Updated case definition information.

Updated with additional questions and answers.

Added a Spanish version of Frequently Asked Questions For Patients: Multistate Meningitis Outbreak Investigation.

COCA Email Updates: September 24 - October 8, 2012

At this time, CDC does not recommend initiation of antifungal prophylaxis in exposed patients who are asymptomatic. These patients should be closely monitored for development of symptoms, with a low threshold for performing lumbar puncture should the patient become symptomatic. In addition, CDC does not recommend empiric antifungal therapy for symptomatic patients who have normal cerebrospinal fluid laboratory examination. These patients should be closely monitored and re-evaluated should their symptoms. Should the patient have progression of symptoms, a lumbar puncture should be repeated immediately.

Related links for specific audiences were added to the Meningitis Outbreak Investigation home page.

The Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) continue to work closely with state public health departments on a multistate investigation of fungal meningitis among patients who received an epidural steroid injection. These cases are associated with a potentially contaminated steroid medication prepared by New England Compounding Center (NECC), located in Framingham, Mass. During this COCA Call, CDC subject matter experts will review current epidemiology of the outbreak, describe clinical presentation and features of fungal meningitis, and review CDC's recommended treatment guidance.

Current Situation section has been updated.

Clinician Guidance has been updated.

Addition of new link to CDC Health Alert Network (HAN) - Multistate Outbreak of Meningitis and Stroke Associated with Potentially Contaminated Steroid Medication

Persons with Meningitis Linked to Epidural Steroid Injections, by State

At this time, CDC does not recommend initiation of antifungal prophylaxis in exposed patients who are asymptomatic. These patients should be closely monitored for development of symptoms, with a low threshold for performing lumbar puncture should the patient become symptomatic. In addition, CDC does not recommend empiric antifungal therapy for symptomatic patients who have normal cerebrospinal fluid laboratory examination. These patients should be closely monitored and re-evaluated should their symptoms worsen.

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Added the following information: All vials of Methylprednisolone Acetate that were sent to Nevada were recalled prior to use.

Instructions for Clinical Teams Regarding Diagnostic Testing and Specimen Submission to CDC - utbreak Associated With Injection of Potentially Contaminated Steroid Products

The Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) continue to work closely with state public health departments on a multistate investigation of fungal meningitis among patients who received an epidural steroid injection. Some of these patients also suffered strokes that may have resulted from their infection. These cases are associated with a potentially contaminated steroid medication prepared by New England Compounding Center (NECC), located in Framingham, Mass. This HAN notice provides updated information about the investigation (including a change in the case definition*), laboratory findings, an expanded voluntary recall of products, and recommendations for clinicians.

FAQs for Patients: Multistate Meningitis Outbreak Investigation

CDC is coordinating a multistate investigation of meningitis among patients who received epidural steroid injections (medication injected into the spine). Several of these patients have had strokes related to the meningitis. In several patients, the meningitis was found to be caused by a fungus that is common in the environment but rarely causes meningitis. This form of meningitis is not contagious. The source of the fungus has not yet been identified, and the cause of infections in the other patients is still being assessed.

Persons with Meningitis Linked to Epidural Steroid Injections, by State

Instructions for Clinical Teams Regarding Diagnostic Testing and Specimen Submission to CDC - Outbreak Associated With Injection of Potentially Contaminated Steroid Products