The number of people afflicted in the continuing fungal meningitis outbreak continues to climb – reaching 438 cases in 19 states -- but the pace is slowing, judging by numbers reported by the CDC on Friday.
Since the last report Wednesday, 15 new cases have been reported, as well as an additional death, bringing that total to 32.
Most of the new cases and the new fatality occurred in Michigan, the state hardest hit by the outbreak.
In contrast, the Wednesday-to-Friday increase a month ago -- Oct. 10 to 12 -- was 48 cases, according to the agency's records.
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The slowdown was predictable -- the infections are linked to a contaminated steroid that was recalled Sept. 26 and people infected are not contagious. But officials have said extended vigilance will be needed because the incubation period for the disease is unclear.
Click here to see a timeline of the outbreak.
In a similar but much smaller outbreak in 2002, the last patient to become ill developed symptoms 152 days after being given a contaminated steroid, according to the Morbidity and Mortality Weekly Report account of the events.
In the first report on a large number of patients, published this week, the median time from the last dose of steroid to the onset of symptoms was 18 days, with a range from 0 to 56.
The current outbreak has been linked to fungal infection – with the black mold Exserohilum rostratum -- of three lots of preservative-free methylprednisolone acetate prepared by the New England Compounding Center (NECC), of Framingham, Mass.
The steroid, mainly given as spinal injections to control chronic back pain, was shipped to pain clinics in 23 states. None of the substance was used in Nevada before the recall, but 19 of the remaining 22 states have reported cases.
About 14,000 people are thought to have been given the substance and could potentially develop disease, the CDC has said.
Michigan, with 128 cases, is hardest hit, followed by Tennessee with 81 and Indiana with 52.
On the other hand, Ohio had been reporting 16 cases, but corrected that to 15, the agency said Friday.
The main effects of the fungal infection have been fungal meningitis, stroke due to presumed fungal meningitis, or other central nervous system-related infection, the CDC has said.
The case total includes 10 incidents of peripheral joint infection, where the steroid was injected into joints to control pain.