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In a December 2013 “lessons learned” opinion, Pappas noted that while the overall (known) mortality associated with the outbreak remains low, “morbidity relating to persistent symptoms and treatment associated toxicity is high”71 indicating that clinical manifestations of the early outbreak have shifted to a less-well characterized, chronic disease setting. The overall cost to human health caused by the 2012 outbreak is immeasurable, as is the total financial impact to healthcare systems. For a single hospital health system, the identification of particulate in an outsourced compounded product triggered an investigation costing nearly 1 million dollars for 5 lots of compounded medication totaling 1090 units, at an added cost of $802.74 per unit purchased.72 The research letter notes “Fungal contamination of MgSO4 required extensive pharmacy, laboratory, infection control, and hospital administrative support; substantial hospital resources for patient and physician notification; ongoing surveillance; and prophylactic treatment of high-risk patients”.72 Remarkably, as the early publications on the outbreak were being published, pharmacies that would later recall products due to identified contamination or lack of assurance of sterility continued to supply the market with non-FDA approved medicines for sterile use, including methylprednisolone acetate suspension.
See submission at http://www.regulations.gov/#!documentDetail;D=FDA-2013-N-1523-0006