Abstract
BackgroundOn 7th June, 2018, a primary school in Beijing, China notified Shunyi CDC of an outbreak of acute respiratory disease characterized by fever and cough among students and resulting in nine hospitalization cases during the preceding 2 weeks. We started an investigation to identify the etiologic agent, find additional cases, develop and implement control measures.MethodsWe defined probable cases as students, teachers and other staffs in the school developed fever (T ≥ 37.5 °C) with cough or sore throat; or a diagnosis of pneumonia during May 1–June 31, 2018. Confirmed cases were probable cases with Mycoplasma pneumoniae detected in oropharyngeal (OP) swabs by quantitative real-time polymerase chain reaction (qPCR). We searched case by reviewing school absenteeism records and interviewing students, teachers and staff in this school. Oropharyngeal swabs were collected from symptomatic students. Two qPCR) assay, a duplex qPCR assay, and sequencing were performed to determine the pathogen, genotype and macrolide resistance at the gene level, respectively.ResultsFrom May 1st to June 31st, 2018, we identified 55 cases (36 probable and 19 confirmed), of whom 25 (45%) were hospitalized for complications. All cases were students, none of the teachers and other staffs in the school were with similar symptoms. The attack rate (AR) was 3.9% (55/1398) for all students. The cases were mainly male (58%), with an age range of 7–8 years (median: 7 years). 72% (18/25) of inpatients had radiograph findings consistent with pneumonia, and some cases were hospitalized for up to 4 weeks. Pathogen detection results indicated that Mycoplasma pneumonia (M. pneumoniae) P1 type 1 was the causative agent in this outbreak, and the strain harbored one point mutation of A to G at position 2063.ConclusionsThe infections by macrolide-resistant M. pneumoniae are not always mild and pneumonia was common and M. pneumoniae could causes serious complications which require long-term hospitalization. In the future infectious disease prevention and control practice, M. pneumoniae should be paid more attention. It is necessary to establish and improve the pathogen and drug resistance surveillance system in order to prevent and control such mutated strains of M. pneumoniae from causing future outbreaks or epidemics in China.
Highlights
On 7th June, 2018, a primary school in Beijing, China notified Shunyi center for disease control and prevention (CDC) of an outbreak of acute respiratory disease characterized by fever and cough among students and resulting in nine hospitalization cases during the preceding 2 weeks
Illness onset occurred during May 14–June 28, 2018 and peaked at the beginning of June (Fig. 1)
The “sunflower dinner table” here is a private institution which makes profit by providing lunch and dinner to students in noon and evening after school time, and it provides space for students to have a nap in the noon
Summary
On 7th June, 2018, a primary school in Beijing, China notified Shunyi CDC of an outbreak of acute respiratory disease characterized by fever and cough among students and resulting in nine hospitalization cases during the preceding 2 weeks. M. pneumoniae infections develop in persons of all ages, especially in children and teenagers [4]. M. pneumoniae can cause extrapulmonary manifestations, including neurologic, dermatologic, hematologic and cardiac syndromes which can result in hospitalization and death [6, 7]. Macrolide antibiotics are commonly used drugs for the treatment of M. pneumoniae infection. With the widespread or inappropriate use of antibiotic, macrolide-resistant M. pneumoniae (MRMP) has become an emerging threat worldwide [8,9,10]. MRMP has become very serious in Asia [11,12,13,14]
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