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Streptococcus pneumoniae Serotype 4 Outbreak in a Home for the Aged: Report and Review of Recent Outbreaks

Published online by Cambridge University Press:  02 January 2015

Sheldon Gleich*
Affiliation:
Division of Infectious Diseases, St John's Episcopal Hospital, Far Rockaway, New York
Yosef Morad
Affiliation:
Division of Infectious Diseases, St John's Episcopal Hospital, Far Rockaway, New York
Ramon Echague
Affiliation:
Department of Internal Medicine, St John's Episcopal Hospital, Far Rockaway, New York
James R. Miller
Affiliation:
Parasitic Disease Surveillance Unit, New York City Department of Health, New York, New York
John Kornblum
Affiliation:
Molecular Typing Laboratory, New York City Department of Health, New York, New York
Jacquelyn S. Sampson
Affiliation:
Respiratory Diseases Branch, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Jay C. Butler
Affiliation:
Respiratory Diseases Branch, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Division of Infectious Diseases, St John's Episcopal Hospital, 327 Beach 19th St, Far Rockaway, NY 11691

Abstract

Objective:

To describe a pneumonia outbreak caused by Streptococcus pneumoniae among residents of a home for the aged and to review contemporary pneumococcal outbreaks.

Design:

Epidemiological investigation.

Methods:

S pneumoniae isolates were serotyped and analyzed by pulsed-field gel electrophoresis. Paired sera were tested for antibodies to pneumococcal surface adhesin A protein (PsaA, a 37-kDa cell-wall protein). Pneumococcal outbreaks reported in the last decade in English were reviewed.

Results:

Pneumonia developed in 18 of 200 residents. In 11 (61%), a pneumococcal etiology was demonstrated. S pneumoniae, serotype 4, was isolated from the blood cultures of 3 patients; all isolates were indistinguishable by pulsed-field gel electrophoresis. Pneumococcal involvement was established in 2 by sputum culture and latex agglutination of parapneumonic fluid and in 6 others by a twofold rise in optical density of serum antibody reactive to PsaA. Pneumococcal immunization had not previously been received by any patient; mortality was 22%. No additional cases were noted following administration of pneumococcal vaccine and antibiotic prophylaxis with penicillin or erythromycin. Twenty-six outbreaks of invasive pneumococcal disease since 1990 were reviewed. Twelve occurred in the United States, and serotypes 23F, 14, and 4 accounted for 8 (67%) of 12 outbreaks. All confirmed serotypes in US outbreaks are included in the 23-valent vaccine. More than one half of pneumococcal outbreaks worldwide involved elderly persons in hospitals or long-term-care facilities.

Conclusions:

A pneumococcal pneumonia outbreak occurred among unvaccinated residents of a residential facility for the aged. Institutionalized elderly persons are at risk of outbreaks of pneumococcal disease and should be vaccinated.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2000

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