title: Multistate Outbreak of Respiratory Infections Among Unaccompanied Children, June 2014-July 2014.
abstract: From January 2014-July 2014, more than 46 000 unaccompanied children (UC) from Central America crossed the US-Mexico border. In June-July, UC aged 9-17 years in 4 shelters and 1 processing center in 4 states were hospitalized with acute respiratory illness. We conducted a multistate investigation to interrupt disease transmission.
  
  
  
  Medical charts were abstracted for hospitalized UC. Nonhospitalized UC with influenza-like illness were interviewed, and nasopharyngeal and oropharyngeal swabs were collected to detect respiratory pathogens. Nasopharyngeal swabs were used to assess pneumococcal colonization in symptomatic and asymptomatic UC. Pneumococcal blood isolates from hospitalized UC and nasopharyngeal isolates were characterized by serotyping and whole-genome sequencing.
  
  
  
  Among 15 hospitalized UC, 4 (44%) of 9 tested positive for influenza viruses, and 6 (43%) of 14 with blood cultures grew pneumococcus, all serotype 5. Among 48 nonhospitalized children with influenza-like illness, 1 or more respiratory pathogens were identified in 46 (96%). Among 774 nonhospitalized UC, 185 (24%) yielded pneumococcus, and 70 (38%) were serotype 5. UC transferring through the processing center were more likely to be colonized with serotype 5 (odds ratio, 3.8; 95% confidence interval, 2.1-6.9). Analysis of core pneumococcal genomes detected 2 related, yet independent, clusters. No pneumococcus cases were reported after pneumococcal and influenza immunization campaigns.
  
  
  
