Notes from the Field: Fungal meningitis redux
The latest Morbidity Mortality Weekly Report means a new opportunity for my favorite columns: Notes from the Field! This week we have an update to a story from last October, reporting a multi-state outbreak of fungal meningitis attributable to contaminated medicine. The latest MMWR update describes new epidemiological data from last year’s outbreak, which was obtained from Department of Defense medical records of employees. The outbreak last year received widespread news coverage, and was ultimately attributed to a lapse in aseptic technique at a compounding pharmacy in New England.
The current update how exposure to the contaminated drugs among military personnel can also be followed by epidemiologists using information in the Department of Defense (DoD) medical record system. Because fungal infections may have a long incubation period, it was critical to identify potential exposures to the contaminated materials in a timely manner, particularly if the individuals are actively deployed to other locations in the interim. The analysis identified almost 500 military members who had potentially been exposed during treatment, and were then followed up. Of those on active duty, 5% of them had been deployed when at risk for developing infection. One of those service members did develop a fungal infection requiring medical evacuation for treatment. Overall, a total of 4 cases of fungal infection were detected among military personnel using this analysis, and three of those developed meningitis.
The report notes several novel approaches that were used to identify these patients. First, claims data within the DoD system was used to identify potential risks in service members who may have been deployed. Second, ongoing surveillance within the DoD with a centralized system allows for an opportunity to more comprehensively follow active duty and reserve military personnel, their families and dependents, as well as retirees. The report notes that although this approach might not be feasible within the whole US population at large, it might be utilized successfully within managed care programs servicing distinct sub-populations.