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Health officials' quick response saves lives in 2012 meningitis outbreak
The 2012-2013 fungal meningitis outbreak that sickened more than 750 people and contributed to 64 deaths may have had an even greater impact if not for the swift action of public health officials, according to a recent study in Emerging Infectious Diseases.
“In September 2012, the [CDC], in collaboration with state and local health departments, initiated a multistate investigation into an outbreak of fungal infections linked to injections of preservative-free methylprednisolone acetate produced at a single compounding pharmacy,” Rachel M. Smith, MD, MPH, medical epidemiologist in the mycotic diseases branch of the CDC, and colleagues wrote. “This contamination resulted in one of the largest outbreaks of health care-associated infections and the largest outbreak of fungal meningitis documented in the United States.”
After the CDC discovered that two lots of methylprednisolone acetate (MPA) contained Exserohilum rostratum — an environmental mold and the primary pathogen in the outbreak — and another contained DNA of the mold, lots were voluntarily recalled by the producer the next day, Smith and colleagues wrote. Two days later, on Sept. 28, 2012, CDC and state officials attempted to contact all 13,534 people who may have been exposed. By Oct. 4, the CDC posted diagnostic and treatment guidelines on its outbreak website and publicized the outbreak.
The CDC used various methods to determine the number of injections, cases of meningitis or stroke, and deaths caused by meningitis or stroke that were averted by the timely actions of public health officials, the researchers wrote.
To determine number of injections averted, the CDC subtracted the estimated volume of MPA injected before the recall from the total volume shipped, and then divided by the most commonly used injection dosage of 1 mL. Cases of meningitis and stroke averted were determined through estimated attack rates based on data from previous outbreaks. Averted deaths were estimated by calculating the 60-day case fatality rate for those diagnosed before Oct. 4, and applied it to patients who were diagnosed after Oct. 4 who were alive 2 months later, as well as cases that were projected to occur after Oct. 4 without the recall.
Smith and colleagues estimate that as many as 3,150 injections, 153 cases of meningitis or stroke, and 124 deaths were averted in the outbreak
“This outbreak showed the devastating effect of contamination in a widely used product designated for sterile use,” the investigators wrote. “Public health actions, made possible by a strong existing public health infrastructure and rapid coordination among federal, state and local partners, likely averted additional exposures, cases and deaths. Maintaining this infrastructure and these partnerships is essential to preserve public health agencies’ abilities to respond quickly and meaningfully to future public health emergencies.” – by David Jwanier
Disclosure: The researchers report no relevant financial disclosures.