In September 2012, the Centers for Disease Control and Prevention (CDC) began receiving reports from health officials in Tennessee about patients diagnosed with a rare form of meningitis. This worrisome information set off alarm bells at the CDC, which quickly launched an emergency response team led by Dr. Jonathan Todd Weber, chief of CDC’s Prevention and Response Branch.
Weber and his team ultimately linked the outbreak to injections of a steroid, which had been produced by the New England Compounding Center in Massachusetts and distributed to 76 facilities in 23 states. While the Food and Drug Administration (FDA) and the Massachusetts Board of Pharmacy investigated the firm and halted further shipments of what turned out to be contaminated medication, the CDC worked with state and local health departments and clinical facilities to notify, in record time, approximately 14,000 potentially exposed patients.
They also helped identify the pathogen and developed tests to detect it; put an epidemiology team to work tracking the course of the outbreak; alerted doctors and health care facilities across the country to stop using supplies of the dangerous drug; provided guidance to physicians on the limited treatment options; and offered a steady stream of information to the public.
“This was the most successful outbreak response we have ever conducted,” said Dr. Ileana Arias, the CDC’s principal deputy. “More quickly than ever before, the CDC team identified what the problem was and where the problem came from, and assured rapid, direct notification of thousands of people who were potentially affected.”
As of April 8, 2013, there were 733 reported cases of patients with infections attributed to the tainted steroid, including 53 deaths in 20 states. Most of the deaths occurred early on during the outbreak, and dramatically decreased after Weber and his CDC team intervened.
Dr. Rima Khabbaz, the CDC’s deputy director for infectious diseases, said it is tragic that people died and were sickened because of the contaminated medication. But she added that the rapid response by Weber and his CDC team made a big difference.
“There is no question that they saved lives,” she said. “This was public health at its best; a quick and decisive response.”
Without early and prolonged treatment, fungal meningitis can lead to stroke and death. Many months of one or more antifungal drugs are required for treatment. Patients exposed to the tainted steroid, which was used to treat back, joint or neck pain, experienced headaches, fever, stiff neck, back pain, dizziness, weakness and loss of balance. This made it essential to track down and assess all those who were exposed, as soon as possible.
Dr. Beth Bell, director of the CDC’s National Center for Emergency and Zoonotic Diseases, said Weber ran CDC’s emergency operations center, “juggling many, many balls in the air while at the same time keeping track of the big picture.”
She said “the outbreak was very complicated,” and required engaging a wide variety of experts.
“They were trying to come up with guidance when information was very, very limited. In a situation like this with a lot of unknowns, there was a need to marshal a lot of people with different expertise,” said Bell.
She said Weber was “a central point of reference,” the individual responsible for coordinating multiple and simultaneous activities in short time frames with the CDC’s chief health officer and the epidemiology, clinical, laboratory, policy, legal and communications teams.
This included the work of CDC’s laboratory scientists, who identified the pathogen causing the illness and in just two days developed tests for its detection. The CDC scientists also identified the specific organisms found in the contaminated medication vials and rapidly tested more than 800 specimens.
Weber’s team provided frequent updates for more than 240 clinical and professional organizations, held clinician conference calls that reached 5,300 participants, released multiple health advisories, and provided regular updates for the press on the CDC’s websites that were accessed more than a million times.
While the response had many moving parts, Weber said the bottom line was protecting public health.
“It was a new infection that had really never been seen or studied before. We had the potential for a new disease infecting many thousands of people in many different states,” Weber said. “Our goal was to get those people notified and help them get properly diagnosed and receive care.”
James Blumenstock, chief of the public health practice at the Association of State and Territorial Health Officials, said the CDC’s public health response represented “skillful and artful execution.”
“The CDC team had the spirit of collaboration, commitment and discipline to maintain 24-hour communication and coordination. There was the field investigation and data sharing between federal and state governments. It had every twist and turn you can think of,” said Blumenstock.