The number of people who may be at risk for meningitis shot up dramatically on Monday, as federal officials expanded the list of medications being investigated for possible contamination at a Massachusetts drug company.
The Food and Drug Administration warned that a second steroid has been linked to a possible case of fungal meningitis, and that a heart surgery drug and all injectable medications made by the same company, New England Compounding Center (NECC), are now suspect.
Anyone who got the drugs "should be alerted to the potential risk of infection," the FDA said.
The new warnings prompted the Minnesota Department of Health to expand its search for patients who may have been affected. Many more people in the state may be getting phone calls in coming days, state officials say.
"We don't know in Minnesota how many clinics or hospitals or doctors' offices received these [products]," said Richard Danila, deputy Minnesota state epidemiologist. But he said the number "may be quite large."
As of Monday, 214 cases and 15 deaths have been reported in 15 states, including five cases of meningitis in Minnesota. All were tied to an injectable steroid contaminated with fungus.
The latest FDA alert was prompted by two new cases: one patient who developed meningitis symptoms from a different steroid and a heart transplant patient who developed fungal infections after receiving a drug called cardioplegic solution, which is used during heart surgery.
Those cases are still under investigation, and FDA officials cautioned that it's possible the heart patients were infected by another source.
Even so, several Minnesota clinics say they are taking new precautions.
At CentraCare Surgery Center in St. Cloud, officials said about 170 patients received the second steroid, triamcinolone acetonide, that was cited in Monday's FDA alert. "We're going to do everything necessary to make sure that our patients are notified," said Jeanine Nistler, a spokeswoman for CentraCare.
"We can say to our patients that we are terribly sorry that there's any cause at all for them to be concerned, and that we will do everything in our power to help them should they develop any symptoms," she added.
Meanwhile, Gillette Children's Hospital in St. Paul said it purchased other types of injectable drugs from NECC, and is checking its patient records to see who got them. "We will contact those patients promptly," said Patty Dunn, a Gillette spokeswoman.
More Minnesota clinics
Until Monday, only two Twin Cities clinics were thought to be involved in the meningitis outbreak -- Medical Advanced Pain Specialists (MAPS) and Minnesota Surgery Center. About 1,000 of their patients received spinal injections with the original steroid, methylprednisolone acetate, that was linked to the illnesses.
But about 20 Minnesota clinics have purchased other steroids from NECC, said Danila, of the health department.
And many more may have bought other types of injectable drugs from the company, he said. "We don't even know," he said.
The company has shut down operations and recalled all its products. But the FDA issued its warning for any products sold since May 21.
Danila said the Health Department has begun contacting NECC's known customers to advise them about the FDA warning.
"They need to contact their patients, either by e-mail, phone or letter, to see whether they actually have any infections that were the result of one of the NECC products," he said.
Allina and HealthPartners have acknowledged buying drugs from NECC, but said Monday that they were unsure if the drugs were included on the new FDA warning list.
Also Monday, officials reported the fifth confirmed case of meningitis in Minnesota, involving a woman in her 20s. However, Danila said more than 100 people have been tested for meningitis, and that they are awaiting further results.
Staff writer Paul McEnroe and the Associated Press contributed to this story. Maura Lerner • 612-673-7384