Abstract
BackgroundInfections with community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) are emerging worldwide. We investigated an outbreak of severe CA-MRSA infections in children following out-patient vaccination.Methods and FindingsWe carried out a field investigation after adverse events following immunization (AEFI) were reported. We reviewed the clinical data from all cases. S. aureus recovered from skin infections and from nasal and throat swabs were analyzed by pulse-field gel electrophoresis, multi locus sequence typing, PCR and microarray. In May 2006, nine children presented with AEFI, ranging from fatal toxic shock syndrome, necrotizing soft tissue infection, purulent abscesses, to fever with rash. All had received a vaccination injection in different health centres in one District of Ho Chi Minh City. Eight children had been vaccinated by the same health care worker (HCW). Deficiencies in vaccine quality, storage practices, or preparation and delivery were not found. Infection control practices were insufficient. CA-MRSA was cultured in four children and from nasal and throat swabs from the HCW. Strains from children and HCW were indistinguishable. All carried the Panton-Valentine leukocidine (PVL), the staphylococcal enterotoxin B gene, the gene complex for staphylococcal-cassette-chromosome mec type V, and were sequence type 59. Strain HCM3A is epidemiologically unrelated to a strain of ST59 prevalent in the USA, although they belong to the same lineage.ConclusionsWe describe an outbreak of infections with CA-MRSA in children, transmitted by an asymptomatic colonized HCW during immunization injection. Consistent adherence to injection practice guidelines is needed to prevent CA-MRSA transmission in both in- and outpatient settings.
Highlights
Staphylococcus aureus is a commensal of the anterior nares in 25% of the human population, and carriage is a risk factor for infection and transmission of S. aureus in hospitals and the community [1,2]
Four children presented with skin and soft tissue infections, including one child (Child 4 in Table 1) with severe tissue necrosis requiring extensive surgical debridement which suggested the presence of necrotizing fasciitis (Figure 1)
We describe an outbreak of severe infections caused by CAMRSA acquired during routine vaccination injection
Summary
Staphylococcus aureus is a commensal of the anterior nares in 25% of the human population, and carriage is a risk factor for infection and transmission of S. aureus in hospitals and the community [1,2]. While methicillin resistant S. aureus (MRSA) are widespread in hospitals, community-acquired MRSA (CA-MRSA) is increasingly responsible for severe skin and soft tissue infections, necrotising fasciitis, and a fatal form of necrotising pneumonia, in previously healthy individuals [3,4,5]. CA-MRSA are responsible for 15–74% of skin and soft-tissue infections among patients presenting to emergency departments in the USA [6]. Infections with community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) are emerging worldwide. We investigated an outbreak of severe CA-MRSA infections in children following out-patient vaccination. S. aureus recovered from skin infections and from nasal and throat swabs were analyzed by pulse-field gel electrophoresis, multi locus sequence typing, PCR and microarray. We describe an outbreak of infections with CA-MRSA in children, transmitted by an asymptomatic colonized HCW during immunization injection. Consistent adherence to injection practice guidelines is needed to prevent CA-MRSA transmission in both in- and outpatient settings
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