UPDATE 1-Calls for oversight grow as US meningitis death toll mounts

* Lawmakers seek tighter regulation of compounding companies

* Outbreak has sickened 124 people in 10 states, killed 12

* May take to early Nov. to identify all stricken inTennessee

(Updates figures, adds quotes)

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, four more deaths were reported 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 124 people, according to state healthdepartments and the Centers for Disease Control and Prevention.

Leading U.S. House and Senate lawmakers from both parties onTuesday asked federal health officials for briefings on theoutbreak as a first step toward possible legislative action tostrengthen federal drug safety regulations.

Oversight committees in both the Senate and House hope tolearn more about the outbreak before Oct. 12 from staff membersof the Food and Drug Administration and the CDC, aides said.

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 thesuspect medication in Tennessee have contracted meningitis, saidDr. David Reagan, chief medical officer for the TennesseeDepartment of Health.

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

The rate of infection overall is not known.

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 highlighted a gap in regulation ofso-called pharmacy compounders, which are facilities that takedrug ingredients and package them into medications and dosagesfor specific clients.

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

George Cary, whose wife Lilian Cary is one of three women todie in the outbreak from Michigan, said Tuesday that Americanshave a strong belief in their medical and political system andthe outbreak should be a wake-up call to the nation.

"We don't have expectations of a faulty regulatory medicalsystem that allows these types of mistakes to be made," Carytold reporters on his front lawn after a memorial for his wife."So perhaps the message is, wake up America."

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.

In Tennessee cases, officials said they have found theaverage incubation period to be 16 days, but they caution thatit could range from six to 42 days for their patients.

Tennessee believes they could still see new cases into theearly part of November, though that could change as moreinformation is collected, officials 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 (15), Florida (6),Minnesota (3), North Carolina (2), Ohio (1) and New Jersey (1).

(Additional reporting by David Morgan, Susan Guyett and MeghanaKeshavan; Editing by Lisa Shumaker and Claudia Parsons)