title: Community outbreak of Mycoplasma pneumoniae infection: school-based cluster of neurologic disease associated with household transmission of respiratory illness.
abstract: BACKGROUND
  We investigated an outbreak of severe neurologic disease and pneumonia that occurred among students at 4 schools in Rhode Island.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Epidemic Intelligence Service, Office of Workforce and Career Development, Atlanta, Georgia, USA.
authors.forename: Nicholas D
authors.initials: ND
authors.lastname: Walter
authors.forename: Gavin B
authors.initials: GB
authors.lastname: Grant
authors.forename: Utpala
authors.initials: U
authors.lastname: Bandy
authors.forename: Nicole E
authors.initials: NE
authors.lastname: Alexander
authors.forename: Jonas M
authors.initials: JM
authors.lastname: Winchell
authors.forename: Hannah T
authors.initials: HT
authors.lastname: Jordan
authors.forename: James J
authors.initials: JJ
authors.lastname: Sejvar
authors.forename: Lauri A
authors.initials: LA
authors.lastname: Hicks
authors.forename: David R
authors.initials: DR
authors.lastname: Gifford
authors.forename: Nicole T
authors.initials: NT
authors.lastname: Alexander
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Thurman
authors.forename: Stephanie B
authors.initials: SB
authors.lastname: Schwartz
authors.forename: Penelope H
authors.initials: PH
authors.lastname: Dennehy
authors.forename: Nino
authors.initials: N
authors.lastname: Khetsuriani
authors.forename: Barry S
authors.initials: BS
authors.lastname: Fields
authors.forename: Michael T
authors.initials: MT
authors.lastname: Dillon
authors.forename: Dean D
authors.initials: DD
authors.lastname: Erdman
authors.forename: Cynthia G
authors.initials: CG
authors.lastname: Whitney
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Moore
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission*; D004196:Disease Outbreaks; D004660:Encephalitis / Q000453:epidemiology / Q000382:microbiology; D005191:Family Characteristics; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009175:Mycoplasma Infections / Q000382:microbiology / Q000635:transmission*; D009177:Mycoplasma pneumoniae; D011446:Prospective Studies; D012189:Retrospective Studies; D012574:Schools; D017192:Skin Diseases, Bacterial / Q000382:microbiology / Q000635:transmission