Multistate Outbreak of Respiratory Infections Among Unaccompanied Children, June 2014–July 2014

Tomczyk, Sara; Arriola, Carmen Sofia; Beall, Bernard; Benitez, Alvaro J.; Benoit, Stephen R.; Berman, LaShondra; Bresee, Joseph S.; Carvalho, Maria da Glória; Cohn, Amanda C.; Cross, Kristen E.; Diaz, Maureen H.; Watkins, Louise Francois; Gierke, Ryan; Hagan, José E.; Harris, Aaron M.; Jain, Seema; Kim, Lindsay; Kobayashi, Miwako; Lindstrom, Stephen; McGee, Lesley; McMorrow, Meredith; Metcalf, Benjamin L.; Moore, Matthew R.; Moura, Iaci; Nix, W. Allan; Nyangoma, Edith; Oberste, M. Steven; Olsen, Sonja J.; Pimenta, Fabiana Cristina; Socias, Christina; Thurman, Kathleen A.; Waller, Jessica L.; Waterman, Stephen H.; Westercamp, Matthew; Wharton, Melinda; Whitney, Cynthia G.; Winchell, Jonas M.; Wolff, Bernard J.; Kim, Curi

doi:10.1093/cid/ciw147

Cited by 6 publications

(8 citation statements)

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“…Fourth, specimen quality can vary between patients and standardization of specimens is difficult, thereby limiting pathogen load confidence. Fifth, while TAC technology requires certain infrastructure to be in place and is not yet commercially available, it has previously been shown to be extremely valuable in outbreak settings, with the CDC serving as a reference lab for testing (26,27). This analysis demonstrates the potential use of TAC for pathogen detection in clusters of hospitalized patients with ARI or CAP for whom high-quality sputum and/or NP/OP samples are available.…”

Section: Discussionmentioning

confidence: 93%

Improved Detection of Respiratory Pathogens by Use of High-Quality Sputum with TaqMan Array Card Technology

et al. 2017

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New diagnostic platforms often use nasopharyngeal or oropharyngeal (NP/OP) swabs for pathogen detection for patients hospitalized with communityacquired pneumonia (CAP). We applied multipathogen testing to high-quality sputum specimens to determine if more pathogens can be identified relative to NP/OP swabs. Children (Ͻ18 years old) and adults hospitalized with CAP were enrolled over 2.5 years through the Etiology of Pneumonia in the Community (EPIC) study. NP/OP specimens with matching high-quality sputum (defined as Յ10 epithelial cells/lowpower field [lpf] and Ն25 white blood cells/lpf or a quality score [q-score] definition of 2ϩ) were tested by TaqMan array card (TAC), a multipathogen real-time PCR detection platform. Among 236 patients with matched specimens, a higher proportion of sputum specimens had Ն1 pathogen detected compared with NP/OP specimens in children (93% versus 68%; P Ͻ 0.0001) and adults (88% versus 61%; P Ͻ 0.0001); for each pathogen targeted, crossing threshold (C T ) values were earlier in sputum. Both bacterial (361 versus 294) and viral detections (245 versus 140) were more common in sputum versus NP/OP specimens, respectively, in both children and adults. When available, high-quality sputum may be useful for testing in hospitalized CAP patients.KEYWORDS community-acquired pneumonia, pneumonia, multipathogen, diagnostics, TaqMan array card, NP/OP, TAC, sputum A cute respiratory infections (ARI), especially lower respiratory tract (LRT) infections, including community-acquired pneumonia (CAP), are a significant cause of morbidity and mortality globally (1-3). Despite advances in diagnostic testing beyond culture-based methods, including molecular and antigen-based approaches, pneumonia etiology often remains undetermined even when systematic and comprehensive specimen collection and methods are employed, particularly in adults (1, 2); one reason for this is that specimens directly from the lungs are often not available. Upper respiratory tract specimens, such as nasopharyngeal and oropharyngeal (NP/OP) swabs, are often collected for molecular testing of respiratory pathogens due to the ease of collection. Some studies suggest that LRT specimens, such as sputum, endotracheal aspirates (ETA), and bronchoalveolar lavage (BAL) fluids, have improved sensitivity compared with NP/OP swabs; while issues of specificity needed to inform clinician

