title: Estimated deaths and illnesses averted during fungal meningitis outbreak associated with contaminated steroid injections, United States, 2012-2013.
abstract: During 2012-2013, the US Centers for Disease Control and Prevention and partners responded to a multistate outbreak of fungal infections linked to methylprednisolone acetate (MPA) injections produced by a compounding pharmacy. We evaluated the effects of public health actions on the scope of this outbreak. A comparison of 60-day case-fatality rates and clinical characteristics of patients given a diagnosis on or before October 4, the date the outbreak was widely publicized, with those of patients given a diagnosis after October 4 showed that an estimated 3,150 MPA injections, 153 cases of meningitis or stroke, and 124 deaths were averted. Compared with diagnosis after October 4, diagnosis on or before October 4 was significantly associated with a higher 60-day case-fatality rate (28% vs. 5%; p<0.0001). Aggressive public health action resulted in a substantially reduced estimated number of persons affected by this outbreak and improved survival of affected patients.
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Smith
authors.forename: Gordana
authors.initials: G
authors.lastname: Derado
authors.forename: Matthew
authors.initials: M
authors.lastname: Wise
authors.forename: Julie R
authors.initials: JR
authors.lastname: Harris
authors.forename: Tom
authors.initials: T
authors.lastname: Chiller
authors.forename: Martin I
authors.initials: MI
authors.lastname: Meltzer
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Park
mesh_terms: D004196:Disease Outbreaks; D004340:Drug Contamination; D005260:Female; D049674:History, 21st Century; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D016921:Meningitis, Fungal / Q000453:epidemiology* / Q000266:history / Q000401:mortality / Q000635:transmission*; D009026:Mortality; D011634:Public Health; D062486:Public Health Surveillance; D013256:Steroids / Q000008:administration & dosage*; D014481:United States / Q000453:epidemiology
chemical_list: D013256:Steroids
keywords: Meningitis; United States; contaminated steroid injections; deaths; disease modeling; disease outbreaks; fungal; fungi; illness; public health response