| NEW YORK
NEW YORK Oct 24 U.S. doctors monitoring
patients for signs of fungal meningitis can consider performing
spinal taps, possibly weekly, on some of those who received
contaminated steroid injections, even if they show no symptoms,
health officials said on Wednesday.
The revised guidelines from the U.S. Centers for Disease
Control and Prevention reflect concern that the last groups of
patients who received the steroid may be at a higher risk of
The recommendation took some physicians by surprise.
"Are we going to do spinal taps on thousands of people once
a week?" asked Dr. Gary Simon, chief of infectious diseases at
George Washington School of Medicine. "I think that deserves
Twenty-four people have died and 312 have been infected
after being treated with methylprednisolone acetate produced by
the New England Compounding Center in Massachusetts, CDC
said. As many as 14,000 people may have been
exposed to the steroid before the product was recalled in late
Previously, the CDC had advised doctors to perform a spinal
tap, which can be painful and poses its own risks, only on
patients who had shown symptoms of meningitis, which include
worsening headache, fever, sensitivity to light, stiff neck, and
On Wednesday, the CDC said doctors should consider
performing a spinal tap on patients who received a steroid shot
less than 42 days ago, since mathematical modeling shows that
people exposed to the contaminated drug within that time are at
greatest risk of developing meningitis. The agency said close
monitoring without a spinal tap remains an equally valid option.
HOPING THE WORST IS OVER
The spinal tap on asymptomatic patients would reduce the
risk of death or stroke from fungal meningitis from an estimated
0.4 percent to 0.3 percent compared with monitoring for symptoms
alone, CDC said.
"The different risks with monitoring or tapping is pretty
minimal," said Dr. Carol Kauffman, chief of infectious disease
at VA Ann Arbor Healthcare System and one of six outside
physicians advising CDC on the fungal meningitis cases. "But if
you're one of those patients, even that small difference might
make a difference to you."
The CDC still warns doctors not to give antifungal
medications as a preventive measure, since the powerful drugs
can cause severe side effects, including kidney and liver
The CDC calculates that the risk of developing meningitis
from the contaminated steroid is now less than 5 percent for all
patients, and less than 1 percent for anyone who received an
injection at least 42 days ago.
In Tennessee, the state where the outbreak was first
identified and which has since seen the highest number of
cases, health officials expressed hope that the
worst of the outbreak may have passed.
"Within 15 days, patients in Tennessee will have passed the
42-day mark," said Dr. John Dreyzehner, commissioner of the
Tennessee Department of Health. "This is the light at the end of
A government source familiar with the situation said that
the revised CDC guidance reflected a desire to offer something
to the "worried well," people who received injections from the
tainted lots and are psychologically distraught by the
uncertainty of whether they will become ill.
The revised guidance essentially gives their doctors the
go-ahead to perform a spinal tap.
With a spinal tap that detects the fungus before the patient
shows symptoms of meningitis, "you might pick up one or two
days," George Washington University's Simon said. "But a day or
two of lead time could make a difference."