The company that produced contaminated medications linked to an unprecedented fungal meningitis outbreak in the US faced mounting scrutiny on Saturday over whether it illegally sold drugs to medical facilities, as the death toll from the disease grew to 15.
The US Centers for Disease Control and Prevention (CDC) said another person died from meningitis, the second death in Indiana.
The number of cases of the disease reported reached 201 in 14 states, according to the CDC and state officials.
Illinois reported its first case of meningitis from a steroid injection and New Hampshire officials reported that state’s first four confirmed cases from the outbreak, which showed no signs of abating.
Tennessee is the worst affected state with six deaths and 52 cases, followed by Michigan with three deaths and 41 cases, including one case of an infection that has not been confirmed as meningitis.
As federal and state authorities scrambled to contain the outbreak, investigators were trying to determine how the medication produced by New England Compounding Center (NECC) was contaminated and whether its sprawling drug supply business complied with licensing laws.
A series of e-mails between the company and a clinic in Mississippi reviewed by reporters show that NECC sold drugs without requiring physicians to supply individual patient prescriptions. The customer confirmed that NECC supplied the clinic with drugs without patient names or prescriptions, which are required by a number of states including Massachusetts, where the company is based.
The e-mails also indicate that NECC referred business to a sister company, Ameridose LLC, despite a statement by Ameridose last week that the two operated separately. NECC has recalled the suspect product, surrendered its license to operate in Massachusetts and suspended operations. Ameridose also has temporarily suspended operations.
“NECC’s intent has always been to operate in compliance with our licenses in the states where we do business,” the company said in a statement.
The US Food and Drug Administration is investigating NECC and there have been calls from some in Congress for a criminal investigation of the company.
“FDA considers this to be one of our top priorities and we are dedicating many resources to this investigation,” the agency said in a statement late on Friday.
Federal regulators have come under criticism for failing to prevent the outbreak by closely regulating drug compounding companies such as NECC, which prepare medications for clinics and doctors largely outside federal oversight. The FDA has said the law does not give it adequate authority to do so, leaving regulation largely to the states.
NECC faces mounting threats from states as well. Several states are investigating the company and at least two — Michigan and Massachusetts — have said the company violated their regulations, according to a survey.
About 14,000 patients received the suspect steroid medications, which were shipped to 76 facilities in 23 states as long ago as May.
Meningitis is an infection of the membranes covering the brain and spinal cord. Symptoms include headache, fever and nausea. Fungal meningitis is a rare form and is not contagious.