Meningitis outbreak spreads in US as number of confirmed infections hits 91

The number of people who have contracted a rare and deadly form of meningitis from a contaminated steroid injection has almost doubled over the weekend, according to the Centers for Disease Control and Prevention (CDC).

A total of seven people have now died of the illness, two of them between Friday and Saturday.

Hospitals and clinics have been alerted to contact patients who have received a spinal injection made by the New England Compounding Center (NECC) in Framingham, Massachusetts, to check them for possible symptoms of the illness. It is unclear how many could potentially be affected, but it could be thousands.

About 17,700 single-dose vials of the steroid were covered in the recall.

On Sunday, the CDC said there were now 91 confirmed cases, up 44 from Friday's total. The patients had received a shot of steroid for back pain, a common treatment.

It could be weeks before any of the patients, several of whom have had strokes related to the meningitis, are in the clear.

The rapidly spreading outbreak has re-ignited the debate over regulation of so-called compounding pharmacies, of which NECC was one, which mix batches of drugs on their own and have little federal oversight. While the FDA regulates manufacturers, compounders register as pharmacies, which are state regulated.

It has since emerged that the therapeutic advantages of spinal steroid injections for back pain are far from certain. The New York Times reported on Sunday that the Cochrane Collaboration, an international group of medical experts who reviewed the data last year, found "no strong evidence for or against" the injections, leaving open the possibility that many patients may have risked their health and lives for little gain.

Tom Carroll, a close friend of Eddie Lovelace, a judge from Kentucky who was one of the outbreak's first victims, questioned how the outbreak happened.

"This wasn't some obscure procedure being done in some obscure hospital," Carroll who is also the family lawyer, told the New York Times. "They had sought out a respected neurosurgeon who had been referred by their family doctor, at a respected hospital. How does this happen?"

Lovelace, 78, had been treated at St Thomas Outpatient Neurosurgery Center, one of scores of medical centres and clinics across 23 states that have received contaminated products.

There have been reports of several complaints against NECC and the FDA have confirmed that in 2006, they sent a warning letter over a string of health and safety violations included the misbranding of drugs and the copying of FDA-approved, commercially available products.

The company, which is now closed, said in a statement on Thursday that despite the FDA warning, "there is no indication of any potential issues with other products".

The steroid is known as preservative-free methylprednisolone acetate, which the compounding pharmacy creates by combining a powder with a liquid.

On Friday, the government released the names of about 75 facilities in 23 states that got recalled doses between July and September. But it is far from clear how many were sent to clinics, how many were used, or how many people who got one will get ill. Once a person is infected it can be up to a month before the symptoms appear.

Patsy Bivins, 68, a retired waitress from Sturgiss, Kentucky, is one of hundreds or even thousands who have been warned to look out for the tell-tale symptoms of a splitting headache, fever, stiff neck, difficulty walking or worsening back pain. Bivins, who was told she may be at risk but didn't need to be checked unless she developed symptoms, told the Associated Press on Friday: "Seems like there should be some way to tell it before you get the symptoms. Honestly, it makes me worse than I was."

The CDC has said the outbreak may have been cause by a steroid made by NECC, where inspectors found at least one sealed vial that was contaminated by a fungus. It's not yet clear how the fungus got into the steroid. But officials, who have not yet completed their investigations, have told health professionals not to use anything made by the pharmacy.

Tennessee remains the worst affected state, with 32 cases, including three deaths. Michigan has had 20 cases, including two deaths while Virginia has 18 cases, with one death. Other affected states are Florida, with four cases; Indiana, eight; Maryland, three including one death; Minnesota, three cases; North Carolina, two cases; and Ohio, one case.