Federal health officials say the death toll in an outbreak of meningitis has risen to seven, with more than 60 people sickened in nine states. The outbreak has been been linked to a steroid used in epidural injections to control back pain.
Ohio and Minnesota reported their first cases Saturday, joining Michigan, Tennessee, Virginia, Indiana, Florida, Maryland and North Carolina on the list of impacted states.
Meningitis is an inflammation of the spinal cord, usually caused by bacteria or viruses.
The steroid — methylprednisolone acetate – has been recalled by its manufacturer, the New England Compounding Center in Framingham, Massachusetts. Federal inspectors found fungus in an unopened vial during an inspection at the company’s plant. Tests are underway to determine the exact type of fungus and if it is related to the meningitis outbreak.
The Centers for Disease Control and Prevention says 75 pain clinics in 23 states are known to have received shipments of methylprednisolone acetate from the pharmacy. The CDC and the Food and Drug Administration are advising doctors to avoid all products made by the company.
Meanwhile, the American Academy of Pain Medicine released a statement urging anyone who has been treated with spinal injections for back pain within the last four weeks to contact their doctor if they have symptoms such as a fever, headache, nausea or neurological problems.
“We urge patients who have received these treatments to err on the side of caution if they have new or worsening symptoms since their injection. They should contact the medical expert, health clinic or hospital where they received their injection, even if the symptoms are very mild in nature,” said Dr. Martin Grabois, President of the Academy
This form of meningitis is not contagious and does not appear related to the spinal procedure involved. However, the outbreak is bringing new attention to epidural steroid injections, which are increasingly being used to control back pain. Critics say spinal injections are too often performed by untrained personnel and in unsanitary conditions that can lead to complications.
This week two medical associations, the American Society of Interventional Pain Physicians (ASIPP) and the North American Neuromodulation Society, announced their opposition to plans by Medicare & Medicaid Services (CMS) to allow nurse anesthetists to receive coverage for epidural steroid injections and other interventional treatments for chronic pain.
“This disregard to the education, board certifications, and training of medical physicians will be detrimental to patients, causing undue hardship and putting an increased financial burden on the healthcare system as poor results proliferate,” said Dr. Laxmaiah Manchikanti, chair and CEO of the ASIPP. “CMS is in essence saying that it doesn’t matter who performs these treatments – ‘no training required.'”
Manchikanti said nurses should not be allowed to diagnose complex conditions, order expensive tests or provide complex treatment for a field of medicine in which they have no formal training.