Outbreak of Streptococcus pneumoniae in a Psychiatric Unit Dr. Katherine Fleming-Dutra Epidemiologist Centers for Disease Control and Prevention Based on the article Streptococcus pneumoniae Serotype 15A in Psychiatric Unit, Rhode Island, USA, 2010–2011 Katherine Fleming-Dutra, Chukwuma Mbaeyi, Ruth Link-Gelles, Nicole Alexander, Alice Guh, Elizabeth Forbes, Bernard Beall, Jonas M. Winchell, Maria da Gloria Carvalho, Fabiana Pimenta, Maja Kodani, Cindy Vanner, Hilary Stevens, Diane Brady, Mardea Caulcrick-Grimes, Utpala Bandy, and Matthew R. Moore Emerging Infectious Diseases November 2012 National Center for Emerging and Zoonotic Infectious Diseases Emerging Infectious Diseases

What is Streptococcus pneumoniae? Streptococcus pneumoniae, also called pneumococcus, is a type of bacteria that causes many common illnesses, including pneumonia, ear infections, and sinus infections. Streptococcus pneumoniae can also cause rare but serious infections, such as bloodstream infections and brain infections, called meningitis.

Why does Streptococcus pneumoniae cause a lot of diseases, not just pneumonia? Streptococcus pneumoniae got its name in the 19th century because it was recognized to be a common cause of pneumonia. Streptococcus pneumoniae can live in the nose of healthy people without causing illness. From the nose, Streptococcus pneumoniae can sometimes move into the lungs, ears, sinuses, or bloodstream to cause disease.

In what settings are Streptococcus pneumoniae infections more likely to show up? Infections caused by Streptococcus pneumoniae are very common in the community. Infections with Streptococcus pneumoniae affect all people, but in particular, young children, the elderly, and people with certain medical conditions, such as lung disease and immune system problems, are at higher risk of being infected.

What happened during an outbreak of Streptococcus pneumoniae in a pediatric psychiatric unit in Rhode Island in 2011? Three cases of confirmed Streptococcus pneumoniae infection and eight cases of pneumonia, many of which were likely caused by Streptococcus pneumoniae, occurred among patients, staff, and visitors in pediatric psychiatric unit in one month. CDC and the state health department investigated and found that six patients on the unit had Streptococcus pneumoniae in their noses, showing that this strain was being spread among patients staff, and visitors on this unit. This unit also had some challenges in preventing infections, such as patients’ lack of understanding about the need for hand washing or sanitizing or for covering their cough and sneeze. To control the outbreak, all the patients were given antibiotics to get rid of the bacteria from the nose, and stronger hand washing practices were used.

Are these kinds of outbreaks common? Outbreaks of Streptococcus pneumoniae infections occur from time to time in settings with: Close contact among people, such as in childcare facilities and military barracks, and People who have medical conditions, such as in hospitals and nursing homes. This outbreak occurred in a pediatric psychiatric unit where the children had close contact with each other and with staff members, which allowed the bacteria to be easily passed between patients and staff.

What was the strain of Streptococcus pneumoniae responsible for this outbreak? Streptococcus pneumoniae serotype 15A was responsible for the confirmed cases in this outbreak. This strain is not covered by pneumococcal vaccines for children and adults. In 2009, this strain caused about 5% of invasive pneumococcal disease cases in the northeastern United States, and <3% in the rest of the United States.

Are there precautions to prevent the transmission of disease in medical care facilities? Medical facilities prevent outbreaks of Streptococcus pneumoniae and many other diseases using infection control practices, like hand washing and ‘cough etiquette’ (cover cough or sneeze). However, many surveys show that staff do not always wash their hands before and after patient care.

What are the recommendations for reducing the risk of disease transmission in clinical setting? The simple, cheap, highly effective way is hand washing or sanitizing. Place hand sanitizer in numerous, easy-to-reach locations throughout the facilities. Educate staff and monitor their practice of hand washing.

How can people protect themselves from becoming infected with Streptococcus pneumoniae? Get pneumococcal vaccines which can protect against the most important Streptococcus pneumoniae strains. Get yearly flu vaccine since Streptococcus pneumoniae can cause infections in people who have flu. Wash hands.

Thank you to all authors Katherine Fleming-Dutra, Chukwuma Mbaeyi, Ruth Link-Gelles, Nicole Alexander, Alice Guh, Elizabeth Forbes, Bernard Beall, Jonas M. Winchell, Maria da Gloria Carvalho, Fabiana Pimenta, Maja Kodani, Cindy Vanner, Hilary Stevens, Diane Brady, Mardea Caulcrick-Grimes, Utpala Bandy, and Matthew R. Moore For more information, please contact: Emerging Infectious Diseases Centers for Disease Control and Prevention 1600 Clifton Road NE, Mailstop D61, Atlanta, GA 30333, USA Telephone: 1-404-639-1960/Fax: 1-404-639-1954 E-mail: eideditor@cdc.gov Web: http://www.cdc.gov/eid/ The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. National Center for Emerging and Zoonotic Infectious Diseases Emerging Infectious Diseases