title: Outbreaks of Invasive Kingella kingae Infections in Closed Communities.
abstract: OBJECTIVE
  To describe the results of the epidemiologic investigation of outbreaks of invasive Kingella kingae infections among attendees at daycare facilities located in 4 closed communities in Israel.
  
  
  METHODS
  The preschool-aged population of communities with clusters of Kingella cases had oropharyngeal cultures performed. K kingae isolates from infected patients and healthy contacts were genotyped by pulsed field gel electrophoresis to determine the spread of outbreak strains.
  
  
  RESULTS
  The affected closed communities (3 military bases and 1 "kibbutz" commune) were characterized by tight social and family networks and intensive mingling. The outbreaks affected 9 of 51 attendees (attack rate: 17.6%) age 8-19 months (median: 12 months), within a 21-day period. Cases included skeletal system infections (n = 8) and bacteremia (n = 1); K kingae isolates were confirmed by the use of blood culture vials and selective media. Clinical presentation was mild and acute-phase reactants were usually normal or only moderately elevated. Thirty out of 55 (54.5%) asymptomatic children carried the outbreak strains. Analysis of the 3 clusters in which the entire preschool-aged population was cultured revealed that 31 of 71 (43.7%) children younger than 24 months of age were colonized with K kingae organisms compared with 8 of 105 (7.6%) older children (P < .001).
  
  
  CONCLUSIONS
  Clusters of invasive K kingae infections characterized by sudden onset, high attack rate, and wide dissemination of the outbreak strain can occur in daycare facilities and closed communities. Because the mild clinical presentation of invasive K kingae infections and the fastidious nature of the organism, a high index of suspicion and use of sensitive detection methods are recommended.
authors.affiliation: Clinical Microbiology Laboratory, Soroka University Medical Center, Beer-Sheva, Israel. Electronic address: yagupsky@bgu.ac.il.
authors.forename: Pablo
authors.initials: P
authors.lastname: Yagupsky
authors.affiliation: Israel Defense Forces Medical Corps, Israel.
authors.forename: Yael
authors.initials: Y
authors.lastname: Ben-Ami
authors.affiliation: Pediatric Infectious Disease Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: Ronit
authors.initials: R
authors.lastname: Trefler
authors.affiliation: Pediatric Infectious Disease Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: Nurith
authors.initials: N
authors.lastname: Porat
mesh_terms: D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D007223:Infant; D007557:Israel / Q000453:epidemiology; D017882:Kingella kingae; D008297:Male; D016870:Neisseriaceae Infections / Q000453:epidemiology*; D012111:Residence Characteristics; D013029:Space-Time Clustering