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Kobayashi M, Pilishvili T, Farrar JL, Leidner AJ, Gierke R, Prasad N, Moro P, Campos-Outcalt D, Morgan RL, Long SS, Poehling KA, Cohen AL. Pneumococcal Vaccine for Adults Aged ≥19 Years: Recommendations of the Advisory Committee on Immunization Practices, United States, 2023. MMWR Recomm Rep 2023; 72:1-39. [PMID: 37669242 PMCID: PMC10495181 DOI: 10.15585/mmwr.rr7203a1] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023] Open
Abstract
This report compiles and summarizes all published recommendations from CDC’s Advisory Committee on Immunization Practices (ACIP) for use of pneumococcal vaccines in adults aged ≥19 years in the United States. This report also includes updated and new clinical guidance for implementation from CDC Before 2021, ACIP recommended 23-valent pneumococcal polysaccharide vaccine (PPSV23) alone (up to 2 doses), or both a single dose of 13-valent pneumococcal conjugate vaccine (PCV13) in combination with 1–3 doses of PPSV23 in series (PCV13 followed by PPSV23), for use in U.S. adults depending on age and underlying risk for pneumococcal disease. In 2021, two new pneumococcal conjugate vaccines (PCVs), a 15-valent and a 20-valent PCV (PCV15 and PCV20), were licensed for use in U.S. adults aged ≥18 years by the Food and Drug Administration ACIP recommendations specify the use of either PCV20 alone or PCV15 in series with PPSV23 for all adults aged ≥65 years and for adults aged 19–64 years with certain underlying medical conditions or other risk factors who have not received a PCV or whose vaccination history is unknown. In addition, ACIP recommends use of either a single dose of PCV20 or ≥1 dose of PPSV23 for adults who have started their pneumococcal vaccine series with PCV13 but have not received all recommended PPSV23 doses. Shared clinical decision-making is recommended regarding use of a supplemental PCV20 dose for adults aged ≥65 years who have completed their recommended vaccine series with both PCV13 and PPSV23 Updated and new clinical guidance for implementation from CDC includes the recommendation for use of PCV15 or PCV20 for adults who have received PPSV23 but have not received any PCV dose. The report also includes clinical guidance for adults who have received 7-valent PCV (PCV7) only and adults who are hematopoietic stem cell transplant recipients
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Rybak A, Varon E, Masson E, Etchevers A, Levy-Brühl D, Ouldali N, Levy C, Cohen R. Investigation of Concurrent Pneumococcal Meningitis in Two Children Attending the Same Day-Care Center. Front Pediatr 2022; 10:945767. [PMID: 35928689 PMCID: PMC9344131 DOI: 10.3389/fped.2022.945767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
Only a few clusters of invasive pneumococcal disease have been described globally in children, and most of these cases occurred before pneumococcal vaccination implementation. Two unusual cases of pneumococcal meningitis, occurring in the same daycare center over a 3-day period, were reported. Both cerebrospinal fluid (CSF) were sent to the National reference center for pneumococci. In addition, we decided to perform a pneumococcal carriage study on all children and staff of the daycare center to analyze the pneumococcal serotypes circulating in this DCC and to discuss an antibiotic chemoprophylaxis. CSF culture was positive for pneumococcus, and serotype 25A was identified by latex agglutination. The second case had negative CSF culture, but CSF antigen test and gene amplification results were positive for Streptococcus pneumoniae. Serotype 12F was identified by using molecular biology. The absence of correlation between these strains was confirmed by multi-locus sequence typing. In the carriage study, we included 29 children (median age 1.9 years, interquartile range 1.4-2.5) and 10 adults. Among the children, 24 carried Streptococcus pneumoniae (83%). The main serotypes isolated were 23A for 6 children and 25A for 5 children; serotypes were non-typeable for 3 children. Only 1 of 10 adults tested carried Streptococcus pneumoniae (serotype 12F). Despite this temporo-spatial pattern, the cases were unrelated and not due to carriage of a particular serotype. No specific action has been taken for the other children attending this DCC, and no other case of bacterial meningitis occurred.
