Walter Nicholas D, Grant Gavin B, Bandy Utpala, Alexander Nicole E, Winchell Jonas M, Jordan Hannah T, Sejvar James J, Hicks Lauri A, Gifford David R, Alexander Nicole T, Thurman Kathleen A, Schwartz Stephanie B, Dennehy Penelope H, Khetsuriani Nino, Fields Barry S, Dillon Michael T, Erdman Dean D, Whitney Cynthia G, Moore Matthew R
Epidemic Intelligence Service, Office of Workforce and Career Development, Atlanta, Georgia, USA.
J Infect Dis. 2008 Nov 1;198(9):1365-74. doi: 10.1086/592281.
We investigated an outbreak of severe neurologic disease and pneumonia that occurred among students at 4 schools in Rhode Island.
We identified cases of encephalitis, encephalomyelitis, and pneumonia that occurred among schoolchildren from 1 September 2006 through 9 February 2007, and we performed serologic tests, polymerase chain reaction (PCR) analysis, and culture for the detection of multiple pathogens in oropharyngeal and nasopharyngeal specimens. Students with positive results of M. pneumoniae IgM serologic testing and no alternative diagnosis were considered to be infected with M. pneumoniae. At school A, we used questionnaires to identify students and their household contacts who made visits to physicians for pneumonia and cough. We compared observed and expected rates of pneumonia.
Rates of pneumonia among elementary students (122 cases/1000 student-years) were > 5-fold higher than expected. Three students had encephalitis or encephalomyelitis, and 76 had pneumonia. Of these 2 groups of students, 2 (66%) and 57 students (75%), respectively, had M. pneumoniae infection. M. pneumoniae was detected by PCR in 10 students with pneumonia; 5 of these specimens were cultured, and M. pneumoniae was isolated in 4. Of 202 households of students attending school A, 20 (10%) accounted for 61% of visits to physicians for pneumonia or cough. Of 19 household contacts of students with pneumonia, 8 (42%) developed pneumonia and 6 (32%) reported visits for cough.
M. pneumoniae caused a community-wide outbreak of cough illness and pneumonia and was associated with the development of life-threatening neurologic disease. Although M. pneumoniae was detected in schools, its transmission in households amplified the outbreak. Interrupting household transmission should be a priority during future outbreaks.
我们调查了罗德岛4所学校学生中发生的严重神经系统疾病和肺炎疫情。
我们确定了2006年9月1日至2007年2月9日在校儿童中发生的脑炎、脑脊髓炎和肺炎病例，并进行了血清学检测、聚合酶链反应（PCR）分析以及对口咽和鼻咽标本中多种病原体的培养。肺炎支原体IgM血清学检测结果呈阳性且无其他诊断的学生被视为感染了肺炎支原体。在学校A，我们使用问卷来确定因肺炎和咳嗽就诊的学生及其家庭接触者。我们比较了观察到的肺炎发病率和预期发病率。
小学生中的肺炎发病率（122例/1000学生年）比预期高5倍以上。3名学生患有脑炎或脑脊髓炎，76名学生患有肺炎。在这两组学生中，分别有2名（66%）和57名学生（75%）感染了肺炎支原体。通过PCR在10名肺炎学生中检测到肺炎支原体；其中5份标本进行了培养，4份分离出肺炎支原体。在学校A上学的学生的202个家庭中，20个（10%）家庭占因肺炎或咳嗽就诊医生的61%。在19名肺炎学生的家庭接触者中，8名（42%）患了肺炎，6名（32%）报告有咳嗽就诊。
肺炎支原体引起了社区范围的咳嗽疾病和肺炎疫情，并与危及生命的神经系统疾病的发生有关。虽然在学校检测到了肺炎支原体，但其在家庭中的传播加剧了疫情。在未来疫情期间，中断家庭传播应成为优先事项。
