Community Outbreak of Mycoplasma pneumoniae Infection: School-Based Cluster of Neurologic Disease Associated with Household Transmission of Respiratory Illness
Identifieur interne : 003226 ( Main/Exploration ); précédent : 003225; suivant : 003227Community Outbreak of Mycoplasma pneumoniae Infection: School-Based Cluster of Neurologic Disease Associated with Household Transmission of Respiratory Illness
Auteurs : Nicholas D. Walter [Géorgie (pays), États-Unis] ; Gavin B. Grant [Géorgie (pays)] ; Utpala Bandy [États-Unis] ; Nicole E. Alexander [États-Unis] ; Jonas M. Winchell [Géorgie (pays)] ; Hannah T. Jordan [Géorgie (pays)] ; James J. Sejvar [Géorgie (pays)] ; Lauri A. Hicks [États-Unis] ; David R. Gifford [États-Unis] ; Nicole T. Alexander [Géorgie (pays)] ; Kathleen A. Thurman [Géorgie (pays)] ; Stephanie B. Schwartz [Géorgie (pays)] ; Penelope H. Dennehy [États-Unis] ; Nino Khetsuriani [Géorgie (pays)] ; Barry S. Fields [Géorgie (pays)] ; Michael T. Dillon [Géorgie (pays)] ; Dean D. Erdman [Géorgie (pays)] ; Cynthia G. Whitney [Géorgie (pays)] ; Matthew R. Moore [Géorgie (pays)]Source :
- Journal of Infectious Diseases [ 0022-1899 ] ; 2008.
Abstract
Background. We investigated an outbreak of severe neurologic disease and pneumonia that occurred among students at 4 schools in Rhode Island. Methods. We identified cases of encephalitis, encephalomyelitis, and pneumonia that occurred among schoolchildren from 1 September 2006 through 9 February 2007, and we performed serologic tests, polymerase chain reaction (PCR) analysis, and culture for the detection of multiple pathogens in oropharyngeal and nasopharyngeal specimens. Students with positive results of M. pneumoniae IgM serologic testing and no alternative diagnosis were considered to be infected with M. pneumoniae. At school A, we used questionnaires to identify students and their household contacts who made visits to physicians for pneumonia and cough. We compared observed and expected rates of pneumonia. Results. Rates of pneumonia among elementary students (122 cases/1000 student-years) were >5-fold higher than expected. Three students had encephalitis or encephalomyelitis, and 76 had pneumonia. Of these 2 groups of students, 2 (66%) and 57 students (75%), respectively, had M. pneumoniae infection. M. pneumoniae was detected by PCR in 10 students with pneumonia; 5 of these specimens were cultured, and M. pneumoniae was isolated in 4. Of 202 households of students attending school A, 20 (10%) accounted for 61% of visits to physicians for pneumonia or cough. Of 19 household contacts of students with pneumonia, 8 (42%) developed pneumonia and 6 (32%) reported visits for cough. Conclusions. M. pneumoniae caused a community-wide outbreak of cough illness and pneumonia and was associated with the development of life-threatening neurologic disease. Although M. pneumoniae was detected in schools, its transmission in households amplified the outbreak. Interrupting household transmission should be a priority during future outbreaks.
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DOI: 10.1086/592281
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Walter</name><affiliation wicri:level="1"><country xml:lang="fr">Géorgie (pays)</country><wicri:regionArea>Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta</wicri:regionArea><wicri:noRegion>Atlanta</wicri:noRegion></affiliation><affiliation wicri:level="1"><country xml:lang="fr">Géorgie (pays)</country><wicri:regionArea>Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta</wicri:regionArea><wicri:noRegion>Atlanta</wicri:noRegion></affiliation><affiliation wicri:level="1"><country wicri:rule="url">États-Unis</country></affiliation><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><placeName><region type="state">Colorado</region></placeName><wicri:cityArea>Reprints or correspondence: Dr. Nicholas D. Walter, Div. of Pulmonary Sciences and Critical Care Medicine, Campus Box 272, School of Medicine 5525, 4200 E. Ninth Ave, Denver</wicri:cityArea></affiliation></author><author><name sortKey="Grant, Gavin B" sort="Grant, Gavin B" uniqKey="Grant G" first="Gavin B." last="Grant">Gavin B. Grant</name><affiliation wicri:level="1"><country xml:lang="fr">Géorgie (pays)</country><wicri:regionArea>Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta</wicri:regionArea><wicri:noRegion>Atlanta</wicri:noRegion></affiliation><affiliation