Gleich S, Morad Y, Echague R, Miller J R, Kornblum J, Sampson J S, Butler J C
Division of Infectious Diseases, St John's Episcopal Hospital, Far Rockaway, New York 11691, USA.
Infect Control Hosp Epidemiol. 2000 Nov;21(11):711-7. doi: 10.1086/501717.
To describe a pneumonia outbreak caused by Streptococcus pneumoniae among residents of a home for the aged and to review contemporary pneumococcal outbreaks.
Epidemiological investigation.
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.
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.
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.
描述一起养老院居民中由肺炎链球菌引起的肺炎暴发情况，并回顾当代肺炎球菌暴发事件。
流行病学调查。
对肺炎链球菌分离株进行血清分型，并采用脉冲场凝胶电泳进行分析。检测配对血清中针对肺炎球菌表面黏附素A蛋白（PsaA，一种37 kDa的细胞壁蛋白）的抗体。回顾过去十年以英文报道的肺炎球菌暴发事件。
200名居民中有18人发生肺炎。其中11人（61%）证实为肺炎球菌病因。从3例患者的血培养中分离出4型肺炎链球菌；所有分离株经脉冲场凝胶电泳分析无法区分。2例通过痰培养及胸腔积液乳胶凝集试验确定为肺炎球菌感染，另外6例通过对PsaA血清抗体光密度升高两倍确定为肺炎球菌感染。此前所有患者均未接种过肺炎球菌疫苗；死亡率为22%。给予肺炎球菌疫苗及青霉素或红霉素预防性抗生素治疗后未发现新增病例。回顾了自1990年以来26起侵袭性肺炎球菌疾病暴发事件。12起发生在美国，其中23F、14和4型占12起暴发事件中的8起（67%）。美国暴发事件中所有确诊血清型均包含在23价疫苗中。全球超过一半的肺炎球菌暴发事件涉及医院或长期护理机构中的老年人。
在一家未接种疫苗的老年居住机构中发生了肺炎球菌肺炎暴发。机构化的老年人有发生肺炎球菌疾病暴发的风险，应接种疫苗。
