CENTERS FOR DISEASE CONTROL AND PREVENTION
October 2012 Meningitis Outbreak Update and Conference Call
On October 10, 2012, the Centers for Disease Control and Prevention (CDC) held a conference call to update
stakeholders on the investigation of fungal meningitis among patients who received an epidural steroid injection. The
outbreak has been linked to potentially contaminated steroid medication prepared by New England Compounding
Center (NECC) in Framingham, MA. Approximately 2,000 participants dialed in to the call, and the CDC has posted an
audio recording and transcript on their Clinician Outreach and Communication Activity (COCA) page here. Further
questions regarding these recommendations or the investigation in general should be emailed to coca@cdc.gov.
In addition to the continuously updated information available on the CDC website, the following recommendations were
provided by Dr. Melissa Schaffer and Dr. Tom Chiller of the National Center for Emerging and Zoonotic Infectious
Diseases at the CDC during the Question & Answer session:
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All fungal samples collected by providers should be sent to the state health departments, who will
transmit them directly to the CDC.
Patients will most likely need to be on antifungal therapy for anywhere from weeks to months. Short
course therapy does not work with fungi, especially mold. A clinical panel will be developing a more
definitive timeline as new data continues to come in.
At this time the CDC is uncertain as to if or when it will release any drugs to the strategic national
stockpile.
The CDC is continuing to look into the clinical response to treatment of those patients who are currently
hospitalized, as well as to which patients are more likely to respond better to treatment. So far, small
cohorts of patients have required more intensive follow up, and there are no good prognostic indicators
at this time. Some patients have been stable on therapy while some have progressed to strokes and
even death.
The typical incubation period thus far has been between 1 and 4 weeks, although shorter and much
longer periods have also been observed. Fungi can remain very indolent for long periods of time;
therefore it is important to be prepared for the possibility of long incubation periods.
State level data on the number of reported cases and the facilities that received contaminated lots are
available for all states on CDC website, but this information is not broken down into county level data.
Almost all causes of death so far have been stroke or a complication of stroke; however, not all autopsy
information is available at this time.
Providers should use their best clinical judgment when continuing to provide patients with epidural
injections. If a facility received lots from the NECC but no patients who have reported symptoms, they
should continue to be cautious. Although there is no evidence that any other drugs from the NECC have
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been contaminated, it remains a serious concern and providers are urged to send any patients reporting
serious symptoms to an ER for a lumbar puncture.
Although there is limited information on this specific outbreak considering dormancy periods, the
incubation period in similar cases has been up to 150 days and progression can be very slow.
At this time, the CDC recommends performing a lumbar puncture on any patient presenting to the ER
with symptoms consistent with case definitions for Meningitis after receiving an epidural injection. The
CDC is not recommending re-tapping unless clinical symptoms have worsened or not improved.
The CDC is not making suggestions about using or refraining from administering other preservative free
steroids produced by other compounding pharmacies at this time.
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