wicri:level="1"><country xml:lang="fr">Géorgie (pays)</country><wicri:regionArea>Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta</wicri:regionArea><wicri:noRegion>Atlanta</wicri:noRegion></affiliation></author><author><name sortKey="Bandy, Utpala" sort="Bandy, Utpala" uniqKey="Bandy U" first="Utpala" last="Bandy">Utpala Bandy</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><placeName><region type="state">Rhode Island</region></placeName><wicri:cityArea>Rhode Island Department of Health, Providence</wicri:cityArea></affiliation></author><author><name sortKey="Alexander, Nicole E" sort="Alexander, Nicole E" uniqKey="Alexander N" first="Nicole E." last="Alexander">Nicole E. Alexander</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><placeName><region type="state">Rhode Island</region></placeName><wicri:cityArea>The Warren Alpert Medical School of Brown University, Providence</wicri:cityArea></affiliation></author><author><name sortKey="Winchell, Jonas M" sort="Winchell, Jonas M" uniqKey="Winchell J" first="Jonas M." last="Winchell">Jonas M. Winchell</name><affiliation wicri:level="1"><country xml:lang="fr">Géorgie (pays)</country><wicri:regionArea>Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta</wicri:regionArea><wicri:noRegion>Atlanta</wicri:noRegion></affiliation></author><author><name sortKey="Jordan, Hannah T" sort="Jordan, Hannah T" uniqKey="Jordan H" first="Hannah T." last="Jordan">Hannah T. Jordan</name><affiliation wicri:level="1"><country xml:lang="fr">Géorgie (pays)</country><wicri:regionArea>Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta</wicri:regionArea><wicri:noRegion>Atlanta</wicri:noRegion></affiliation><affiliation wicri:level="1"><country xml:lang="fr">Géorgie (pays)</country><wicri:regionArea>Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta</wicri:regionArea><wicri:noRegion>Atlanta</wicri:noRegion></affiliation></author><author><name sortKey="Sejvar, James J" sort="Sejvar, James J" uniqKey="Sejvar J" first="James J." last="Sejvar">James J. Sejvar</name><affiliation wicri:level="1"><country xml:lang="fr">Géorgie (pays)</country><wicri:regionArea>Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta</wicri:regionArea><wicri:noRegion>Atlanta</wicri:noRegion></affiliation><affiliation wicri:level="1"><country xml:lang="fr">Géorgie (pays)</country><wicri:regionArea>Vector-Borne Infectious Diseases, Centers for Disease Control and Prevention, Atlanta</wicri:regionArea><wicri:noRegion>Atlanta</wicri:noRegion></affiliation></author><author><name sortKey="Hicks, Lauri A" sort="Hicks, Lauri A" uniqKey="Hicks L" first="Lauri A." last="Hicks">Lauri A. Hicks</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><placeName><region type="state">Rhode Island</region></placeName><wicri:cityArea>The Warren Alpert Medical School of Brown University, Providence</wicri:cityArea></affiliation></author><author><name sortKey="Gifford, David R" sort="Gifford, David R" uniqKey="Gifford D" first="David R." last="Gifford">David R. Gifford</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><placeName><region type="state">Rhode Island</region></placeName><wicri:cityArea>Rhode Island Department of Health, Providence</wicri:cityArea></affiliation></author><author><name sortKey="Alexander, Nicole T" sort="Alexander, Nicole T" uniqKey="Alexander N" first="Nicole T." last="Alexander">Nicole T. Alexander</name><affiliation wicri:level="1"><country xml:lang="fr">Géorgie (pays)</country><wicri:regionArea>Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta</wicri:regionArea><wicri:noRegion>Atlanta</wicri:noRegion></affiliation></author><author><name sortKey="Thurman, Kathleen A" sort="Thurman, Kathleen A" uniqKey="Thurman K" first="Kathleen A." last="Thurman">Kathleen A. Thurman</name><affiliation wicri:level="1"><country xml:lang="fr">Géorgie (pays)</country><wicri:regionArea>Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta</wicri:regionArea><wicri:noRegion>Atlanta</wicri:noRegion></affiliation></author><author><name sortKey="Schwartz, Stephanie B" sort="Schwartz, Stephanie B" uniqKey="Schwartz S" first="Stephanie B." last="Schwartz">Stephanie B. Schwartz</name><affiliation wicri:level="1"><country xml:lang="fr">Géorgie (pays)</country><wicri:regionArea>Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta</wicri:regionArea><wicri:noRegion>Atlanta</wicri:noRegion></affiliation></author><author><name