UPDATE 2-Calls for oversight grow as U.S. meningitis scare widens

* Lawmakers seek tighter regulation of compounding companies

* Outbreak has sickened 138 people in 11 states, killed 12

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

(Updates with latest number of cases, new case in Idaho, HHSofficial)

By Tim Ghianni

NASHVILLE, Tenn., Oct 10 (Reuters) - Pressure mounted forgreater regulation of a little known corner of thepharmaceuticals industry in response to a meningitis scare thatwidened to 11 states on Wednesday with the first case confirmedin Idaho.

Since the Sept. 25 recall of three lots of a steroidproduced by a Massachusetts company, 138 people have contractedmeningitis and 12 have died, according to the latest tally fromthe Centers of Disease Control and Idaho on Wednesday.

The Idaho case was the first discovered in the westernUnited States. The hardest hit state is Tennessee with 44 peoplesickened with the rare disease.

The number of cases has grown rapidly as healthpractitioners contacted some 13,000 people around the countrywho received injections from a potentially tainted supply ofsteroid medication shipped to 23 states.

Congress came under pressure to close what critics see as aloophole in regulation that left the company linked to thetainted product largely exempt from federal regulation.

"We urge Congress to give FDA (the Food and DrugAdministration) the authority it needs to assure these kinds ofoutbreaks do not happen again," said an official of the U.S.Department of Health and Human Services, who declined to beidentified because of ongoing investigations.

This followed leading U.S. House and Senate lawmakers fromboth parties asking federal health officials on Tuesday forbriefings on the outbreak as a first step toward possiblelegislative action to strengthen federal drug safetyregulations.

Some patients expressed anger that such a sensitive area assteroid medication was so lightly regulated.

George Cary, whose wife Lilian Cary is one of three peopleto die in Michigan, said on Tuesday that Americans have a strongbelief in their medical and political system and the outbreakshould 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."

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 compounding pharmacies, 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 their suppliers, not the compounders, which aresubject to a patchwork 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.

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

Tennessee authorities believe they could still see new casesinto the early part of November, though that could change asmore information 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 44 cases of meningitis, followed by Michigan withthree deaths and 28 cases, Virginia with one death and 27 casesand Maryland with one death and nine cases.

The other states with cases are Indiana (15), Florida (6),Minnesota (3), North Carolina (2), Ohio (1), New Jersey (2) andIdaho (1).

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