Calls for oversight grow as US meningitis death toll mounts

* About 5 pct of patients who got shots have developedmeningitis

* Lawmakers seek tighter regulation of compounding companies By Tim Ghianni

NASHVILLE, Tenn., Oct 10 (Reuters) - The toll from theoutbreak of fungal meningitis tied to contaminated steroid shotsthat has killed 12 people in the United States was expected togrow on Wednesday, raising pressure for stricter oversight of alargely unregulated corner of the pharmaceutical world.

On Tuesday, the outbreak claimed four more lives and Floridabecame the latest state to report at least one death linked tothe illness in a widening health scare.

Since the Sept. 25 recall of three lots of a steroidproduced by a Massachusetts company, the outbreak has spread to10 states and infected 121 people, according to state healthdepartments and the Centers for Disease Control and Prevention.

In five states -- Tennessee, Michigan, Maryland, Virginia,and Florida -- the outbreak has claimed lives, with the latestvictim a 70-year-old man in Florida.

As many as 13,000 people received the injections to relieveback pain and other complaints and are at risk of infection, theCDC said, although the number ultimately stricken is likely tobe far fewer.

For the first time on Tuesday, Tennessee state healthofficials gave an estimate of the rate of infection among thosepatients who received injections from the recalled steroidsupplies.

Approximately 5 percent of patients treated with the suspectmedication have contracted meningitis, said Dr. David Reagan,chief medical officer for the Tennessee Department of Health.Based on that rate of infection and the 13,000 shots given, thenumber of confirmed cases could grow to about 650 from thecurrent 121.

"We expect that most people who were exposed to this willnot develop a fungal infection," Reagan said.

Meningitis is an infection of the membranes covering thebrain and spinal cord. Symptoms include headache, fever andnausea. Fungal meningitis, unlike viral and bacterialmeningitis, is not contagious.

The outbreak has alarmed health officials and highlighted agap in regulation of so-called pharmacy compounders, which arefacilities that take drug ingredients and package them intomedications and dosages for specific clients.

The federal Food and Drug Administration regulates only theingredients and not the compounders, which are subject to apatchwork of state oversight.

Some of the thousands of people exposed may have to waitanxiously for weeks because the incubation period of the diseaseis up to a month, health experts said.

The potentially tainted steroid vials, which have beenrecalled, were shipped to 76 facilities in 23 states, the CDChas said.

Tennessee has been the hardest hit state, with six reporteddeaths and 39 cases of meningitis, followed by Michigan withthree deaths and 25 cases, Virginia with one death and 24 casesand Maryland with one death and eight cases.

The other states with cases are Indiana (12), Florida (6),Minnesota (3), North Carolina (2), Ohio (1) and New Jersey (1).

(Editing by Lisa Shumaker)