sortKey="Dennehy, Penelope H" sort="Dennehy, Penelope H" uniqKey="Dennehy P" first="Penelope H." last="Dennehy">Penelope H. Dennehy</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><placeName><region type="state">Rhode Island</region></placeName><wicri:cityArea>The Warren Alpert Medical School of Brown University, Providence</wicri:cityArea></affiliation></author><author><name sortKey="Khetsuriani, Nino" sort="Khetsuriani, Nino" uniqKey="Khetsuriani N" first="Nino" last="Khetsuriani">Nino Khetsuriani</name><affiliation wicri:level="1"><country xml:lang="fr">Géorgie (pays)</country><wicri:regionArea>Viral Diseases, Centers for Disease Control and Prevention, Atlanta</wicri:regionArea><wicri:noRegion>Atlanta</wicri:noRegion></affiliation></author><author><name sortKey="Fields, Barry S" sort="Fields, Barry S" uniqKey="Fields B" first="Barry S." last="Fields">Barry S. Fields</name><affiliation wicri:level="1"><country xml:lang="fr">Géorgie (pays)</country><wicri:regionArea>Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta</wicri:regionArea><wicri:noRegion>Atlanta</wicri:noRegion></affiliation></author><author><name sortKey="Dillon, Michael T" sort="Dillon, Michael T" uniqKey="Dillon M" first="Michael T." last="Dillon">Michael T. Dillon</name><affiliation wicri:level="1"><country xml:lang="fr">Géorgie (pays)</country><wicri:regionArea>Scientific Resources, Centers for Disease Control and Prevention, Atlanta</wicri:regionArea><wicri:noRegion>Atlanta</wicri:noRegion></affiliation></author><author><name sortKey="Erdman, Dean D" sort="Erdman, Dean D" uniqKey="Erdman D" first="Dean D." last="Erdman">Dean D. Erdman</name><affiliation wicri:level="1"><country xml:lang="fr">Géorgie (pays)</country><wicri:regionArea>Viral Diseases, Centers for Disease Control and Prevention, Atlanta</wicri:regionArea><wicri:noRegion>Atlanta</wicri:noRegion></affiliation></author><author><name sortKey="Whitney, Cynthia G" sort="Whitney, Cynthia G" uniqKey="Whitney C" first="Cynthia G." last="Whitney">Cynthia G. Whitney</name><affiliation wicri:level="1"><country xml:lang="fr">Géorgie (pays)</country><wicri:regionArea>Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta</wicri:regionArea><wicri:noRegion>Atlanta</wicri:noRegion></affiliation></author><author><name sortKey="Moore, Matthew R" sort="Moore, Matthew R" uniqKey="Moore M" first="Matthew R." last="Moore">Matthew R. Moore</name><affiliation wicri:level="1"><country xml:lang="fr">Géorgie (pays)</country><wicri:regionArea>Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta</wicri:regionArea><wicri:noRegion>Atlanta</wicri:noRegion></affiliation></author></analytic><monogr></monogr><series><title level="j" type="main">Journal of Infectious Diseases</title><title level="j" type="abbrev">Journal of Infectious Diseases</title><idno type="ISSN">0022-1899</idno><idno type="eISSN">1537-6613</idno><imprint><publisher>The University of Chicago Press</publisher><date type="published">2008</date><biblScope unit="vol">198</biblScope><biblScope unit="issue">9</biblScope><biblScope unit="page" from="1365">1365</biblScope><biblScope unit="page" to="1374">1374</biblScope></imprint><idno type="ISSN">0022-1899</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0022-1899</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract">Background. We investigated an outbreak of severe neurologic disease and pneumonia that occurred among students at 4 schools in Rhode Island. Methods. We identified cases of encephalitis, encephalomyelitis, and pneumonia that occurred among schoolchildren from 1 September 2006 through 9 February 2007, and we performed serologic tests, polymerase chain reaction (PCR) analysis, and culture for the detection of multiple pathogens in oropharyngeal and nasopharyngeal specimens. Students with positive results of M. pneumoniae IgM serologic testing and no alternative diagnosis were considered to be infected with M. pneumoniae. At school A, we used questionnaires to identify students and their household contacts who made visits to physicians for pneumonia and cough. We compared observed and expected rates of pneumonia. Results. Rates of pneumonia among elementary students (122 cases/1000 student-years) were >5-fold higher than expected. Three students had encephalitis or encephalomyelitis, and 76 had pneumonia. Of these 2 groups of students, 2 (66%) and 57 students (75%), respectively, had M. pneumoniae