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Section: Discussionmentioning

confidence: 93%

Improved Detection of Respiratory Pathogens by Use of High-Quality Sputum with TaqMan Array Card Technology

et al. 2017

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“…In addition, country of origin was not associated with serotype 5 colonization in the 2014 survey. 2 Therefore, we believe that our survey results can still be used to guide PCV13 policy for the general population of unaccompanied children.…”

Section: Discussionmentioning

confidence: 91%

“…We believe that outbreak control interventions in 2014, which included resolution of crowding, 2 may have interrupted transmission of serotype 5 among unaccompanied children. S. pneumoniae serotype 5 is considered to be one of the most outbreak-prone serotypes while being a rare cause of colonization in nonoutbreak settings.…”

Section: Discussionmentioning

confidence: 99%

“…A pneumococcal colonization survey conducted in July 2014 among nonhospitalized children at the 4 affected programs found that serotype 5 was the most frequently isolated serotype [9% (70/774) of surveyed children]. 2 Serotype 5 is rarely isolated in the United States 3 but is included in the 13-valent pneumococcal conjugate vaccine (PCV13). To aid in controlling transmission of pneumococcus, 1 dose of PCV13 was recommended for all unaccompanied children.…”

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confidence: 99%

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Pneumococcal Serotype 5 Colonization Prevalence Among Newly Arrived Unaccompanied Children 1 Year After an Outbreak—Texas, 2015

Kobayashi

Misegades

Fleming-Dutra

et al. 2017

Pediatric Infectious Disease Journal

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In 2014, an acute respiratory illness outbreak affected unaccompanied children from Central America entering the United States; 9% of 774 surveyed children were colonized with Streptococcus pneumoniae serotype 5. In our 2015 follow-up survey of 475 children, serotype 5 was not detected, and an interim recommendation to administer 13-valent pneumococcal conjugate vaccine to all unaccompanied children was discontinued.

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“…Some of these further identified articles were in journals not indexed by PubMed and would not have been identified regardless of search terms. One article not identified by our search reported a serotype 5 outbreak among unaccompanied minors in the US during 2014 [ 136 ]. Our conclusions are consistent with the unidentified article and this article provides further evidence for co-infection transmission.…”

Section: Discussionmentioning

confidence: 99%

Streptococcus pneumoniae outbreaks and implications for transmission and control: a systematic review

et al. 2018

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BackgroundStreptococcus 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.MethodsWe conducted a review of published S. pneumoniae outbreaks, defined as at least two linked cases of S. pneumoniae.ResultsA 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.ConclusionsTo 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.Electronic supplementary materialThe online version of this article (10.1186/s41479-018-0055-4) contains supplementary material, which is available to authorized users.

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Multistate Outbreak of Respiratory Infections Among Unaccompanied Children, June 2014–July 2014

Abstract: This respiratory disease outbreak was due to multiple pathogens, including Streptococcus pneumoniae serotype 5 and influenza viruses. Pneumococcal and influenza vaccinations prevented further transmission. Future efforts to prevent similar outbreaks will benefit from use of both vaccines.

Cited by 6 publications

References 23 publications

Improved Detection of Respiratory Pathogens by Use of High-Quality Sputum with TaqMan Array Card Technology

Improved Detection of Respiratory Pathogens by Use of High-Quality Sputum with TaqMan Array Card Technology

Pneumococcal Serotype 5 Colonization Prevalence Among Newly Arrived Unaccompanied Children 1 Year After an Outbreak—Texas, 2015

Streptococcus pneumoniae outbreaks and implications for transmission and control: a systematic review

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