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An Outbreak of Severe Infections with Community-Acquired MRSA Carrying the Panton-Valentine Leukocidin Following Vaccination

2007; Public Library of Science; Volume: 2; Issue: 9 Linguagem: Inglês

10.1371/journal.pone.0000822

1932-6203

Tang Chi Thuong, Nguyen Dac Tho, Ngô Thị Hoa, Nguyễn Thị Minh Phương, Lê Văn Tuấn, To Song Diep, Jodi A. Lindsay, Nguyen The Dung, Bach Van Cam, Le Quoc Thinh, Lê Thanh Hải, Le Dieu Linh, James I. Campbell, Nguyen Thi Kim Tien, Nguyen Van Vinh Chau, Joshua Cockfield, Giang Truong Le, Phan Van Nghiem, Lê Hoàng Sơn, Huynh Tan Son, Le Van Phung, Megan Counahan, Adwoa Bentsi-Enchill, Richard B. Brown, James Mark Simmerman, Nguyen Tran Chinh, Tran Tinh Hien, Jeremy Farrar, Constance Schultsz,

Bacterial biofilms and quorum sensing

Background Infections with community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) are emerging worldwide. We investigated an outbreak of severe CA-MRSA infections in children following out-patient vaccination. Methods and Findings We carried out a field investigation after adverse events following immunization (AEFI) were reported. We reviewed the clinical data from all cases. S. aureus recovered from skin infections and from nasal and throat swabs were analyzed by pulse-field gel electrophoresis, multi locus sequence typing, PCR and microarray. In May 2006, nine children presented with AEFI, ranging from fatal toxic shock syndrome, necrotizing soft tissue infection, purulent abscesses, to fever with rash. All had received a vaccination injection in different health centres in one District of Ho Chi Minh City. Eight children had been vaccinated by the same health care worker (HCW). Deficiencies in vaccine quality, storage practices, or preparation and delivery were not found. Infection control practices were insufficient. CA-MRSA was cultured in four children and from nasal and throat swabs from the HCW. Strains from children and HCW were indistinguishable. All carried the Panton-Valentine leukocidine (PVL), the staphylococcal enterotoxin B gene, the gene complex for staphylococcal-cassette-chromosome mec type V, and were sequence type 59. Strain HCM3A is epidemiologically unrelated to a strain of ST59 prevalent in the USA, although they belong to the same lineage. Conclusions We describe an outbreak of infections with CA-MRSA in children, transmitted by an asymptomatic colonized HCW during immunization injection. Consistent adherence to injection practice guidelines is needed to prevent CA-MRSA transmission in both in- and outpatient settings.