infection. M. pneumoniae was detected by PCR in 10 students with pneumonia; 5 of these specimens were cultured, and M. pneumoniae was isolated in 4. Of 202 households of students attending school A, 20 (10%) accounted for 61% of visits to physicians for pneumonia or cough. Of 19 household contacts of students with pneumonia, 8 (42%) developed pneumonia and 6 (32%) reported visits for cough. Conclusions. M. pneumoniae caused a community-wide outbreak of cough illness and pneumonia and was associated with the development of life-threatening neurologic disease. Although M. pneumoniae was detected in schools, its transmission in households amplified the outbreak. Interrupting household transmission should be a priority during future outbreaks.</div></front></TEI><affiliations><list><country><li>Géorgie (pays)</li><li>États-Unis</li></country><region><li>Colorado</li><li>Rhode Island</li></region></list><tree><country name="Géorgie (pays)"><noRegion><name sortKey="Walter, Nicholas D" sort="Walter, Nicholas D" uniqKey="Walter N" first="Nicholas D." last="Walter">Nicholas D. Walter</name></noRegion><name sortKey="Alexander, Nicole T" sort="Alexander, Nicole T" uniqKey="Alexander N" first="Nicole T." last="Alexander">Nicole T. Alexander</name><name sortKey="Dillon, Michael T" sort="Dillon, Michael T" uniqKey="Dillon M" first="Michael T." last="Dillon">Michael T. Dillon</name><name sortKey="Erdman, Dean D" sort="Erdman, Dean D" uniqKey="Erdman D" first="Dean D." last="Erdman">Dean D. Erdman</name><name sortKey="Fields, Barry S" sort="Fields, Barry S" uniqKey="Fields B" first="Barry S." last="Fields">Barry S. Fields</name><name sortKey="Grant, Gavin B" sort="Grant, Gavin B" uniqKey="Grant G" first="Gavin B." last="Grant">Gavin B. Grant</name><name sortKey="Grant, Gavin B" sort="Grant, Gavin B" uniqKey="Grant G" first="Gavin B." last="Grant">Gavin B. Grant</name><name sortKey="Jordan, Hannah T" sort="Jordan, Hannah T" uniqKey="Jordan H" first="Hannah T." last="Jordan">Hannah T. Jordan</name><name sortKey="Jordan, Hannah T" sort="Jordan, Hannah T" uniqKey="Jordan H" first="Hannah T." last="Jordan">Hannah T. Jordan</name><name sortKey="Khetsuriani, Nino" sort="Khetsuriani, Nino" uniqKey="Khetsuriani N" first="Nino" last="Khetsuriani">Nino Khetsuriani</name><name sortKey="Moore, Matthew R" sort="Moore, Matthew R" uniqKey="Moore M" first="Matthew R." last="Moore">Matthew R. Moore</name><name sortKey="Schwartz, Stephanie B" sort="Schwartz, Stephanie B" uniqKey="Schwartz S" first="Stephanie B." last="Schwartz">Stephanie B. Schwartz</name><name sortKey="Sejvar, James J" sort="Sejvar, James J" uniqKey="Sejvar J" first="James J." last="Sejvar">James J. Sejvar</name><name sortKey="Sejvar, James J" sort="Sejvar, James J" uniqKey="Sejvar J" first="James J." last="Sejvar">James J. Sejvar</name><name sortKey="Thurman, Kathleen A" sort="Thurman, Kathleen A" uniqKey="Thurman K" first="Kathleen A." last="Thurman">Kathleen A. Thurman</name><name sortKey="Walter, Nicholas D" sort="Walter, Nicholas D" uniqKey="Walter N" first="Nicholas D." last="Walter">Nicholas D. Walter</name><name sortKey="Whitney, Cynthia G" sort="Whitney, Cynthia G" uniqKey="Whitney C" first="Cynthia G." last="Whitney">Cynthia G. Whitney</name><name sortKey="Winchell, Jonas M" sort="Winchell, Jonas M" uniqKey="Winchell J" first="Jonas M." last="Winchell">Jonas M. Winchell</name></country><country name="États-Unis"><noRegion><name sortKey="Walter, Nicholas D" sort="Walter, Nicholas D" uniqKey="Walter N" first="Nicholas D." last="Walter">Nicholas D. Walter</name></noRegion><name sortKey="Alexander, Nicole E" sort="Alexander, Nicole E" uniqKey="Alexander N" first="Nicole E." last="Alexander">Nicole E. Alexander</name><name sortKey="Bandy, Utpala" sort="Bandy, Utpala" uniqKey="Bandy U" first="Utpala" last="Bandy">Utpala Bandy</name><name sortKey="Dennehy, Penelope H" sort="Dennehy, Penelope H" uniqKey="Dennehy P" first="Penelope H." last="Dennehy">Penelope H. Dennehy</name><name sortKey="Gifford, David R" sort="Gifford, David R" uniqKey="Gifford D" first="David R." last="Gifford">David R. Gifford</name><name sortKey="Hicks, Lauri A" sort="Hicks, Lauri A" uniqKey="Hicks L" first="Lauri A." last="Hicks">Lauri A. Hicks</name><name sortKey="Walter, Nicholas D" sort="Walter, Nicholas D" uniqKey="Walter N" first="Nicholas D." last="Walter">Nicholas D. 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