Abstract
Staphylococcal scalded skin syndrome (SSSS) is a blistering skin condition caused by exfoliative toxin-producing strains of Staphylococcus aureus. Outbreaks of SSSS in maternity settings are rarely reported. We describe an outbreak of SSSS that occurred among neonates born at a maternity unit in England during December 2012 to March 2013. Detailed epidemiological and microbiological investigations were undertaken. Eight neonates were found to be infected with the outbreak strain of S. aureus, of spa type t346, representing a single pulsotype. All eight isolates contained genes encoding exfoliative toxin A (eta) and six of them contained genes encoding toxin B (etb). Nasal swabs taken during targeted staff screening yielded a staphylococcal carriage rate of 21% (17/80), but none contained the outbreak strain. Mass screening involving multi-site swabbing and pooled, enrichment culture identified a healthcare worker (HCW) with the outbreak strain. This HCW was known to have a chronic skin condition and their initial nasal screen was negative. The outbreak ended when they were excluded from work. This outbreak highlights the need for implementing robust swabbing and culture methodswhen conventional techniques are unsuccessful in identifying staff carrier(s). This study adds to the growing body of evidence on the role of HCWs in nosocomial transmission of S. aureus.
Highlights
Staphylococcal scalded skin syndrome (SSSS) predominantly but not exclusively affects neonates and children under the age of five years
A review of the Staphylococcal Reference Unit database of Public Health England showed that around 50–100 cases of SSSS are confirmed in England each year, which equates to 0.94–1.88 cases/million/year
We describe the investigation and control measures that led to the resolution of the outbreak
Summary
Staphylococcal scalded skin syndrome (SSSS) predominantly but not exclusively affects neonates and children under the age of five years. It results from infection with strains of Staphylococcus aureus containing genes encoding exfoliative toxin A (eta) and B (etb). Around 5% of all S. aureus produce exfoliative toxins. These toxins act in the zona granulosa of the epidermis, leading to a spectrum of illness ranging from mild localised blistering to extensive generalised lesions [1]. Incidence of SSSS probably varies among countries in Europe, with estimates ranging from 0.56 cases/million/year in France to 2.53 cases/ million/year in the Czech Republic [3,4]
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