Clinical Response, Outbreak Investigation, and Epidemiology of the Fungal Meningitis Epidemic in the United States: Systematic Review.
Level 4 - case-series / case-control
Systematic review of observational outbreak investigations, case series, and surveillance reports
PubMed 26681583 · doi:10.1017/dmp.2015.137
What was done
The authors conducted a systematic review using the PRISMA framework to analyze the 2012–2013 multistate fungal meningitis epidemic in the United States. They identified and analyzed 19 published articles addressing clinical response, outbreak investigation, and epidemiology, while excluding articles focusing solely on compounding pharmacies, legislation, litigation, diagnostics, microbiology, and pathogenesis.
What was found
The outbreak was traced to contaminated methylprednisolone acetate lots produced by the New England Compounding Center in Massachusetts, with Exserohilum rostratum identified as the predominant pathogen. By October 23, 2013, the epidemic resulted in a final total of 751 cases and 64 deaths nationwide.
Why it matters
This review synthesizes the epidemiological trajectory and interagency public health investigation that identified and contained the largest healthcare-associated fungal outbreak in US history.
Limits
The review relies on 19 published retrospective reports and surveillance summaries, which may carry reporting and publication biases. It deliberately excluded data on diagnostic assays, microbial pathogenesis, and pharmacy regulatory mechanisms.
Cited by
- supports Around 2012–2013, a compounding pharmacy in New England distributed contaminated specimens that caused an outbreak of fungal meningitis.