title: Outbreak of pneumonia in the setting of fatal pneumococcal meningitis among US Army trainees: potential role of Chlamydia pneumoniae infection.
abstract: BACKGROUND
  Compared to the civilian population, military trainees are often at increased risk for respiratory infections. We investigated an outbreak of radiologically-confirmed pneumonia that was recognized after 2 fatal cases of serotype 7F pneumococcal meningitis were reported in a 303-person military trainee company (Alpha Company).
  
  
  METHODS
  We reviewed surveillance data on pneumonia and febrile respiratory illness at the training facility; conducted chart reviews for cases of radiologically-confirmed pneumonia; and administered surveys and collected nasopharyngeal swabs from trainees in the outbreak battalion (Alpha and Hotel Companies), associated training staff, and trainees newly joining the battalion.
  
  
  RESULTS
  Among Alpha and Hotel Company trainees, the average weekly attack rates of radiologically-confirmed pneumonia were 1.4% and 1.2% (most other companies at FLW: 0-0.4%). The pneumococcal carriage rate among all Alpha Company trainees was 15% with a predominance of serotypes 7F and 3. Chlamydia pneumoniae was identified from 31% of specimens collected from Alpha Company trainees with respiratory symptoms.
  
  
  CONCLUSIONS
  Although the etiology of the outbreak remains unclear, the identification of both S. pneumoniae and C. pneumoniae among trainees suggests that both pathogens may have contributed either independently or as cofactors to the observed increased incidence of pneumonia in the outbreak battalion and should be considered as possible etiologies in outbreaks of pneumonia in the military population.
authors.affiliation: Epidemic Intelligence Service, Office of Workforce and Career Development assigned to Influenza Epidemiology and Prevention Branch, Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. fdawood@cdc.gov
authors.forename: Fatimah S
authors.initials: FS
authors.lastname: Dawood
authors.forename: John F
authors.initials: JF
authors.lastname: Ambrose
authors.forename: Bruce P
authors.initials: BP
authors.lastname: Russell
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Hawksworth
authors.forename: Jonas M
authors.initials: JM
authors.lastname: Winchell
authors.forename: Nina
authors.initials: N
authors.lastname: Glass
authors.forename: Kathleen
authors.initials: K
authors.lastname: Thurman
authors.forename: Michele A
authors.initials: MA
authors.lastname: Soltis
authors.forename: Erin
authors.initials: E
authors.lastname: McDonough
authors.forename: Agnes K
authors.initials: AK
authors.lastname: Warner
authors.forename: Emily
authors.initials: E
authors.lastname: Weston
authors.forename: Nakia S
authors.initials: NS
authors.lastname: Clemmons
authors.forename: Jennifer
authors.initials: J
authors.lastname: Rosen
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Mitchell
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Faix
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Blair
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Moore
authors.forename: John
authors.initials: J
authors.lastname: Lowery
mesh_terms: D000293:Adolescent; D000328:Adult; D002690:Chlamydia Infections / Q000453:epidemiology / Q000382:microbiology*; D016993:Chlamydophila pneumoniae / Q000235:genetics / Q000302:isolation & purification* / Q000502:physiology; D003430:Cross-Sectional Studies; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D008297:Male; D008586:Meningitis, Pneumococcal / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D008875:Middle Aged; D008889:Military Personnel / Q000706:statistics & numerical data*; D018410:Pneumonia, Bacterial / Q000453:epidemiology / Q000382:microbiology*; D013296:Streptococcus pneumoniae / Q000235:genetics / Q000302:isolation & purification* / Q000502:physiology; D014481:United States / Q000453:epidemiology; D055815:Young Adult