title: An explosive outbreak of Streptococcus pneumoniae serotype-8 infection in a highly vaccinated residential care home, England, summer 2012.
abstract: In August 2012, an explosive outbreak of severe lower respiratory tract infection (LRTI) due to Streptococcus pneumoniae serotype-8 occurred in a highly vaccinated elderly institutionalized population in England. Fifteen of 23 residents developed LRTI over 4 days (attack rate 65%); 11 had confirmed S. pneumoniae serotype-8 disease, and two died. Following amoxicillin chemoprophylaxis and pneumococcal polysaccharide vaccine (PPV) re-vaccination no further cases occurred in the following 2 months. No association was found between being an outbreak-associated case and age (P = 0.36), underlying comorbidities [relative risk (RR) 0.84 95% confidence interval (CI) 0.34-2.09], or prior receipt of PPV (RR 1.4, 95% CI 0.60-3.33). However, the median number of years since PPV was significantly higher for cases (n = 15, 10.2 years, range 7.3-17.9 years) than non-cases (n = 8, 7.2 years, range 6.8-12.8 years) (P = 0.045), provided evidence of waning immunity. Alternative vaccination strategies should be considered to prevent future S. pneumoniae outbreaks in institutionalized elderly populations.
authors.affiliation: Centre for Infectious Disease Surveillance and Control,Public Health England,London,UK.
authors.forename: H L
authors.initials: HL
authors.lastname: Thomas
authors.affiliation: West Midlands Public Health England Centre,Birmingham,UK.
authors.forename: R
authors.initials: R
authors.lastname: Gajraj
authors.affiliation: Respiratory and Vaccine Preventable Bacteria Reference Unit,Public Health England,London,UK.
authors.forename: M P E
authors.initials: MP
authors.lastname: Slack
authors.affiliation: Respiratory and Vaccine Preventable Bacteria Reference Unit,Public Health England,London,UK.
authors.forename: C
authors.initials: C
authors.lastname: Sheppard
authors.affiliation: Public Health England Birmingham Laboratory,Health of England NHS Foundation Trust,Birmingham,UK.
authors.forename: P
authors.initials: P
authors.lastname: Hawkey
authors.affiliation: Public Health England Birmingham Laboratory,Health of England NHS Foundation Trust,Birmingham,UK.
authors.forename: S
authors.initials: S
authors.lastname: Gossain
authors.affiliation: West Midlands Public Health England Centre,Birmingham,UK.
authors.forename: C M
authors.initials: CM
authors.lastname: Drew
authors.affiliation: Centre for Infectious Disease Surveillance and Control,Public Health England,London,UK.
authors.forename: R G
authors.initials: RG
authors.lastname: Pebody
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004196:Disease Outbreaks; D004739:England / Q000453:epidemiology; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D009735:Nursing Homes; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000276:immunology; D022242:Pneumococcal Vaccines / Q000276:immunology / Q000627:therapeutic use; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000276:immunology / Q000517:prevention & control; D012621:Seasons
chemical_list: D022242:Pneumococcal Vaccines
keywords: Disease outbreaks; pneumococcal infections; pneumococcal polysaccharide vaccine