UPDATE 1-Deadly U.S. meningitis outbreak increases to 91 cases

(Adds latest numbers from CDC)

By Tim Ghianni

NASHVILLE, Tenn., Oct 7 (Reuters) - U.S. health officials on Sunday reported an additional 27 cases in a fungal meningitis outbreak linked to steroid injections that has killed seven people and now affected 91 in nine states.

The U.S. Centers for Disease Control and Prevention (CDC) reported a new total of 91 cases in an update on its website, up from 64 on Saturday. Most of the new cases were reported in Michigan, where the total increased to 20 from five. Virginia's total increased to 18 from 11.

The widening outbreak has alarmed health officials across the United States and focused attention on regulations of pharmaceutical compounding companies like the one that produced the drugs, the New England Compounding Center Inc in Framingham, Massachusetts.

The company shipped 17,676 vials of the steroid methylprednisolone acetate to 76 facilities in 23 states from July through September, the Massachusetts Health Department said.

The steroid is used as a painkiller, usually for the back, and could have been injected in thousands of patients, authorities have said.

Meningitis is an infection of the membranes covering the brain and spinal cord, and affected patients started showing a variety of symptoms from one to four weeks after their injections.

The company, which was previously the subject of complaints, said it had suspended its operations while an investigation proceeds and has recalled the three lots of the drug.

A compounding pharmacy takes medications from pharmaceuticals manufacturers and makes them into specific dosages and strengths for use by doctors.

The drug ingredients are regulated by the FDA, but compounders are regulated by state agencies, the industry's trade association said.

Complaints against New England Compounding Center (NECC) in 2002 and 2003 about the processing of medication resulted in an agreement with government agencies in 2006 to correct deficiencies, the Massachusetts Health Department said.

In 2011, there was another inspection of the facility and no deficiencies were found. In March 2012, another complaint was made about the potency of a product used in eye surgery procedures. That investigation is continuing, the state health department said.

The nine states where cases have been reported are Florida, Indiana, Maryland, Michigan, Minnesota, North Carolina, Ohio, Tennessee and Virginia.

Tennessee, where the outbreak was first detected, accounted for most of the cases, with 32, including three deaths. Many patients there remain hospitalized, some listed in critical condition.

Michigan had 20 cases and two deaths. One person died in Maryland and another in Virginia, the CDC said.

Reuters had reported 65 cases on Saturday, including one additional case after the CDC published its total.

(Reporting by Colleen Jenkins; Editing by Jackie Frank)