  This respiratory disease outbreak was due to multiple pathogens, including Streptococcus pneumoniae serotype 5 and influenza viruses. Pneumococcal and influenza vaccinations prevented further transmission. Future efforts to prevent similar outbreaks will benefit from use of both vaccines.
authors.affiliation: Epidemic Intelligence Service Respiratory Diseases Branch.
authors.forename: Sara
authors.initials: S
authors.lastname: Tomczyk
authors.affiliation: Epidemic Intelligence Service Influenza Division.
authors.forename: Carmen S
authors.initials: CS
authors.lastname: Arriola
authors.affiliation: Respiratory Diseases Branch.
authors.forename: Bernard
authors.initials: B
authors.lastname: Beall
authors.affiliation: Respiratory Diseases Branch.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Benitez
authors.affiliation: Division of Global Migration and Quarantine.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Benoit
authors.affiliation: Influenza Division.
authors.forename: LaShondra
authors.initials: L
authors.lastname: Berman
authors.affiliation: Influenza Division.
authors.forename: Joseph
authors.initials: J
authors.lastname: Bresee
authors.affiliation: Respiratory Diseases Branch.
authors.forename: Maria
authors.initials: M
authors.lastname: da Gloria Carvalho
authors.affiliation: Immunization Services Division.
authors.forename: Amanda
authors.initials: A
authors.lastname: Cohn
authors.affiliation: Respiratory Diseases Branch.
authors.forename: Kristen
authors.initials: K
authors.lastname: Cross
authors.affiliation: Respiratory Diseases Branch.
authors.forename: Maureen H
authors.initials: MH
authors.lastname: Diaz
authors.affiliation: Epidemic Intelligence Service Respiratory Diseases Branch.
authors.forename: Louise K
authors.initials: LK
authors.lastname: Francois Watkins
authors.affiliation: Respiratory Diseases Branch.
authors.forename: Ryan
authors.initials: R
authors.lastname: Gierke
authors.affiliation: Epidemic Intelligence Service Global Immunizations Division, Centers for Disease Control and Prevention, Atlanta, Georgia US Public Health Service, Rockville, Maryland.
authors.forename: Jose E
authors.initials: JE
authors.lastname: Hagan
authors.affiliation: Respiratory Diseases Branch US Public Health Service, Rockville, Maryland.
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Harris
authors.affiliation: Influenza Division.
authors.forename: Seema
authors.initials: S
authors.lastname: Jain
authors.affiliation: Respiratory Diseases Branch US Public Health Service, Rockville, Maryland.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Kim
authors.affiliation: Epidemic Intelligence Service Respiratory Diseases Branch.
authors.forename: Miwako
authors.initials: M
authors.lastname: Kobayashi
authors.affiliation: Influenza Division.
authors.forename: Stephen
authors.initials: S
authors.lastname: Lindstrom
authors.affiliation: Respiratory Diseases Branch.
authors.forename: Lesley
authors.initials: L
authors.lastname: McGee
authors.affiliation: Influenza Division US Public Health Service, Rockville, Maryland.
authors.forename: Meredith
authors.initials: M
authors.lastname: McMorrow
authors.affiliation: Respiratory Diseases Branch.
authors.forename: Benjamin L
authors.initials: BL
authors.lastname: Metcalf
authors.affiliation: Respiratory Diseases Branch US Public Health Service, Rockville, Maryland.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Moore
authors.affiliation: Respiratory Diseases Branch.
authors.forename: Iaci
authors.initials: I
authors.lastname: Moura
authors.affiliation: Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: W Allan
authors.initials: WA
authors.lastname: Nix
authors.affiliation: Epidemic Intelligence Service Division of Global Migration and Quarantine.
authors.forename: Edith
authors.initials: E
authors.lastname: Nyangoma
authors.affiliation: Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: M Steven
authors.initials: MS
authors.lastname: Oberste
authors.affiliation: Influenza Division.
authors.forename: Sonja J
authors.initials: SJ
authors.lastname: Olsen
authors.affiliation: Respiratory Diseases Branch.
authors.forename: Fabiana
authors.initials: F
authors.lastname: Pimenta
authors.affiliation: Epidemic Intelligence Service National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia.
authors.forename: Christina
authors.initials: C
authors.lastname: Socias
authors.affiliation: Respiratory Diseases Branch.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Thurman
authors.affiliation: Respiratory Diseases Branch.
authors.forename: Jessica
authors.initials: J
authors.lastname: Waller
authors.affiliation: Division of Global Migration and Quarantine.
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Waterman
authors.affiliation: Epidemic Intelligence Service Respiratory Diseases Branch.
authors.forename: Matthew
authors.initials: M
authors.lastname: Westercamp
authors.affiliation: Immunization Services Division.
authors.forename: Melinda
authors.initials: M
authors.lastname: Wharton
authors.affiliation: Respiratory Diseases Branch US Public Health Service, Rockville, Maryland.
authors.forename: Cynthia G
authors.initials: CG
authors.lastname: Whitney
authors.affiliation: Respiratory Diseases Branch.
authors.forename: Jonas M
authors.initials: JM
authors.lastname: Winchell
authors.affiliation: Respiratory Diseases Branch.
authors.forename: Bernard
authors.initials: B
authors.lastname: Wolff
authors.affiliation: US Public Health Service, Rockville, Maryland Office of Refugee Resettlement, Administration for Children and Families, Washington D.C.
authors.forename: Curi
authors.initials: C
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D002648:Child; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007252:Influenza Vaccines; D007251:Influenza, Human / Q000453:epidemiology / Q000517:prevention & control / Q000821:virology; D008297:Male; D008800:Mexico / Q000208:ethnology; D009305:Nasopharynx / Q000382:microbiology / Q000821:virology; D009975:Orthomyxoviridae; D022242:Pneumococcal Vaccines; D011018:Pneumonia, Pneumococcal / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D012036:Refugees / Q000706:statistics & numerical data*; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D012307:Risk Factors; D013296:Streptococcus pneumoniae; D014481:United States / Q000453:epidemiology; D035862:Vulnerable Populations / Q000706:statistics & numerical data*
chemical_list: D007252:Influenza Vaccines; D022242:Pneumococcal Vaccines
keywords: Streptococcus pneumoniae; influenza; outbreak; unaccompanied children; vaccination