There has been an outbreak of the deadly fungal meningitis disease in the US, affecting thousands of people with 16 people already dead. According to the website of the Center for Disease Control and Prevention (CDC), authorities are  gravely concerned with the sudden outbreak linked to pharmacy-distributed steroids.

The outbreak of fungal meningitis has been directly linked to steroids supplied by Massachusetts-based New England Compounding Center (NECC); the company has announced that it is proceeding with an “abundance of caution” because of the risk of contamination, although there is no evidence so far that any of its other products have been contaminated.

Meningitis is a rare disorder that evolves as a consequence of spreading fungus through the blood to the spinal cord. It is generally caused by the inflammation of protective membranes covering the brain and spinal cord called meninges. In other words it is swelling of edges or lining around spinal cord and brain.

Speculation tells us that injections distributed by NECC, called methylprednisolone acetate, used widely to nurse back pain, may have been cause of this clinical mayhem. Close to 13,000 people may have received the drug as part of their treatment. So far cases of meningitis have surfaced in Tennessee, Michigan, Pennsylvania, New Hampshire, Illinois, Indiana, Minnesota, New Jersey, Texas, Idaho, Maryland, North Carolina, Virginia, Ohio and Florida.

According to the CDC, more than 20 states have received the implicated drugs, and it has launched a multistate investigation to figure out the underlying cause of meningitis outbreak.

The CDC issued a cautionary call for patients who feel ill. They advise that anyone who is concerned about whether they received medication from the NECC should contact their physician. The CDC also issued clinician guidelines stating that physicians should contact patients who have been exposed. The CDC also warned that people with weaker immune systems, like those suffering from AIDS, are at greater risk of getting infected with fungal meningitis.

Dr Michael Carome, from a Washington based public advocacy group Public Citizen, said “Congress exempted drugs compounded by pharmacists from the usual safety and efficacy requirement.”

If speculation turns out to be true, and the cause of the outbreak is pharmacy miscalculation, then from broader perspective it is a regulatory loophole rather than clinical blunder.

David Miller, Chief Executive Officer at IACP, brought severity to the situation when he said that “this is not traditional compounding we’re talking about, it is multi-state selling and large-scale manufacturing.”

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Sixteen are confirmed dead and thirty are in isolation in Kagadi hospital from the well-known and terrifying virus, Ebola.

Ebola is a viral infection related to HIV that is characterized by fever, body aches, rash, abdominal pain, and in most case violent hemorrhaging (bleeding from body openings). Similar to HIV, Ebola is spread only through contact with bodily fluids. Death rates from previous outbreaks range from 50-90% and there is no known cure or treatment except to treat the symptoms. Knowledge of the virus was made popular by the book The Hot Zone which was later the basis of the film ‘Outbreak.’

Ebola was originally discovered in 1976 in the Democratic Republic of the Congo and is named after the Ebola River. Five strains, all named for regions, are known to exist: Zaire, Sudan, Cote d’Ivoire, Bundibugyo, Reston. This latest outbreak is the Sudan strain of the Ebola virus.

This outbreak has been centered in the Western region of Uganda and began in the city of Kibaale, about 100 miles from the capital, Kampala. The origin of the virus is unknown although the Kibaale Forest has a high concentration of monkeys and birds that are known transmitters of the disease.

The World Health Organization (WHO), United States Center for Disease Control and Prevention (CDC), Doctors Without Borders, and the Ugandan government are all working tirelessly to contain this outbreak. So far only two cases have been found far away from the original outbreak zone, one infected person was 200 miles outside of Kampala and had traveled from the area.

The other suspected case was in Eldoret, a large town in the Rift Valley in Kenya. Health officials are working on tracking down all 232 people who have had contact with the thirty individuals in isolation at the hospital and the sixteen who died originally.

Olimpia de la Rosa, the emergency coordinator for Doctors without Borders stated, “Right now there is no treatment for Ebola, so the most effective measure we can take is to contain the spread of the disease. That is why we need to start working immediately. Other cases need to be rapidly identified because containment is what can stop it.”

The thirty in isolation are currently only suspected to have the Ebola virus, although according to Dr. Dan Kyamanywa, at least three have been officially confirmed as having the virus.

Five of the thirty are prisoners from Kibaale prison and are showing the signs of vomiting, fever, and diarrhea. The rest of the cases will be verified when the blood samples return from the CDC labs in the US or the lab in Kampala (the only lab in Uganda capable of performing the analysis). Those with the virus – or just suspected to have it – are put in isolation and the medical personnel must wear many layers of protective gear.

Dr. Kyamanywa stated, “We do expect the number of suspected cases to increase. It’s important to break transmission and reduce the number of contacts that suspected cases have.”

According to the Ugandan Health Minister, Dr. Christine Ondoa, the outbreak initially went undetected because the patients only exhibited signs of fever and vomiting but no hemorrhaging, the most obvious symptom of the disease. The President of Uganda, Yoweri Museveni, has asked Ugandans to refrain from handshaking, kissing, using public transport, having casual sex, and do-it-yourself burials.

The Ugandan government has also suffered from a lack of supplies. According to health official Stephen Mfashingabo, “There was no money from the Health Ministry to fund activities since this outbreak was confirmed and there was also no food.”

Many Ugandans are terrified about the outbreak. In 2000 another Ebola outbreak occurred, infecting 425 and killing more than half. Market day on Wednesday, August 1 was cancelled and many residents in Uganda are scared to go shopping, visit churches and mosques, or travel. Tumusiime Jamilo, a reporter for a local Ugandan station reported, “Fears of catching Ebola have twisted people’s lives. They can’t go to the markets to buy things, [others can’t] sell their products and that’s hitting their pockets.”

The thirty in the hospital twelve were admitted very recently. It is still unknown how effective the prevention methods have been.

Image Courtesy of  uusc4all

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