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Affiliation(s)
- Alexis Rybak
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France.,AFPA, Association Française de Pédiatrie Ambulatoire, Orléans, France.,Assistance Publique-Hôpitaux de Paris, Clinical Epidemiology Unit, Robert Debré University Hospital, ECEVE INSERM UMR 1123, Université de Paris, Paris, France.,Assistance Publique-Hôpitaux de Paris, Pediatric Emergency Department, Robert Debré University Hospital, Université de Paris, Paris, France
| | - Emmanuelle Varon
- Université Paris Est, IMRB-GRC GEMINI, Créteil, France.,Laboratory of Medical Biology and National Reference Centre for Pneumococci, Intercommunal Hospital of Créteil, Créteil, France
| | - Elodie Masson
- Assistance Publique-Hôpitaux de Paris, Pediatric Emergency Department, Bicêtre University Hospital, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - Anne Etchevers
- The National Public Health institute, Saint-Maurice, France
| | | | - Naïm Ouldali
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France.,Assistance Publique-Hôpitaux de Paris, Clinical Epidemiology Unit, Robert Debré University Hospital, ECEVE INSERM UMR 1123, Université de Paris, Paris, France.,Assistance Publique-Hôpitaux de Paris, Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Université de Paris, Paris, France.,Infectious Diseases Division, CHU Sainte Justine - Montreal University, Montreal, QC, Canada
| | - Corinne Levy
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France.,AFPA, Association Française de Pédiatrie Ambulatoire, Orléans, France.,Université Paris Est, IMRB-GRC GEMINI, Créteil, France.,Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Robert Cohen
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France.,AFPA, Association Française de Pédiatrie Ambulatoire, Orléans, France.,Université Paris Est, IMRB-GRC GEMINI, Créteil, France.,Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, Créteil, France.,Neonates Department, Centre Hospitalier Intercommunal de Créteil, Créteil, France
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Ali SA, Taj MK, Ali SH. Antimicrobial Resistance Pattern of Bacterial Meningitis Among Patients in Quetta, Pakistan. Infect Drug Resist 2021; 14:5107-5120. [PMID: 34880636 PMCID: PMC8646111 DOI: 10.2147/idr.s339231] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/23/2021] [Indexed: 12/22/2022] Open
Abstract
Introduction Bacterial meningitis (BM) is a lethal infectious disease that persists as a substantial cause of morbidity and mortality. The antimicrobial drug resistance in BM pathogens poses a major threat to the community while raising challenges for clinicians. For the first time, we elucidate the incidence rate of BM and its drug resistance among the population of Quetta, Balochistan. Methods A cross-sectional study was conducted (from January 2018 to March 2021) among meningitis patients admitted to government hospitals in Quetta. The cerebrospinal fluid (CSF) specimen was collected and processed for microbiological and cytological analysis. Bacterial isolates were identified and confirmed using phylogenetic analysis of the 16S rRNA gene. Results We found 35.9% (321/894) confirmed cases of BM among the population of Quetta, Balochistan. The identified bacterial isolates comprised Streptococcus pneumoniae 14.7% (130/894), Staphylococcus aureus 6.9% (61/894), Neisseria meningitidis 5.7% (51/894), Haemophilus influenzae 2.5% (22/894), Escherichia coli 4.5% (40/894), and Klebsiella pneumoniae 1.9% (17/894). A high percentage in male patients of 20.8% (186/894) was identified as compared to female patients of 15.1% (135/894). Extreme age groups such as infants (age range: 1 month to 1 year) and adults (age range: 61 years to 99 years) with low immunity were critically affected by BM. Clinical parameters such as abnormal CSF appearance, pH, and high WBCs in BM patients with endocarditis as the underlying disease were significantly at elevated risk of fatal outcome. 16S rRNA gene phylogenetic analysis confirmed the evolutionary similarity of isolated strains with prevailing pathogenic strains in Asia. Furthermore, age was identified as a significant risk factor for clinical outcomes. Conclusion The majority of the identified BM patients belonged to rural areas with limited health-care facilities and paramedic staff. The high case fatality rate 11% demonstrates increased antibiotic resistance among BM isolates, thereby stimulating its devastation in underdeveloped regions. Timely detection and intensive treatment of BM may improve critical outcomes in patients.
