Dr. Rachel Smith was immediately concerned when she got a call last September from the Tennessee Department of Public Health informing her that a patient at a pain clinic there had a very rare type of fungal meningitis. A fungal diseases expert with the Centers for Disease Control and Prevention (CDC), Smith first speculated that the infection might be caused by unsterile needles at the clinic where the patient was treated. Investigators quickly deduced that the source of the contamination was steroid shots given for back or neck pain.
It was the first clue Smith had that a national emergency was brewing, and researchers would have to act quickly in order to save lives.
The next step after identifying the suspect shots, which were made by New England Compounding Center (NECC), was to contact all the pain clinics that had received the injections. CDC representatives asked the clinics to be on the lookout for patients who developed symptoms of meningitis – headache, fever, pain at the injection site.
It proved challenging at times, with Smith having to leave multiple voicemails and messages at pain clinics across the country. When a clinic in North Carolina responded that they had a patient with puzzling symptoms who had received steroid shots, Smith said they realized the gravity of the situation.
Smith was immediately suspicious when she learned the shots were made by a compounding pharmacy. “Compounding pharmacies and compounded products had been the source of other outbreaks,” she told NBC News. “When we saw this drug had been compounded we were at little more worried about it.”
Compounding pharmacies take drug ingredients and mix them according to doctors’ orders. The drug ingredients are first approved by the Food and Drug Administration (FDA), however the agency does not regulate compounding pharmacies. They are overseen by state pharmacy boards.
The CDC and the public health system worked quickly to identify the affected lots, notify medical professionals and launch an investigation. To date, 620 people have become infected with fungal infections including meningitis. Thirty-nine have died.
Still, regulators say the outbreak could have been much worse had public health officials and the CDC not been so diligent in finding the source of the problem. Previous fungal outbreaks have had death tolls around 40 percent. The current fungal outbreak, in which 14,000 people were exposed, has killed only 6 percent of those infected.
Source: NBC News