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Hundreds seen at risk in meningitis outbreak

A sign on the door to the New England Compounding Center requests no soliciting at the Framingham, Mass. company, Wednesday Oct. 3, 2012. An outbreak of a rare and deadly form of meningitis has now sickened 26 people in five states who received steroid injections mostly for back pain, health officials said Wednesday. The Food and Drug Administration identified the maker of the steroid as New England Compounding Center, a specialty pharmacy. (AP Photo/Bob Salsberg)

A sign on the door to the New England Compounding Center requests no soliciting at the Framingham, Mass. company, Wednesday Oct. 3, 2012. An outbreak of a rare and deadly form of meningitis has now sickened 26 people in five states who received steroid injections mostly for back pain, health officials said Wednesday. The Food and Drug Administration identified the maker of the steroid as New England Compounding Center, a specialty pharmacy. (AP Photo/Bob Salsberg)

A sign marks an entrance to Saint Thomas Hospital medical campus in Nashville, Tenn., on Wednesday, Oct. 3, 2012. An outbreak of a rare and deadly form of meningitis that has sickened more than two dozen people was first detected among patients treated at the Saint Thomas Outpatient Neurosurgery Center in the complex. (AP Photo/Erik Schelzig)

In this Tuesday, Oct. 2, 2012 photo, Dr. David Reagan, chief medical officer for the Tennessee Department of Health, right, and Dr. Marion Kayiner, also with the state health department tell local and national media about an outbreak of fungal meningitis infections that have already killed two and sickened 13 others in Nashville, Tenn. (AP Photo/The Tennessean, Shelley Mays) NO SALES

A sign in front of the Waverly Business Center lists the New England Compounding and other business in Framingham, Mass., Wednesday Oct. 3, 2012. An outbreak of a rare and deadly form of meningitis has now sickened 26 people in five states who received steroid injections mostly for back pain, health officials said Wednesday. The Food and Drug Administration identified the maker of the steroid as New England Compounding Center, a specialty pharmacy. (AP Photo/Marshall Wolff, The MetroWest Daily News)

In this Tuesday, Oct. 2, 2012 photo, Dr. David Reagan, chief medical officer for the Tennessee Department of Health,center, and Dr. Marion Kayiner talks with local and national media about an outbreak of fungal meningitis infections that have already killed two and sickened 13 others in Nashville, Tenn. (AP Photo/The Tennessean, Shelley Mays) NO SALES

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NEW YORK (AP) — The potential scope of the meningitis outbreak that has killed at least five people widened dramatically Thursday as health officials warned that hundreds, perhaps thousands, of patients who got steroid back injections in 23 states could be at risk.

Clinics and medical centers rushed to contact patients who may have received the apparently fungus-contaminated shots. And the Food and Drug Administration urged doctors not to use any products at all from the Massachusetts pharmacy that supplied the suspect steroid solution.

It is not clear how many patients received tainted injections, or even whether everyone who got one will get sick.

So far, 35 people in six states — Tennessee, Virginia, Maryland, Florida, North Carolina and Indiana — have contracted fungal meningitis, and five of them have died. All had received steroid shots for back pain, a highly common treatment.

In an alarming indication the outbreak could get a lot bigger, Massachusetts health officials said the pharmacy involved, the New England Compounding Center of Framingham, Mass., has recalled three lots consisting of a total of 17,676 single-dose vials of the steroid, preservative-free methylprednisolone acetate.

An unknown number of those vials reached 75 clinics and other facilities in 23 states between July and September, federal health officials said. Several hundred of the vials, maybe more, have been returned unused, one Massachusetts official said.

But many other vials were used. At one clinic in Evansville, Ind., more than 500 patients got shots from the suspect lots, officials said. At two clinics in Tennessee, more than 900 patients — perhaps many more — did.

The investigation began about two weeks ago after a case was diagnosed in Tennessee. The time from infection to onset of symptoms is anywhere from a few days to a month, so the number of people stricken could rise.

Investigators this week found contamination in a sealed vial of the steroid at the New England company, according to FDA officials. Tests are under way to determine if it is the same fungus blamed in the outbreak.

The company has shut down operations and said it is working with regulators to identify the source of the infection.

“Out of an abundance of caution, we advise all health care practitioners not to use any product” from the company, said Ilisa Bernstein, director of compliance for the FDA’s Center for Drug Evaluation and Research.

Tennessee has by far the most cases with 25, including three deaths. Deaths have also been reported in Virginia and Maryland.

Meningitis is an inflammation of the lining of the brain and spinal cord. Symptoms include severe and worsening headache, nausea, dizziness and fever.

The type of fungal meningitis involved is not contagious like the more common forms. It is caused by a fungus often found in leaf mold and is treated with high-dose antifungal medications, usually given intravenously in a hospital.

Robert Cherry, 71, a patient who received a steroid shot at a clinic in Berlin, Md., about a month ago, went back Thursday morning after hearing it had received some of the tainted medicine.

“So far, I haven’t had any symptoms … but I just wanted to double check with them,” Cherry said. “They told me to check my temperature and if I have any symptoms, I should report straight to the emergency room, and that’s what I’ll do.”

The New England company is what is known as a compounding pharmacy. These pharmacies custom-mix solutions, creams and other medications that generally aren’t commercially available in the form or the dose required.

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Associated Press writers Travis Loller in Nashville and Randall Chase in Wilmington, Del., and AP chief medical writer Marilynn Marchione in Milwaukee contributed to this story.

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Online:

http://www.cdc.gov/meningitis/fungal.html

Associated Press

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