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Affiliation(s)
- Syeda Ayesha Ali
- Center for Advanced Studies in Vaccinology and Biotechnology (CASVAB), University of Balochistan, Quetta, Pakistan.,Department of Biochemistry, Sardar Bahadur Khan Women's University (SBKWU), Quetta, Pakistan
| | - Muhammad Kamran Taj
- Center for Advanced Studies in Vaccinology and Biotechnology (CASVAB), University of Balochistan, Quetta, Pakistan
| | - Syeda Hafsa Ali
- Department of Microbiology, Balochistan University of Information Technology, Engineering, and Management Sciences (BUITEMS), Quetta, Pakistan
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Awulachew E, Diriba K, Awoke N. Bacterial Isolates from CSF Samples and Their Antimicrobial Resistance Patterns Among Children Under Five Suspected to Have Meningitis in Dilla University Referral Hospital. Infect Drug Resist 2020; 13:4193-4202. [PMID: 33262614 PMCID: PMC7695221 DOI: 10.2147/idr.s264692] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 11/10/2020] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Bacterial meningitis is a medical emergency that requires immediate medical attention. It causes an estimated 288,649 deaths worldwide per year, of which 94,883 death occur among children under 5 years old. Up to 24% of survivors suffer from long-term sequelae such as epilepsy, mental disability, or sensorineural deafness, especially when the disease is contracted during early childhood. OBJECTIVE This study aimed to assess bacterial isolates of cerebrospinal fluid (CSF) samples and their antimicrobial resistance patterns among children under 5 years old in Dilla University Referral Hospital. MATERIAL AND METHODS Hospital-based cross-sectional study design was used to collect clinical data and CSF sample from children under 5 years old who were suspected for meningitis. Sediment of CSF samples was inoculated to blood agar plate, chocolate agar plate, and MacConkey agar for bacterial isolation and identification. Chemical analysis and cytological analysis were also conducted based on standard operating procedures. RESULTS From a total of 287 CSF samples cultured, causative bacteria were detected in 38 (13.2%). From culture positive cases, the most frequent isolate was Streptococcus pneumoniae (13 (34.2%)) followed by Staphylococcus aureas (7 (18.4%)), Neisseria meningitidis (6 (16%)) and Escherichia coli (6 (16%)). Haemophilus influenzae type b was isolated in 4 (10.5%) children with meningitis. Another cause of meningitis was Streptococcus agalactiae which accounted for 10.5%. Cryptococcus neoformans was detected in 4 (1.9%) cases of meningitis. Of all bacterial isolates, about 42.1% (16/38) were multi-drug resistant. About 38.5% of S. pneumoniae had multi-drug resistance, while about 33.3% of N. meningitidis, 50% of H. influenzae, 57.1% of S. aureas and 40% of E. coli showed multi-drug resistance. CONCLUSION A high prevalence of bacterial meningitis and high rate of drug resistance were observed. Streptococcus pneumoniae was the leading cause of bacterial meningitis among children under 5 years old.
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Affiliation(s)
- Ephrem Awulachew
- Department of Medical Laboratory Science, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Kuma Diriba
- Department of Medical Laboratory Science, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Netsanet Awoke
- Department of Medical Laboratory Science, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
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Amin-Chowdhury Z, Iyanger N, Ramsay ME, Ladhani SN. Outbreaks of severe pneumococcal disease in closed settings in the conjugate vaccines era, 2010-2018: A systematic review to inform national guidance in the UK. J Infect 2019; 79:495-502. [PMID: 31629865 DOI: 10.1016/j.jinf.2019.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 10/10/2019] [Accepted: 10/13/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Pneumococcal outbreaks are rare but they still occur, particularly in closed settings usually involving vulnerable groups. We undertook a systematic review to identify strategies for controlling pneumococcal outbreaks since the licensure of higher-valent pneumococcal conjugate vaccines (PCVs). METHODS A systematic literature search was performed for pneumococcal outbreaks published since 2010. A cluster was defined as two or more cases of severe pneumococcal disease in a closed setting within 14 days. RESULTS Eleven reports were identified, including seven caused by serotypes in both the 13-valent PCV (PCV13) and the 23-valent polysaccharide vaccine (PPV23); two were due to a PCV13-only serotype (6A) and one each by a PCV13-related serotype (6C) and a non-vaccine serotype (15A). Eight reported infection control measures, including reinforcing hand washing, respiratory hygiene and patient cohorting. PPV23 was used in five outbreaks, while PCV13 and both vaccines were used in one outbreak each. Different antibiotics were used for chemoprophylaxis in eight outbreaks. CONCLUSIONS Most pneumococcal outbreaks are currently caused by vaccine-preventable serotypes, and PPV23 is the preferred vaccine in more than half the outbreaks. Early implementation of infection control measures is important, and antibiotic chemoprophylaxis should be considered for high-risk individuals.
