Health Workers Reduced Illnesses from Fungal Meningitis Outbreak: Report

A new editorial examines the response by public health workers, local and national, to the recent fungal meningitis outbreak, indicating that first responders helped to decrease the number of illnesses and highlighting the importance of “strong and sustained public health systems with their many essential partners.”

Published online last week by the Journal of the American Medical Association, the editorial examined the response to the recent national outbreak of fungal meningitis linked to contaminated epidural steroid injections mixed at one compounding pharmacy.

The outbreak was the largest health care-associated fungal infection outbreak reported in the United States, reaching nearly 700 cases and 45 deaths, according to the U.S. Centers for Disease Control and Prevention (CDC).

In the editorial, co-authors Beth P. Bell, MD, and Rima F. Khabbaz, MD, focus on the impact local and state clinical and public health practitioners made in rapid detection, response and treatment. The essay champions the Tennessee Department of Health (TDOH) for responding to the initial clinician alert, asking appropriate questions about patient exposure to the unusual form of meningitis and contacted the health department quickly.

In addition, the editorial outlines the quick response by the CDC and rapid communication with TDOH to identify the source of the infection, methylprednisolone injections from the New England Compounding Center (NECC) in Framingham, Mass. The corticosteroid is often injected directly into the spine to relieve back pain and treat inflammation.

The effort to contact nearly 14,000 potentially exposed patients and physicians across 23 states and recall more than 17,000 distributed shots also played an important role in preventing wider spread of the outbreak. The quick execution of this monumental task among other rapid responses and focused communication is what allowed for early detection and response to the outbreak.

During the outbreak crisis period, the CDC quickly identified the fungal organism, Exserohilum rostratum, and identified methods of detecting the organism, which rarely affects humans, through testing of the cerebrospinal fluid. The information was quickly communicated to state and local hospitals. The use of this information aided the FDA in mobilizing support at the state health department and clinical labs to test more than 800 specimens within 26 states to determine infection.

Communication Key in Mitigating Outbreak Effects

Outside of testing, communication played a key role in informing the many required parties of pertinent information through conference calls involving more than 5,000 participants, creation and dissemination of clinical videos and regular updates. The CDC meningitis outbreak pages were accessed more than 1 million times alone.

Amid the testing, prevention and treatment efforts, nearly 700 cases of fungal meningitis have been confirmed resulting in 45 deaths as lawsuits continue to mount across the country in local and state courts against the NECC.

In spite of the high number of deaths linked to the outbreak, the collaborative public health preparedness efforts of local and state health departments coupled with efficient communication helped to dramatically reduce the 30-day case fatality rate.

“Beyond highlighting issues surrounding safe compounding practices, the outbreak also reminds us that despite our prevention efforts everyday systems malfunction and cause harm, new infections emerge, and unforeseen illnesses arise,” wrote Bell.

The editorial also noted several issues of weakness surrounding the response to the outbreak, such as a need to modernize public health systems with the best available technology and the recent reduction of nearly 45,000 jobs in local health departments causing greater reliance on the CDC for funding and support for infectious disease programs.