The outbreak has been tied to a popular epidural medication used to relieve back pain that originated at a specialty pharmacy in Massachusetts. The company suspended operations last week and recalled all its products, including 17,676 potentially tainted vials of steroid sold to 75 hospitals and clinics in 23 states.
About 13,000 people received epidural injections of methylprednisolone acetate from those vials between May 21 and Sept. 26, the day after the voluntary recall, according to the Centers for Disease Control and Prevention. Symptoms of fungal meningitis take one to four weeks to appear, the CDC said.
"Most will not get sick," spokesman Curtis Allen said. But the agency expects more infections.
Fungal meningitis - a fungus infection that inflames the protective membranes of the brain and spinal cord - is rare. The precise source still has not been determined, although it has clearly been linked to the steroid.
It cannot be spread from person to person. As with outbreaks of infectious food-borne pathogens such as salmonella, however, the urgent task of protecting the population falls to a public health infrastructure, mainly government but with crucial help from industry, that is invisible most of the time.
Federal agencies typically get the credit - and, more often, the blame - for how outbreaks are managed. But they rely on local reporting at both ends: to spot patterns of infection and, once patterns have been established, to find people who may be at risk.
In the current outbreak, the New England Compounding Center of Framingham, Mass., the specialty pharmacy, began a voluntary recall on Sept. 25. The pharmacist at South Jersey Healthcare Regional Medical Center in Vineland got a call from the company between 2 and 3 a.m. the next day, said Paul Simon, a spokesman for South Jersey Healthcare.
Vials from the contaminated lots at the Vineland medical center and its sibling, Elmer Hospital, were immediately set aside, he said. That same day, the health system combed its records and identified 124 patients who had received the medication. Seventy of those had gotten the injections as an epidural, into the sleeve surrounding the spinal cord, where an infection can become systemic; infections in other areas would likely remain localized.
Meanwhile, federal health officials and other researchers were trying to determine the extent of the risk and how broad an action to take. They do this balancing act all the time, but it becomes known only in highly publicized cases, such as when health officials were widely criticized for initially overestimating the danger in the H1N1 flu pandemic three years ago.
Last Tuesday, hospital systems throughout New Jersey, where six clinics were known to have received the recalled steroid, were alerted by the state Department of Health to be on the lookout for patients showing symptoms of fungal meningitis. Those can include fever, new or worsening headache, neck stiffness, sensitivity to light, new weakness or numbness, increasing pain, and redness or swelling of the epidural injection site.
On Thursday, hospitals and clinics were advised to contact all patients who had received the steroid. With the list already compiled, said Simon, South Jersey Healthcare had called - although not necessarily reached - everyone on the list by noon Friday. Hospital and county health department nurses then started visiting homes.
By Tuesday afternoon, 123 patients had been reached, said Simon, and county health workers had left a note on the door of the 124th.
The health system ran daily clinics beginning Friday to evaluate people who had gotten injections. Through Tuesday, 102 patients - including some who had gotten the shots elsewhere - had been seen, and 17 of them were referred to testing to rule out meningitis.
The man who was hospitalized had received an injection at Premier Orthopedics on Sept. 26, before the Vineland practice was notified of the recall, state Health Department spokeswoman Donna Leusner said.
He went to the hospital complaining of headaches and a fever Thursday and was admitted Saturday. He is recovering.
Health Commissioner Mary E. O'Dowd said in a statement that nearly all of the state's roughly 650 patients at risk from injections at six clinics - four of them in North Jersey - have been notified.
Two clinics in Pennsylvania - in Altoona and Jefferson Hills - also received tainted lots. No fungal infections have been identified there.
Contact Don Sapatkin at 215-854-2617 or firstname.lastname@example.org.