of three months, and possibly as long as a year. cases tennessee was the first state to have a reported case on september 21, 2012. the cdc reported that as of january 14, 2013, 678 people in 19 states had contracted a fungal disease, of whom 44 died. as of march 10, 2013, 48 people had died and 720 were being treated for persistent fungal infections. these cases were associated with three lots of methylprednisolone acetate, portions of which were shipped by necc to 73 health care facilities in 23 states. the product was also sent to four states where no cases had been reported, and no complaints or cases were found in massachusetts, the only state where necc had a license. the final figures, which were disclosed in may 2015 when the litigation came to a close, were over 800 sickened with 64 deaths. a later report said that 798 had been affected and "over 100" had died. prescribing of steroids for back and joint pain the frequency of steroid injections to treat back pain in medicare patients increased 121% from 1997 to 2006. some doctors believe the efficacy of steroid injections for back and joint pain has not been demonstrated by scientific evidence, and challenge their use in these cases at all. according to the new england journal of medicine, "... it's important to note that many patients received these sterile injections for back and joint pain, a procedure that lacks high-quality evidence of efficacy. these problems cannot be laid entirely at the feet of compounders when clinicians persist in clinical practices despite weak evidence of efficacy." doctors in professional societies are not in agreement about treatment guidelines. although steroid injection for back pain clearly works in some cases, health researchers are "nearly unanimous" that it is "vastly overused". a 2009 cochrane review of injection therapy for subacute and chronic low back pain indicated no strong evidence exists for or against the use of any type of injection therapy. a four-year study released in 2013 suggested epidural steroid injections may actually lead to worse outcomes whether or not the patient later underwent surgery, and no evidence showed receiving steroid injections helped patients to avoid surgery. also, in patients who had previously been treated with epidural steroids, evidence indicated surgery was more complicated than in patients who had not. compounding pharmacies