Public health system response vital during fungal meningitis outbreak

Last year’s public health system response to the largest healthcare-associated fungal meningitis outbreak in U.S. history highlighted the importance of the system at local, state, and federal levels, according to an editorial published online at the end of January by the Journal of the American Medical Association.

Clinical and public health professionals were key in detecting and responding to this outbreak, which resulted in 46 deaths and affected more than 700 patients who received injections of contaminated methylprednisolone acetate produced by the New England Compounding Center (NECC), Framingham, Mass.

“Effectively responding to this catastrophic event required rapid actions by clinical and public health practitioners who worked to ensure discontinued use of the suspect medication, notify at-risk patients and their physicians, and decipher the many unknowns about the outbreak to provide the best guidance,” wrote Beth P. Bell, MD, MPH, and Rima F. Khabbaz, MD, staffers at the Centers for Disease Control and Prevention (CDC).

The system in action

After receiving information from a clinician about the treatment of an unusual case of meningitis, the Tennessee Department of Health alerted the CDC, which promptly contacted state and local health departments about the problem. Within a few days, the source of the outbreak was identified - contaminated methylprednisolone acetate injections for pain relief from NECC - and almost 14,000 patients and their physicians were contacted in 23 states about potential exposure to the pathogen.

Laboratory scientists at the CDC identified the predominant pathogen as Exserohilum rostratum, a fungus that rarely affects humans. An assay to detect the pathogen in cerebrospinal fluid was developed in two days. CDC and FDA worked together to identify the pathogens in the NECC contaminated vials, testing more than 800 samples from 26 states.

“CDC sent regular updates to more than 240 clinical and professional organizations; held clinician conference calls including more than 5000 participants; partnered with Medscape to release a clinical video, which was viewed nearly 40,000 times; and released multiple health advisories through its Health Alert Network,” Bell and Khabbaz said.

More resources needed

However, the authors wrote, U.S. health systems are still vulnerable, despite the excellent response to this outbreak. In the last 5 years, more than 45,000 jobs have been eliminated at the state and local levels in health departments, with greater need for funding from the CDC to keep infectious disease programs viable.

“Clearly, an important lesson from this outbreak is the critical need for strong and sustained public health systems engaged with their many essential partners,” Bell and Khabbaz concluded.