"Doctors and patients will need to be vigilant for several months because fungal infections can be slow to develop. It may take one to four weeks or longer for patients to exhibit symptoms," New Jersey Health Commissioner Mary E. O'Dowd said in a statement.
The four residents being treated - none of them critical - by doctors at South Jersey Healthcare Regional Medical Center all live in Cumberland County. They received methylprednisolone acetate injections at one of two Vineland locations: Premier Orthopaedic Associates and the Regional Medical Center.
No illnesses have yet been linked to the only other locations in the tristate area known to have received shipments of the recalled steroid: South Jersey Healthcare Elmer Hospital in Salem County; four clinics in North Jersey; and two in southwestern Pennsylvania.
A total of 375 vials of tainted medication was received at the clinics in Altoona and Jefferson Hills, Pa., but about 20 percent had not been used by the time of the recall, a Pennsylvania Department of Health spokeswoman said Friday.
More than 99 percent of potentially affected patients have been contacted, she said. Less than 1 percent have been medically evaluated. Six patients have been referred for further testing to rule out meningitis, she said.
New Jersey officials said nearly all of the 634 residents who received the injections had been contacted.
A spokesman for South Jersey Healthcare, which has been evaluating patients who received the injections from its own hospitals and from Premier Orthopaedics, said Friday that 58 people had been referred for spinal taps to rule out meningitis.
One of the new cases the New Jersey Department of Health announced Friday was that of a 59-year-old man who received an injection on Sept. 12 at Premier and who was admitted to the medical center Tuesday with headaches and fever.
He, as well as the previously announced cases - two men, ages 70 and 57 - was being treated there with intravenous antifungal medication and was recovering.
The fourth case is a 52-year-old woman who received an injection in August at the medical center. She visited the emergency room on Tuesday with headaches and back and neck pain and is being closely monitored as an outpatient, the state Health Department said Friday.
The South Jersey Healthcare system's home health nurses are working with the Cumberland and Salem County Health Departments to make home visits to possibly affected patients who have not been reached by phone, officials in Trenton said. Those counties include large migrant-worker populations.
Symptoms include new or worsening headache; fever; neck stiffness; sensitivity to light; and redness, soreness, or swelling at the injection site. Nationally, some patients have also reported stroke symptoms, including localized weakness (on one side of the face, drooping face), numbness, or slurred speech.
Laboratory confirmation of fungal meningitis linked to the medication the Massachusetts pharmacy distributed can take time, and "presumptive" cases are treated medically as though they were confirmed.
As of Wednesday, the CDC's fungal disease laboratory had confirmed the presence of the fungus Exserohilum in 10 people with meningitis and the fungus Aspergillus in one, the agency said Friday.
Contact Don Sapatkin at 215-854-2617 or firstname.lastname@example.org.