title: Outbreaks of serious pneumococcal disease in closed settings in the post-antibiotic era: a systematic review.
abstract: OBJECTIVE
  Since the introduction of antibiotics, pneumococcal disease is predominantly sporadic, with occasional outbreaks. Our objective was to review the epidemiology of reported outbreaks of serious pneumococcal disease in closed settings to inform the development of guidelines to manage such outbreaks.
  
  
  METHODS
  We systematically reviewed the literature for reported outbreaks of serious pneumococcal disease in closed settings to inform the development of guidelines in managing such outbreaks.
  
  
  RESULTS
  We identified 42 outbreaks reported in 39 papers---14 in hospitals, 12 in long term care facilities, five outbreaks in households, four in military settings, three in child care settings and two each in homeless shelters and jails. The serotype/group most frequently associated with outbreaks was 14 (seven outbreaks) followed by 4 (five outbreaks) then serotypes/groups 1, 9 and 9V each causing four outbreaks. The median outbreak size was four cases (2 - 46). The median duration was eight days, with 84% of cases occurring within 14 days of the first case.
  
  
  CONCLUSIONS
  Outbreaks of serious pneumococcal disease are likely to continue happening requiring early recognition and implementation of public health measures in order to interrupt transmission. This study facilitated the development of the first UK interim guidelines for managing such outbreaks.
authors.affiliation: Health Protection Agency, Centre for Infections, 61 Colindale Avenue, London NW9 5EQ, UK.
authors.forename: Chikwe
authors.initials: C
authors.lastname: Ihekweazu
authors.forename: Marina
authors.initials: M
authors.lastname: Basarab
authors.forename: Deborah
authors.initials: D
authors.lastname: Wilson
authors.forename: Isabel
authors.initials: I
authors.lastname: Oliver
authors.forename: David
authors.initials: D
authors.lastname: Dance
authors.forename: Robert
authors.initials: R
authors.lastname: George
authors.forename: Richard
authors.initials: R
authors.lastname: Pebody
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D004196:Disease Outbreaks; D006801:Humans; D011008:Pneumococcal Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents