Update: Tennessee Department of Health and CDC Investigating Meningitis Cases

Meningitis Teleconference Media briefing - October 3, 2012

Statement from Tennessee Health Commissioner John Dreyzehner, MD, MPH, FACOEM

Good afternoon. Again, before we begin our press briefing today, we want to extend our sympathy to the patients and their families impacted by this tragic situation.

We want to thank all the health and medical professionals working cooperatively in both the investigation of this outbreak and in the continuing care of patients.  From individuals working in emergency rooms and hospitals, to diagnostic experts in offices, we’re received astounding cooperation and assistance.

We also want to thank the media for your efforts to provide accurate, timely information to the general public.  That has been an important element in our efforts to rapidly disseminate information to key audiences.

• Five new cases in TN have been confirmed in the last 24 hours bringing the total to18 total cases in TN with no additional deaths
  • One of the new cases received an ESI at the Specialty Surgery Center in Crossville, TN
  • One of the new cases had steroid medication from a second lot of methylprednisolone acetate, the material of greatest interest
  • In addition to the two clinics previously reported, PCA Pain Care Center in Oak Ridge received some of the newly identified lot. They were contacted last week as a precautionary measure and have assessed their patients. No cases have been identified from the PCA Pain Care Center in Oak Ridge.

• Two patients have fungi seen in biopsy samples, consistent with Aspergillus
  • This is in addition to the patient already reported with confirmed Aspergillus fumigatus meningitis
  • This is stronger evidence for the fungal nature of these cases
• As you have been reporting, the type of meningitis we are dealing with in this situation is NOT communicable from person to person.

Just prior to this call, the Tennessee Department of Health issued information via the statewide Tennessee Health Alert Network.  In that alert, we have notified medical professionals the prime suspect for this meningitis outbreak is methylprednisolone acetate and we identified the Compounding Center involved.

With recent analysis of information pertaining to lots of materials from this center, we believe it is important to make the medical community aware of the supplier.  We expect our partners with the CDC and the FDA to provide this information to a broader national audience soon. 

We have broadened the window of time backward from the July 30 2012 provided earlier, to July 1 2012.  Based on our mission to protect people in Tennessee, we feel it is important to be appropriately cautious in expanding the time window to identify others who may have been affected. Note that no new cases are presently in the expanded window.  We are casting a wider net as a precaution.

Again, this is an evolving situation with data and materials being continuously reviewed. 

• Additional potential cases are currently being evaluated
• While we are closer to identifying the cause, we have not concluded there is only one factor at this time. We continue to evaluate all possible factors.

We would like to reinforce that each of the three clinics in Tennessee has been fully cooperative.  Additionally, many clinicians have helped to identify and treat patients potentially impacted by this outbreak. We greatly appreciate all of the cooperation and assistance.

We would like to reassure everyone that this outbreak has no relationship to other cases of bacterial or viral meningitis recently occurring in Tennessee.

• Women who receive epidurals during delivery have no reason to be concerned about this cluster of cases.

I will now provide some of the information we have regarding the first 12 meningitis cases we identified.  They range in age from 49 to 89 years of age. Nine of the first 12 were female.  We can’t provide more information to the general public about specific individuals due to privacy concerns, but we will continue to provide aggregate data as it becomes available.

It’s important to talk about symptoms.  For this type of meningitis, those include worsening to severe headache, nausea, dizziness and fevers.  Other symptoms can include slurred speech, unsteady gait, urinary retention, weakness, sensory deficit.  Some of these conditions may exist in some older patients already, so we want clinicians to have a heightened index of suspicion for patients who may have received epidural steroid injections from any of the three clinics in Tennessee from July 1 to Sept. 28.

For those of you who have been following this investigation for a few days, we appreciate your understanding as we move as quickly as we can. We are committed to transparency -- and providing information that is accurate and timely without compromising the investigation.  The involved clinics and centers, all hospitals providing follow-up care, and other health and medical practitioners have literally – not figuratively – been working around the clock in this investigation. 

This is a complex situation, and points out the importance of good communication. TDH is grateful for the assistance and cooperation it has received from the CDC, the FDA and other state Health Departments.

Tomorrow we will hold a press briefing via conference call, at 1:00 p.m., using the same number.  CDC staff will continue to assist with questions from any reporter wanting information that TDH cannot provide.  Thank you.