

The outbreak stemmed from steroid drugs that were distributed by the New England Compounding Center in Framingham, Mass. The victims in the outbreak all received steroid shots made by the specialty pharmacy, which recalled three lots of the steroid last month.

Federal health officials confirmed Thursday that fungus found in one lot of the contaminated steroid matches the fungus blamed for the national meningitis outbreak, confirming New England Compounding Center’s link to the illnesses.

The pharmacy has suspended operations and surrendered its license.

While the injectable steroids remain the only drugs implicated in the outbreak, the U.S. Food and Drug Administration advised health care professionals to follow up with patients who received any injectable drug from the New England Compounding Center after May 21.

Health officials also are investigating whether medications used in eye and heart surgeries are connected to the outbreak.

To be on the safe side, the Maine CDC has advised health providers to remove from their shelves and return any supplies from the New England Compounding Center, including lotions, creams and eye drops, Pinette said. In Maine, 45 hospitals, clinics and other health care facilities have ordered and used supplies from the Massachusetts pharmacy over the last year, she said. That includes 31 that have used the products since the beginning of 2012.

Doctors are waiting for more guidance from health officials about when and how to notify patients about the concerns surrounding New England Compounding’s products, said Gordon Smith of the Maine Medical Association. Physicians want to avoid unduly worrying patients, since the injectable steroid is so far the only medication definitively linked to the outbreak, but also want patients to know about potential risks, he said.

“We’re just in a waiting period right now to see what further information comes forth and what the language might be that we might use with patients so they’re not unnecessarily alarmed,” Smith said.

Patients who received an injection or other product made by NECC after May 21 are advised to look for symptoms of infection, including meningitis. The signs and symptoms of meningitis include fever, headache, stiff neck, nausea and vomiting, sensitivity to light, and changed mental status. Symptoms of other infections can include fever, swelling, and pain and redness at the injection site.

Symptoms of fungal meningitis may take from four to six weeks to appear.

Patients can call their doctors to learn whether any injections they received were sourced from NECC, Pinette said.

“If you are concerned, the most important thing is to make a call to your primary care provider so they can sit down and counsel you and reassure you and give you advice,” she said.

Federal officials don’t expect NECC’s shutdown to lead to drug shortages. The FDA hypothesizes that “the reason why NECC was oftentimes used was because they had extremely rapid turnaround and the cost of their medications tended to be cheaper,” Pinette said.

For information on the fungal meningitis outbreak, visit www.fda.gov.

The Associated Press contributed to this report.

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