Clinical features, outcomes, and costs of a conjunctivitis outbreak caused by the ST448 strain of Streptococcus pneumoniae.
OBJECTIVE
An outbreak of pneumococcal conjunctivitis occurred at Dartmouth College in 2002. We describe the clinical features, outcomes, and costs associated with this outbreak.


METHODS
Six hundred ninety-eight students were diagnosed with conjunctivitis; culture of conjunctival discharge was obtained for 254. A screening protocol was used to evaluate 67 patients. A retrospective survey was offered to all 698 cases and follow-up clinical examination to all patients with culture-confirmed infection (n = 110). Local ophthalmology offices were contacted to develop a cost analysis. The college health service provided conjunctivitis data for nonoutbreak years.


RESULTS
Of 67 patients evaluated using the screening protocol, findings associated with culture-confirmed Streptococcus pneumoniae conjunctivitis (P < 0.01) were red eye visible from 2 feet, any type of conjunctival discharge, obscuration of tarsal conjunctival blood vessels, and chemosis. Two hundred thirty-two students responded to our retrospective survey; 89% reported bilateral eye involvement; 96% received topical antibiotics and noted symptom improvement within 3 days of treatment. No ocular sequelae were identified as a result of this infection. No recurrent outbreaks have occurred at Dartmouth since the initial event. The estimated cost of this outbreak including evaluations, cultures, and antibiotics ranged from $66,468 to $120,583.


CONCLUSIONS
The ST448 strain of S. pneumoniae caused a disruptive outbreak of conjunctivitis at Dartmouth College. A screening protocol was effective at identifying culture-positive cases. Although most culture-positive patients experienced bilateral conjunctivitis, the clinical course was mild with quick resolution of symptoms after initiating antibiotics and no ocular sequelae.
Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.
Michael E
ME
Zegans
Paul A
PA
Sanchez
Donald S
DS
Likosky
Rory T
RT
Allar
Michael
M
Martin
Joseph D
JD
Schwartzman
John H
JH
Pryor
John H
JH
Turco
Cynthia G
CG
Whitney
D000287:Administration, Topical; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D003231:Conjunctivitis / Q000453:epidemiology* / Q000382:microbiology* / Q000473:pathology / Q000503:physiopathology; D004196:Disease Outbreaks / Q000191:economics*; D017048:Health Care Costs; D006801:Humans; D008403:Mass Screening; D011008:Pneumococcal Infections / Q000175:diagnosis / Q000188:drug therapy; D012189:Retrospective Studies; D013045:Species Specificity; D013296:Streptococcus pneumoniae / Q000235:genetics*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult
D000900:Anti-Bacterial Agents