Scattered across the carefully landscaped main campus of the Centers for Disease Control and Prevention (CDC) are the staff on the front lines fighting a rare outbreak of fungal meningitis: A scientist in a white lab coat peers through a microscope at fungi on a glass slide. In another room, another researcher uses what looks like a long, pointed eye dropper to suck up DNA samples that will be tested for the suspect fungus.
Not far away in another building is the emergency operations center, which is essentially the war room. There's a low hum of voices as employees work the phones, talking to health officials, doctors and patients who received potentially contaminated pain injections believed to be at the root of the outbreak. Workers sit at rows of computers, gathering data, advising doctors and reaching out to thousands of people who may have been exposed. Overall, dozens of people are working day and night to bring the outbreak under control. More than 200 people in 14 states have been sickened, including 15 who have died.
There is a sense of urgency - people are dying, and lives could be saved if those who are sickened get treated in time. But it's not a race against a fast-spreading illness like avian flu or SARS - or even the fictional virus the CDC fails to unravel in the popular TV series "The Walking Dead." Unlike those outbreaks, this strain of meningitis isn't contagious and doesn't spread between people. It is likely isolated to the contaminated steroid, produced by the New England Compounding Center in Framingham, Mass.
"This is a very unusual infection," said Dr. John Jernigan, a CDC medical epidemiologist who is leading the clinical investigation team for the outbreak response. "So, treatment recommendations, diagnostic recommendations are all going to be new, and we're learning as we go on this one."
Meningitis, an inflammation of the membranes surrounding the brain and spinal cord, is not uncommon. But it is usually caused by bacteria, and it is very unusual to see it in patients with normal immune systems, Jernigan said. This strain is caused by a fungus that is common in dirt and grasses - people routinely come into contact with it without getting sick - but it has never before been identified as the cause of meningitis.
By Friday Oct. 12, officials believed they had reached about 90 percent of those who were potentially affected, Jernigan said. They planned to continue trying to reach every person to see if they've had problems and to warn them to be on the lookout for symptoms, which can include severe headache, nausea, dizziness and fever. The CDC says many of the cases have been mild, but some people had strokes.
A meeting is held each morning to review overnight developments and plot a course of action for the day, and another at the end of the day summarizes the day's developments and looks ahead to the next day. Maps on big screens in the front of the emergency operations center track the states where the tainted medications were sent and the tally of cases reported in affected states.
A few steps away in the joint information center, another team works to keep the information about the outbreak on the CDC's website up to date and disseminate information via the media and other outlets.
In another building on the campus tucked away in the northeast corner of Atlanta, in a part of the CDC that specializes in fungal infections, about 15 scientists in the reference and research labs are logging 12 hours or more a day and working through weekends to test samples coming in from around the country.
Because the lab scientists had never worked with this particular fungus in cerebrospinal fluid before, they had to quickly develop new tests to detect it before they could start analyzing the hundreds of samples - cerebrospinal fluid samples, cultures and bits of tissue - sent in from around the country, research lab team leader Ana Litvintseva said.
Dressed in a white coat Friday, Shawn Lockhart, the fungal reference lab team leader, peered through a microscope as images of what looked like red pea pods appeared on a computer screen next to him. Many other closely related fungi look similar, but a tiny dot at the end of a pod told him he was looking at the fungus believed to be at the root of the outbreak.
Normally, the reference lab works on difficult samples sent in from state health departments, while the research lab works on research projects. But the scale of this outbreak means those projects are mostly being shelved at the moment.
"The scale is much, much bigger than we would normally work with," said research lab team leader Ana Litvintseva said. "We are working every weekend and people are here 12 to 13 hours at a time and we're testing samples nonstop."