Information for Health Professionals
For influenza information, health professionals should view the most current clinical guidance for the 2012-2013 influenza season at the Centers for Disease Control and Prevention or download the Kentucky Department for Public Health's guidance for clinicians and infection control practitioners issued January 25, 2013.
The weekly CDC FluView providing an overview of flu surveillance and related information can be viewed at this page. More information about the flu season can also be found here, and transcripts of CDC media telebriefings are also available.
The FDA has also recently approved Flublok, a seasonal influenza vaccine made using new technology.
- Fungal Meningitis Outbreak Information
The multi-state fungal meningitis outbreak related to contaminated injectable steroid solution (preservative-free Methylprednisolone Acetate or “MPA”) produced by the New England Compounding Center (NECC), a compounding-only pharmacy in Massachusetts, is ongoing. Although Kentucky is shown with no cases on the national maps, this is because cases are being attributed to the state where the patient received the contaminated medication. Kentucky did not receive any of the implicated MPA solution, but six surrounding states did. To date, we have been informed of nine cases of illness in Kentucky residents, including two deaths.
Three issues are very important for clinicians:
1) Identifying patients with signs and symptoms of fungal meningitis or joint infections quickly for treatment and reporting purposes;
2) Notifying patients who have been exposed to other injectable NECC products, including ophthalmic solutions used for surgery, and cardioplegic solutions on or after May 21, 2012.
3) Removing all NECC products from use at your practice.
Identifying patients with possible fungal infections related to this outbreak:
A difficulty in the present situation is the long incubation period for fungal infections, 10-70 days typically. We expect more cases to arise from the previous steroid injection exposures, and new cases are being identified nationally on a daily basis.
We need to quickly identify these patients for two reasons: 1) To diagnose and treat appropriately to lower the risk of further illness and death; and 2) To gather information on exposures that may be related to additional contaminated products.
Therefore, we are relying on clinicians to carefully diagnose and test patients with meningitis and joint infections who had injections from NECC products. Both bacterial and fungal cultures should be collected for proper testing and sent through your normal laboratory system. The implicated steroid solution was used primarily for epidurals and joint injections but all fungal infections at otherwise sterile sites should be considered and/or investigated.
If your facility identifies any positive results for fungal infection in a previously sterile site, please:
1) Relay that information to your local health department’s Regional Epidemiologist and;
2) Enter a report on the FDA MedWatch system (instructions are embedded in that webpage about how to submit a MedWatch report online.).
Notifying patients who were exposed to NECC Products since May 21, 2012
The FDA recommends that all patients who received treatment involving injectable solutions from the NECC, including ophthalmic solutions used for surgery and cardioplegic solutions, be notified so that they may seek quick assessment if they experience any suspect symptoms. Other NECC products are not implicated in the outbreak but were produced at the same facility during the same time frame as the contaminated MPA and so the FDA wants to heighten detection of any illness arising from use of NECC’s compound solutions.
In order to contact patients, the FDA, in conjunction with CDC, produced a letter template to be used by clinicians to send to patients to inform them of the situation.
Download the template letter.
Removing all NECC products from use at your practice
NECC voluntarily recalled all of its products from the market on October 6, 2012. If your practice has any remaining NECC products, these should be pulled from active stock and sequestered in a place where they will not be accidentally used. None of the products shipped to Kentucky facilities are implicated in the current outbreak, but are being recalled out of “an abundance of caution,” according to the FDA. Please hold any product until further notice as specific instruction for return or disposal of NECC products has not been provided yet.
The FDA intends to make public a list of all NECC products that were distributed since May, 2011 and the facilities that received these products. KDPH has contacted all Kentucky facilities that received NECC products since May, 2012 (the period of concern) to insure that these products have been removed from use. However, if your practice might still have NECC products from before May, 2012, you should make sure to remove these from use.
For more information, please see the following websites: FDA; CDC; or Health Alerts.