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Affiliation(s)
- Zahin Amin-Chowdhury
- Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom.
| | - Nalini Iyanger
- North East and North Central London Health Protection Team, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Mary E Ramsay
- Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Shamez N Ladhani
- Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom; Paediatric Infectious Diseases Research Group, St. George's University of London, Cranmer Terrace, London SW17 0RE, United Kingdom.
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Zivich PN, Grabenstein JD, Becker-Dreps SI, Weber DJ. Streptococcus pneumoniae outbreaks and implications for transmission and control: a systematic review. Pneumonia (Nathan) 2018; 10:11. [PMID: 30410854 PMCID: PMC6217781 DOI: 10.1186/s41479-018-0055-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 10/08/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Streptococcus pneumoniae is capable of causing multiple infectious syndromes and occasionally causes outbreaks. The objective of this review is to update prior outbreak reviews, identify control measures, and comment on transmission. METHODS We conducted a review of published S. pneumoniae outbreaks, defined as at least two linked cases of S. pneumoniae. RESULTS A total of 98 articles (86 respiratory; 8 conjunctivitis; 2 otitis media; 1 surgical site; 1 multiple), detailing 94 unique outbreaks occurring between 1916 to 2017 were identified. Reported serotypes included 1, 2, 3, 4, 5, 7F, 8, 12F, 14, 20, and 23F, and serogroups 6, 9, 15, 19, 22. The median attack rate for pneumococcal outbreaks was 7.0% (Interquartile range: 2.4%, 13%). The median case-fatality ratio was 12.9% (interquartile range: 0%, 29.2%). Age groups most affected by outbreaks were older adults (60.3%) and young adults (34.2%). Outbreaks occurred in crowded settings, such as universities/schools/daycares, military barracks, hospital wards, and long-term care facilities. Of outbreaks that assessed vaccination coverage, low initial vaccination or revaccination coverage was common. Most (73.1%) of reported outbreaks reported non-susceptibility to at least one antibiotic, with non-susceptibility to penicillin (56.0%) and erythromycin (52.6%) being common. Evidence suggests transmission in outbreaks can occur through multiple modes, including carriers, infected individuals, or medical devices. Several cases developed disease shortly after exposure (< 72 h). Respiratory outbreaks used infection prevention (55.6%), prophylactic vaccination (63.5%), and prophylactic antibiotics (50.5%) to prevent future cases. PPSV23 covered all reported outbreak serotypes. PCV13 covered 10 of 16 serotypes. For conjunctival outbreaks, only infection prevention strategies were used. CONCLUSIONS To prevent the initial occurrence of respiratory outbreaks, vaccination and revaccination is likely the best preventive measure. Once an outbreak occurs, vaccination and infection-prevention strategies should be utilized. Antibiotic prophylaxis may be considered for high-risk exposed individuals, but development of antibiotic resistance during outbreaks has been reported. The short period between initial exposure and development of disease indicates that pneumococcal colonization is not a prerequisite for pneumococcal respiratory infection.
