An Outbreak of Conjunctivitis Due to Atypical Streptococcus pneumoniae
Michael Martin, M.D., M.P.H., John H. Turco, M.D., Michael E. Zegans, M.D., Richard R. Facklam, Ph.D., Samir Sodha, M.D., M.P.H., John A. Elliott, Ph.D., John H. Pryor, M.A., Bernard Beall, Ph.D., Dean D. Erdman, Dr.P.H., Yolanda Y. Baumgartner, M.B.A., Paul A. Sanchez, M.D., Joseph D. Schwartzman, M.D., José Montero, M.D., Anne Schuchat, M.D., and Cynthia G. Whitney, M.D., M.P.H.
Background In February 2002, clinicians at the Dartmouth CollegeHealth Service recognized an outbreak of conjunctivitis; culturesof conjunctival swabs implicated Streptococcus pneumoniae. Aninvestigation was begun to determine the extent of the outbreak,confirm the cause, identify modes of transmission, and implementcontrol measures.
Methods Investigators reviewed the health service's data basefor diagnoses of conjunctivitis. Viral and bacterial cultureswere obtained from ill students. Bile-soluble isolates thatwere susceptible to ethylhydrocupreine (optochin) and thereforewere presumed to be pneumococci underwent serotyping, capsularstaining, pulsed-field gel electrophoresis, a DNA probe, andmultilocus sequence typing. A cohort study of risk factors wasconducted with the use of the Internet. Control measures includeddistribution of alcohol-based hand gel and messages about prevention.
Results Among 5060 students, 698 (13.8 percent) received a diagnosisof conjunctivitis from January 1, 2002, through April 12, 2002,including 22 percent of first-year students. Presumed pneumococciwere isolated from 43.3 percent of conjunctival swabs (110 of254); viral cultures performed on 85 specimens were negative.DNA probes and multilocus sequence typing confirmed that theorganisms were pneumococci, although the bacteria did not havethe characteristic capsule. On pulsed-field gel electrophoresis,strains were found to be identical to pneumococci that causedoutbreaks of conjunctivitis in other parts of the country in1980. Analysis of survey data from 1832 students indicated thatclose contact with a student with conjunctivitis, wearing contactlenses, membership on a sports team, and attending parties ator living in a fraternity or sorority house were associatedwith conjunctivitis. The rate of diagnosis of conjunctivitisdeclined after the implementation of control measures and afterspring break.
Conclusions This large outbreak of conjunctivitis on a collegecampus was caused by an atypical, unencapsulated strain of S.pneumoniae that was identical to strains that had caused outbreakstwo decades earlier.
Source Information
From the Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases (M.M., R.R.F., J.A.E., B.B., A.S., C.G.W.), and the Division of Viral and Rickettsial Diseases (D.D.E.), National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta; the Dartmouth College Health Service (J.H.T., Y.Y.B.), Dartmouth–Hitchcock Medical Center (M.E.Z., J.D.S.), and Dartmouth Medical School (J.H.P., P.A.S.) — all in Hanover, N.H.; the UCLA School of Medicine, Los Angeles (S.S.); and the Office of Community and Public Health, New Hampshire Department of Health and Human Services, Concord (J.M.).
Address reprint requests to Dr. Whitney at the Division of Bacterial and Mycotic Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd. N.E., MS C23, Atlanta, GA 30333, or at cwhitney{at}cdc.gov.
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