Alarming Rise in Deaths Due to Steroid Epidural Injections

If you’re a doctor or medical provider who is treating patients for backache with steroid epidural injections, you’ve got to be alarmed over the steady rise of meningitis outbreaks—now approaching 100 in nine states nationwide. Eight people have already lost their lives and hundreds more could be affected. Several patients also suffered strokes that may have resulted from their infection.

As recently reported in USA Today, the tainted steroid, produced by New England Compounding Center was recalled Sept. 26. Unfortunately, about 17,700 vials of the steroids were shipped to 75 clinics in 23 states where patients have already been injected.

The Centers for Disease Control and Prevention warned clinicians to actively contact patients who received potentially contaminated injections starting May 21, 2012. The suspect medicines are associated with three lots of preservative-free methylprednisolone acetate (80mg/ml). Aspergillus, the fungus blamed for the outbreak is airborne and often found in leaf mold, according to William Schaffner, an infectious disease expert at the Vanderbilt University School of Medicine in Nashville.

"All patients who may have received these medications need to be tracked down immediately," said Benjamin Park, medical officer, at the CDC's mycotic diseases branch. "It is possible that if patients with infection are identified soon and put on appropriate anti-fungal therapy, lives may be saved." 

Healthcare providers and patients have been alerted to look for symptoms of the infection, including fever, new or worsening headache, neck stiffness, sensitivity to light, new weakness or numbness, increasing pain, redness or swelling of the injection site. These symptoms generally appear from 1 to 4 weeks after patients have been injected. Not all patients who received the medicine will become sick.

While claiming that none of its other products have been contaminated, The New England Compounding Center recalled all of its products as a precautionary measure. The Food and Drug Administration had previously told health professionals not to use any of the center's distributed products, and health officials said they found foreign material in other products produced by the center.

Anders Cohen, chief of neurosurgery and spine surgery at the Brooklyn Hospital Center in New York, advises patients to wait until the CDC's investigation is completed before getting steroid injections. The tainted steroids "are such a potential health hazard for patients because the medication is site specific, delivered to the spinal canal, and nerves in the spinal cord," said Cohen.

Cohen indicated that this outbreak underscores the stress in the pharmaceutical industry, which is under pressure to produce volumes of certain medications. Companies unable to keep up with demand will outsource production and rely on compounding pharmacies, which make their own medications from basic ingredients. Compounding companies can side-step the stringent regulatory guidelines that govern pharmaceutical companies.

If you’re a healthcare professional, you should advise patients about getting these steroid shots. Some healthcare providers are recommending patients wait; others suggest patients consider taking oral pain medications.

Photo courtesy of MorgueFile.com