By DENISE GRADY
The more recently a patient received a spinal injection with the contaminated
steroid implicated in a nationwide outbreak of fungal meningitis, the higher the risk of
developing the disease, federal health officials are reporting.
People injected with the contaminated drug within the last six weeks — since Sept. 11 — may be at the greatest risk, and extra monitoring should be considered for them even if they have no symptoms, according to an advisory posted online Tuesday night by the Centers for Disease Control and Prevention. The drug was recalled on Sept. 26. More recent injections may carry higher risk because the drug was older and had grown more and more contaminated as it sat on the shelf with the fungus multiplying inside the vials.
Even so, the risk of developing the disease remains relatively small, officials reported.
So far, 317 people in 17 states have been infected in the outbreak, and 24 have died. The disease has been traced to three lots of methylprednisolone produced by the New England Compounding Center in Framingham, Mass. About 14,000 people have been injected with it.
The new information is based on an analysis of the existing cases.
Preventive treatment with antifungal drugs is not being recommended, because the drugs can have severe side effects. Instead, experts say, high-risk patients with no symptoms should be monitored, and treated only if tests find a sign of infection.
The advisory suggests two options for monitoring people who were exposed to the contaminated drug within the past six weeks but who have no symptoms. The first option is to keep watching for symptoms, and to perform a spinal tap if they occur. Meningitis symptoms include headaches, stiff neck, dizziness, fever and sensitivity to light. If the spinal tap finds more than five white blood cells in the spinal fluid — a sign of infection — treatment should begin.
The second option is to perform a spinal tap even if there are no symptoms. If there are five or fewer white blood cells, there should be no treatment, but the patient should still be followed. Spinal taps can be done once a week until six weeks have passed since the last spinal injection with the contaminated drug. The patient should still be followed after that, but at that point another spinal tap would be done only if symptoms developed.
The advisory notes that spinal taps are not risk-free — something that doctors and patients should take into account. They can cause headaches. And in someone who was injected with the contaminated drug, there is a theoretical risk that during a spinal tap, the needle could pick up fungus already present in the patient and transfer it directly into the spinal fluid — thus increasing the odds of the very disease it is meant to detect.
For people who received the spinal injections more than six weeks ago and have no symptoms, the C.D.C. recommends monitoring for symptoms and, if they occur, performing a spinal tap.
The advisory also gives risk estimates for people exposed to the tainted drug. Because the drug was recalled on Sept. 26, at least 27 days should have passed since anyone was injected with it. By the 26th day, the risk of meningitis would be no greater than 5 percent, and it would drop to no greater than 1 percent by 42 days. Most patients would have even lower risk, the C.D.C. said, and their risk will keep dropping as more time elapses since the last injection.
Fungal meningitis can cause strokes. The advisory estimates that on Day 26, the stroke risk would be no greater than 0.4 percent, and would drop to no greater than 0.08 percent by Day 42.
Source found here
People injected with the contaminated drug within the last six weeks — since Sept. 11 — may be at the greatest risk, and extra monitoring should be considered for them even if they have no symptoms, according to an advisory posted online Tuesday night by the Centers for Disease Control and Prevention. The drug was recalled on Sept. 26. More recent injections may carry higher risk because the drug was older and had grown more and more contaminated as it sat on the shelf with the fungus multiplying inside the vials.
Even so, the risk of developing the disease remains relatively small, officials reported.
So far, 317 people in 17 states have been infected in the outbreak, and 24 have died. The disease has been traced to three lots of methylprednisolone produced by the New England Compounding Center in Framingham, Mass. About 14,000 people have been injected with it.
The new information is based on an analysis of the existing cases.
Preventive treatment with antifungal drugs is not being recommended, because the drugs can have severe side effects. Instead, experts say, high-risk patients with no symptoms should be monitored, and treated only if tests find a sign of infection.
The advisory suggests two options for monitoring people who were exposed to the contaminated drug within the past six weeks but who have no symptoms. The first option is to keep watching for symptoms, and to perform a spinal tap if they occur. Meningitis symptoms include headaches, stiff neck, dizziness, fever and sensitivity to light. If the spinal tap finds more than five white blood cells in the spinal fluid — a sign of infection — treatment should begin.
The second option is to perform a spinal tap even if there are no symptoms. If there are five or fewer white blood cells, there should be no treatment, but the patient should still be followed. Spinal taps can be done once a week until six weeks have passed since the last spinal injection with the contaminated drug. The patient should still be followed after that, but at that point another spinal tap would be done only if symptoms developed.
The advisory notes that spinal taps are not risk-free — something that doctors and patients should take into account. They can cause headaches. And in someone who was injected with the contaminated drug, there is a theoretical risk that during a spinal tap, the needle could pick up fungus already present in the patient and transfer it directly into the spinal fluid — thus increasing the odds of the very disease it is meant to detect.
For people who received the spinal injections more than six weeks ago and have no symptoms, the C.D.C. recommends monitoring for symptoms and, if they occur, performing a spinal tap.
The advisory also gives risk estimates for people exposed to the tainted drug. Because the drug was recalled on Sept. 26, at least 27 days should have passed since anyone was injected with it. By the 26th day, the risk of meningitis would be no greater than 5 percent, and it would drop to no greater than 1 percent by 42 days. Most patients would have even lower risk, the C.D.C. said, and their risk will keep dropping as more time elapses since the last injection.
Fungal meningitis can cause strokes. The advisory estimates that on Day 26, the stroke risk would be no greater than 0.4 percent, and would drop to no greater than 0.08 percent by Day 42.
Source found here
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