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Affiliation(s)
- Paul N. Zivich
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC USA
| | | | - Sylvia I. Becker-Dreps
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC USA
- Department of Family Medicine, University of North Carolina Chapel Hill, Chapel Hill, NC USA
| | - David J. Weber
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC USA
- Division of Infectious Diseases, Department of Medicine, University of North Carolina Chapel Hill, Chapel Hill, NC USA
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Ben-David D, Schwaber MJ, Adler A, Masarwa S, Edgar R, Navon-Venezia S, Schwartz D, Porat N, Kotlovsky T, Polivkin N, Weinberg I, Lazary A, Ohana N, Dagan R. Persistence and complex evolution of fluoroquinolone-resistant Streptococcus pneumoniae clone. Emerg Infect Dis 2014; 20:799-805. [PMID: 24751142 PMCID: PMC4012785 DOI: 10.3201/eid2005.130142] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This clone has persisted in a post–acute care facility for >5 years. Prolonged outbreaks of multidrug-resistant Streptococcus pneumoniae in health care facilities are uncommon. We found persistent transmission of a fluroquinolone-resistant S. pneumoniae clone during 2006–2011 in a post–acute care facility in Israel, despite mandatory vaccination and fluoroquinolone restriction. Capsular switch and multiple antimicrobial nonsusceptibility mutations occurred within this single clone. The persistent transmission of fluoroquinolone-resistant S. pneumoniae during a 5-year period underscores the importance of long-term care facilities as potential reservoirs of multidrug-resistant streptococci.
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Zulz T, Wenger JD, Rudolph K, Robinson DA, Rakov AV, Bruden D, Singleton RJ, Bruce MG, Hennessy TW. Molecular characterization of Streptococcus pneumoniae serotype 12F isolates associated with rural community outbreaks in Alaska. J Clin Microbiol 2013; 51:1402-7. [PMID: 23408692 PMCID: PMC3647894 DOI: 10.1128/jcm.02880-12] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 02/07/2013] [Indexed: 11/20/2022] Open
Abstract
Outbreaks of invasive pneumococcal disease (IPD) caused by Streptococcus pneumoniae serotype 12F were observed in two neighboring regions of rural Alaska in 2003 to 2006 and 2006 to 2008. IPD surveillance data from 1986 to 2009 and carriage survey data from 1998 to 2004 and 2008 to 2009 were reviewed to identify patterns of serotype 12F transmission. Pulsed-field gel electrophoresis was performed on all available isolates, and selected isolates were characterized by additional genetic subtyping methods. Serotype 12F IPD occurred in two waves in Alaska between 1986 and 2008. While cases of disease occurred nearly every year in Anchorage, in rural regions, 12F IPD occurred with rates 10- to 20-fold higher than those in Anchorage, often with many years between disease peaks and generally caused by a single predominant genetic clone. Carriage occurred predominantly in adults, except early in the rural outbreaks, when most carriage was in persons <18 years old. In rural regions, carriage of 12F disappeared completely after outbreaks. Different 12F clones appear to have been introduced episodically into rural populations, spread widely in young, immunologically naïve populations (leading to outbreaks of IPD lasting 1 to 3 years), and then disappeared rapidly from the population. Larger population centers might have been the reservoir for these clones. This epidemiologic pattern is consistent with a highly virulent, but immunogenic, form of pneumococcus.
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Affiliation(s)
- Tammy Zulz
- Arctic Investigations Program, DPEI, NCEZID, Centers for Disease Control and Prevention, Anchorage, Alaska, USA.
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Fleming-Dutra K, Mbaeyi C, Link-Gelles R, Alexander N, Guh A, Forbes E, Beall B, Winchell JM, Carvalho MDG, Pimenta F, Kodani M, Vanner C, Stevens H, Brady D, Caulcrick-Grimes M, Bandy U, Moore MR. Streptococcus pneumoniae serotype 15A in psychiatric unit, Rhode Island, USA, 2010-2011. Emerg Infect Dis 2013; 18:1889-93. [PMID: 23092658 PMCID: PMC3559171 DOI: 10.3201/eid1811.120454] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
During a pneumococcal disease outbreak in a pediatric psychiatric unit in a hospital in Rhode Island, USA, 6 (30%) of 20 patients and staff were colonized with Streptococcus pneumoniae serotype 15A, which is not included in pneumococcal vaccines. The outbreak subsided after implementation of antimicrobial drug prophylaxis and enhanced infection control measures.
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