ROBERT SIEGEL, HOST:
The CDC announced today that as many as 14,000 people have been exposed to the potentially contaminated steroid treatments. And we're going to hear now about the massive effort under way to identify, notify and, if need be, treat them.
Dr. Rachel Smith is an epidemic intelligence service officer at the Centers for Disease Control in Atlanta. And she says the vast majority of those exposed have now been contacted.
DR. RACHEL SMITH: The state and local health departments, as well as the facilities, have contacted an estimated over 90 percent of the patients that were exposed in a variety of methods: either by direct phone call, registered letter, voicemail or home visit.
SIEGEL: Now, what's the problem with the other 10 percent, hard to find or some states haven't done as good a job as others? Who are those?
SMITH: So states and facilities are working hard to contact the last 10 percent. It's still an ongoing effort for them. And so that's continuing as we speak.
SIEGEL: And once people are identified as having been exposed and notified, who decides and how is it decided whether they should be given some anti-fungal medication?
SMITH: Yeah. So the CDC has come up with a series of case definitions which is used by states and local health departments to identify people that we feel are cases in this investigation, in this outbreak. It takes into account a few different issues, including exposure to the product that was compounded by New England Compounding Center, as well as symptoms, as well as abnormal cerebrospinal profile in the case of people with meningitis.
And people who meet our case definitions, which can be found on our Web site, we at the CDC are recommending that they get treatment for the outbreak - meningitis.
SIEGEL: But if someone was exposed to the batch of steroid shots, but has shown no symptoms so far of fungal meningitis, will they likely not be a candidate for medication at this time?
SMITH: Right. So CDC is not recommending at this time that asymptomatic people be screened with a lumbar puncture. But what we are recommending is that all exposed people should be vigilant and seek medical evaluation if symptoms do occur and be referred for, potentially, a diagnostic evaluation. We are not recommending at this time that people who've been exposed and are asymptomatic receive any prophylactic medication either.
SIEGEL: The health commissioner of Tennessee has said that the estimated incubation period for fungal meningitis has been increased, that now he speaks of a range of from six days to 42 days. It had been put at two days to 28 days. First, how did that happen and what does that mean for the notification effort?
SMITH: At this point in time, the investigation into this outbreak is ongoing, and so the range of incubation periods is not yet known entirely.
SIEGEL: Is it fair to infer from that, that this outbreak is teaching CDC a lot about fungal meningitis? And we're learning more about this disease every day, it seems.
SMITH: Yeah, fungal meningitis, especially due to mold, which is what we think many people in this outbreak that - they have, is a very rare entity. And there's very few case reports in literature. And so we're definitely learning more and more about it as we proceed with this investigation.
SIEGEL: Well, which people out there can rest easy now? I guess if you haven't had any contact with this medication since the middle of the month of May, then you wouldn't have been exposed to it at all, I assume.
SMITH: I don't think that we know enough right now to say that people are quote, unquote, "out of the woods" if they had an injection, you know, after May 21st, but - you know, in May, and they don't have symptoms right now. People need to be vigilant for symptoms if they were exposed to these three lots of product.
SIEGEL: Dr. Smith, thank you very much for talking with us.
SMITH: Thank you.
SIEGEL: Dr. Rachel Smith, she's an epidemic intelligence service officer at the Centers for Disease Control and Prevention in Atlanta. Transcript provided by NPR, Copyright National Public Radio.