UPDATE 2-Number of U.S. meningitis cases rises to 49 in deadly outbreak

* Vials of steroids linked to outbreak sent to 23 states

* Doctor urges that recipients be tracked down immediately

(Updates with national total rising, CDC, doctor quotes)

By Tim Ghianni

NASHVILLE, Tenn., Oct 5 (Reuters) - The number of peoplestricken with a rare form of meningitis linked to steroidinjections rose to 49 in seven U.S. states, authorities said onFriday, in a widening outbreak that has killed at least fivepeople.

Michigan said it had confirmed six cases of fungalmeningitis, the seventh state to report people falling ill afterreceiving the injections, mainly for back pain.

Other states with cases are Tennessee, Virginia, Florida,Maryland, North Carolina and Indiana.

The U.S. Centers for Disease Control reported 47 cases ofmeningitis on Friday, while Michigan reported an additional twocases not included in the CDC count. That brought the nationaltotal to 49, compared with 35 on Thursday.

Tennessee accounts for most of those, and state officialssaid on Friday the number there had risen to 29 cases, up fourfrom Thursday. While there were no more deaths reported onFriday, Tennessee officials said on Thursday there were morepatients in critical condition in intensive care.

Three of the deaths so far have been in Tennessee, where theoutbreak began, and one each in Virginia and Maryland.

Vials of steroids linked to the outbreak were shipped toabout 75 facilities in 23 states and could have been used toinject thousands of patients, authorities have said.

"All patients who may have received these medications needto be tracked down immediately," Dr. Benjamin Park, a medicalofficer in the CDC Mycotic Diseases Branch, said on Friday in astatement. "It is possible that if patients with infection areidentified soon and put on appropriate antifungal therapy, livesmay be saved."

While fungal meningitis is rare and life-threatening, it isnot spread by person-to-person contact.

The infected patients have shown a variety of symptoms fromone to four weeks after their injections, including fever, a newor worsening headache, nausea and neurological problems thatwould be consistent with deep brain stroke, the CDC said.

All the cases have so far been traced to three lots of thesteroid prepared at New England Compounding Center Inc inFramingham, Massachusetts. The company said it had suspended itsoperations while the investigation proceeds.


The Massachusetts Health Department said there were 17,676vials of medication in each of the three lots ofmethylprednisolone acetate sent out July through September andhave a shelf life of 180 days.

Dr. Anders Cohen, chief of neurosurgery and spine surgery atthe Brooklyn Hospital Center in New York, said patients withback pain should wait to have steroid injections until the CDCconfirms all the tainted lots are off the market.

"In the meantime, they can ask their physicians about otheralternatives such as oral pain medications," Cohen said.

The CDC said it had not yet determined the rate of infectionamong patients who received the potentially tainted steroid. Therate of infection is important because it would help pinpointthe scope of the potential outbreak.

In addition to Tennessee and Michigan, six cases have beenreported in Virginia, two in Florida, two in Maryland, one inNorth Carolina and three in Indiana, the CDC said.

The steroid was sent to California, Connecticut, Florida,Georgia, Idaho, Illinois, Indiana, Maryland, Michigan,Minnesota, North Carolina, New Hampshire, New Jersey, Nevada,New York, Ohio, Pennsylvania, Rhode Island, South Carolina,Tennessee, Virginia, Texas and West Virginia, the CDC said.

Each state could have hundreds of patients or more who wereexposed through injections.

(Reporting by Tim Ghianni; Writing by David Bailey; Editing byGreg McCune and Peter Cooney)

((david.bailey@thomsonreuters.com)(312 371 4002))