Period of Risk for Fungal Meningitis after Steroid Injections Unknown

The number of fungal meningitis infections among individuals who received recalled injections from the New England Compounding Center (NECC) continues to rise, as the death toll hit 23 this weekend. However, health officials remain unsure of exactly how long individuals may be at risk after receiving one of the epidural steroids, as little is known about the fungus that is causing the outbreak.

Although a recall was issued for all NECC medications about four weeks ago, new cases of fungal meningitis are expected to continue to surface well into November, and possibly even past Thanksgiving, as it could take weeks, or even months, before symptoms of problems first appear in many cases.

Federal health officials have identified Exserohilum Rostratum as the fungus in the epidural steroid injections, which is a black mold that is known to attack plants that is associated with grass and rotting wood. Exserohilum is typically not known to cause illness in humans, and CDC officials describe the incubation period of this fungal infection as a “big question,” because of its unknown rate of progression.

According to the latest case count provided by the CDC, which was updated Sunday afternoon, the outbreak includes 285 confirmed cases identified in 16 different states. There are 282 cases of fungal meningitis or stroke caused by a presumed fungal meningitis, plus three cases of peripheral joint infections in the knee, hip shoulder or elbow. At least 23 people nationwide have died in connection with the outbreak.

Fungal Meningitis Risk May Extend More Than One Month

Many of the fungal meningitis infections identified so far have had an incubation period between two to four weeks; however, some cases have been even longer than that. Thus far, none of the cases are known to have extended beyond two months.

Investigators have only been able to confirm exact information regarding the dates of injection and onset of symptoms in 155 of the meningitis cases. A lack of information contributes to the question regarding the incubation period, along with many patients having had multiple injections of the steroid.

Additionally, joint infections in the elbows, knees, ankles, shoulders and hips may take much longer to develop than the fungal meningitis infections. Officials say the attack rate is low, citing the low infection rate of the nearly 14,000 patients estimated to have received the injections.

Officials believe that no patients received any spinal steroid injections past the recall on September 21, possibly extending the time frame for new cases through the end of November.

Nearly 97 percent of the 14,000 people estimated to have received the infected epidural steroid injection have been contacted and advised to watch for signs and symptoms of meningitis, according to the CDC.

For those who develop even minor symptoms of meningitis, such as headaches, experts have recommended that they get a spinal tap to determine if they are infected. They also recommend immediate treatment with Voriconazole, an anti-fungal, if spinal fluid testing shows an increased level of white blood cells.

Mounting Fungal Meningitis Lawsuits Over Outbreak

Amidst the rising number of confirmed infections, a growing number of people have filed a lawsuit over the fungal meningitis outbreak in courts throughout the country.

The lawsuits allege that NECC sold the contaminated drugs in connection with the outbreak, putting plaintiffs at risk of contracting meningitis.

Given the minimal assets and unknown insurance coverage available to satisfy the claims, some of the lawsuits have named individual executives of the compounding pharmacy, in an effort to attach their assets and pursue the individuals beyond the company and their holdings.

The NECC’s business license was revoked and operations of the Ameridose LLC, a related drug manufacturer, were shut down pending the investigation.