Distributed via Health Alert NetworkDecember 20, 2012, 11:55 ET (11:55 AM ET)CDC HAN-0338-2012-12-20-U-N
Update: Multistate Outbreak of Fungal Infections among Persons Who Received Injections with Contaminated Medication
Summary: New information from diagnostic imaging of patients exposed to contaminated methylprednisolone acetate (MPA1) from the New England Compounding Center (NECC) in Framingham, Mass., demonstrates the need for assertive clinical evaluation of these patients for the possibility of an unrecognized, localized spinal or paraspinal infection. This Health Alert Network (HAN) notice provides updated guidance and information about the ongoing multistate outbreak of fungal infections as follows:
CDC continues to work closely with state public health departments in response to a multistate outbreak of fungal meningitis and other infections among patients exposed to contaminated MPA1 from one of three lots distributed by NECC. As of December 18, 2012, a total of 620 cases, which includes 39 deaths, have been reported in 19 states. CDC continues to post up-to-date information online, including case count, distribution by state, as well as clinician and patient guidance, at www.cdc.gov/hai/outbreaks/meningitis.html. Since early October, CDC has advised clinicians to closely monitor and evaluate patients who received injections of contaminated MPA from NECC.
On November 20, 2012, CDC issued a HAN notification (CDC HAN-00335-2012-11-20-ADV-N; emergency.cdc.gov/HAN/han00335.asp) that described preliminary information about epidural abscess and other clinical syndromes diagnosed in patients exposed to implicated MPA from NECC. The HAN advisory also noted that CDC has been receiving increasing reports of spinal or paraspinal localized infection (e.g., epidural abscess, phlegmon, discitis, vertebral osteomyelitis, or arachnoiditis). The notification further recommended that physicians obtain an MRI with contrast of symptomatic area(s) in patients with new or worsening symptoms at or near the injection site.
In the last two reporting periods (December 3-17), states have reported to CDC a total of 80 new cases, most of which are spinal/paraspinal infections.
Preliminary Data on Spinal/ Paraspinal Infections
CDC and state health department partners continue to receive data from states about patients under the care of physicians who are acting on CDCâs diagnostic recommendations.
Additional Diagnostic Guidance
These data suggest that some patients who received spinal or paraspinal injections with implicated MPA from NECC may currently have an unrecognized, localized spinal or paraspinal infection. CDC is therefore re-emphasizing the need for clinicians to remain vigilant for evidence of fungal infection in these patients. Additional guidance for evaluating patients and for obtaining MRI testing is as follows:
CDC's previous Interim Treatment and Diagnostic Guidance for Central Nervous System and Parameningeal Infections Associated with Injection of Contaminated Steroid Products (www.cdc.gov/hai/outbreaks/clinicians/guidance_cns.html) continues to apply.
In November, CDC established a Clinicians Consultation Network telephone service to assist physicians who are directly involved in the treatment of patients associated with this outbreak and may have clinical questions. To access the Clinicians Consultation Network service, physicians should call 1-800-CDC-INFO (1-800-232-4636). A CDC-INFO agent will verify your role as a healthcare provider and help connect you to the service. Operating hours are the same as those for CDC-INFO, 8:00 am to 8:00 pm Monday through Friday (Eastern Time), except federal holidays.
CDC continues to work with state health departments and others to gather data from existing and newly reported cases of fungal infection. This information will be used to inform updates to existing guidance. Healthcare professionals with patients under their care should check CDCâs website (www.cdc.gov/hai/outbreaks/clinicians/index.html) for the most up-to-date clinical guidance because information is subject to change.
1 NECC lots of methylprednisolone acetate (PF) 80mg/ml:Methylprednisolone Acetate (PF) 80 mg/ml Injection, Lot #05212012@68, BUD 11/17/2012Methylprednisolone Acetate (PF) 80 mg/ml Injection, Lot #06292012@26, BUD 12/26/2012Methylprednisolone Acetate (PF) 80 mg/ml Injection, Lot #08102012@51, BUD 2/6/2013
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