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A cluster of invasive pneumococcal disease in young children in child care
T Cherian1, M C Steinhoff, L H Harrison
1Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD 21205.
Insights
A child care setting experienced an invasive pneumococcal disease outbreak. This highlights the need for vigilance and effective pneumococcal vaccines for young children.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Invasive pneumococcal disease (IPD) poses a significant threat to young children.
- Child care settings can facilitate the transmission of infectious agents.
Purpose of the Study:
- To investigate an outbreak of invasive pneumococcal disease in a family child-care home.
- To characterize the Streptococcus pneumoniae strain responsible for the outbreak using molecular methods.
Main Methods:
- Outbreak investigation in a family child-care home.
- Standard microbiological procedures for pathogen isolation.
- Ribosomal DNA gene-restriction patterns (ribotyping) for strain characterization.
Main Results:
- Four children in a six-child facility developed IPD or severe pneumococcal conjunctivitis within an 8-day period.
- Type 12F Streptococcus pneumoniae was identified in ill children and carriage was detected in healthy children.
- All outbreak isolates shared an identical ribotype pattern, indicating a common source.
- Rifampin treatment failed to eradicate nasopharyngeal carriage of the organism.
Conclusions:
- Child care environments can serve as epicenters for invasive pneumococcal disease outbreaks in young children.
- Increased surveillance for pneumococcal disease clusters in child care facilities is warranted.
- Development and implementation of a pneumococcal vaccine effective in infants and young children are crucial.
Objective:
To investigate a cluster of invasive pneumococcal disease in children 8 to 26 months of age, using standard microbiological procedures and ribosomal DNA gene-restriction patterns to characterize the outbreak strain.
Design:
Outbreak investigation.
Setting:
A family child-care home with six children in Baltimore, Md.
Results:
During an 8-day period, three of the six children in the family child-care home had febrile illnesses with pneumococcal bacteremia, and a fourth had purulent pneumococcal conjunctivitis. Type 12F Streptococcus pneumoniae was isolated from the four ill children and from the nasopharynges of the two healthy children. Ribotyping revealed all outbreak isolates had an identical ribotype pattern. Administration of rifampin to the children did not eradicate carriage of the organism.
Conclusions:
Our data demonstrate that child care provides an opportunity for outbreak of invasive pneumococcal disease in young children. This observation suggests a need for increased alertness for clusters of pneumococcal disease in young children in child-care facilities and underscores the necessity for a pneumococcal vaccine that is effective in infants and young children.