As attention from a multistate outbreak of meningitis centered on a Massachusetts specialty pharmacy on Thursday, Maryland clinics reached out to hundreds of patients who may have received injections of the steroid linked to the cases.
The outbreak has sickened 35 people, killing five, in six states. Maryland had two of those cases, including one death. All received steroid shots for back pain.
Maryland health officials said Thursday said early detection was important because the illness is treatable.
"We believe there are hundreds of patients who have received the injection," said Dr. Lucy Wilson, chief of the state Department of Health and Mental Hygiene's center for surveillance, infection prevention and outbreak response, during a news briefing.
U.S. health officials urged doctors and hospitals not to use any products from New England Compounding Center in Framingham, Mass. Investigators this week found contamination in a sealed vial of the steroid at the company, according to Food and Drug Administration officials.
Massachusetts health officials said Thursday the pharmacy has recalled three lots consisting of 17,676 single-dose vials of the steroid, preservative-free methylprednisolone acetate. The recalled steroid had been shipped to facilities in 23 states since July.
The company has shut down operations and said it is working with regulators to identify the source of the infection.
Investigators said they are still trying to confirm the infection's source, but the one common theme in all the illnesses is that each patient got the steroid medication.
Several Maryland medical facilities spent Thursday calling patients who received injections of the possibly tainted steroid. DHMH said seven clinics around the state received the drug.
Physicians and hospitals have been told by DHMH to contact their patients who received the injection between July 30 and Sept. 28, and to dispose of the product.
The incubation period for fungal meningitis is between one and four weeks, Wilson said. The type of fungal meningitis involved is not contagious.
Box Hill Surgery Center in Abingdon spent the past week working to provide information to patients, medical director Ritu Bhambhani said.
"I have been in practice a little over 11 years. I have yet to see a case of meningitis," Bhambhani said. "Since it came out in the news, we have had multiple patients call, and I am trying to address [their concerns]. We are making sure they are not downplaying any symptoms."
She did not have a number for how many patients might be affected because she said the lists were still being compiled.
Those experiencing fever, increasing headaches, neck stiffness, swelling or infection at the injection site, or stroke symptoms, should contact their doctor, Wilson said.
Some patients weren't waiting to hear from the clinics.
"We have a lot of patients that are calling in that are concerned," said Kim Merrill, the nurse administrator at the Harford County Ambulatory Surgery Center.
Merrill said she believed some 200 to 300 people needed to be contacted. She had no reports that anyone had become ill.
An administrator at the Greenspring Surgery Center said they had about 300 people to contact and expected to have calls finished Thursday.
Other centers have been less affected.
"Thankfully for us, it was only six patients," said Janice Stewart, nurse administrator of SurgCenter of Bel Air.
Maryland Pain Specialists in Towson said none of its patients received a spinal injection of the steroid from the company.
The other clinics that received the drug were Berlin Interventional Pain Management and Zion Ambulatory Center, Baltimore.
LaVerne Naesea, executive director of the Maryland pharmacy board, declined to say whether state regulators were probing the Massachusetts pharmacy. She said the company has had a permit to do business in Maryland since 2003 and that there's no record of it having been publicly disciplined.
A new regulation empowers Maryland to investigate out-of-state pharmacies that do business in the state, regardless of any investigations taken by the state where the pharmacy is located, Naesea said.
Baltimore Sun reporter Andrea F. Siegel, Aegis reporter Bryna Zumer and Associated Press reporters contributed to this report.