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APHA Scientific Session and Event Listing

Ran Balicer, MD, MPH¹, Hagai Levine, MD¹, Eyal Klement¹, Ron Dagan, MD², and Salman Zarka, MD, MPH³. (1) Army Health Branch, Medical Corps, IDF, 02149, Tel Hashomer, Israel, 972-3-7376340, rbalicer@netvision.net.il, (2) Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University, POB 151, Beer-Sheva, Israel, (3) Army Health Branch and Haifa University School of Public Health, Medical Corps, IDF and Haifa University, 02149, Tel Hashomer, Israel

Introduction: A severe respiratory disease outbreak (SRDO) occurred in a military base, necessitating extensive studies and widespread intervention.

Methods: Epidemiological investigation including enhanced active clinical surveillance, environmental testing )e.g. legionella). Clinical samples were taken on outbreak days 3, 18 and 28 from over 100 patients and contacts controls, and were tested for bacterial (e.g. pneumococcus, mycoplasma, legionella) and viral (e.g. influenza, RSV, adenovirus) pathogens.

Results: 16 radiologically confirmed pneumonia and 55 febrile respiratory disease cases occurred within two weeks, mainly among 800 recruits in basic training. Recruits were sent home on outbreak day 5 before the causative agents were determined, to prevent further spread. In three of the pneumonia cases serious complications have occurred which required intensive care. In these patients positive blood cultures and/or sputum cultures were attained – all yielding Streptococcus pneumoniae serotype 5. Carriage rates of this serotype proved as high as 50% in recruits' companies. Prophylactic treatment with azithromycin and mass vaccination with 23-valent polysaccharide pneumococcal vaccine (administered on days 12-13) resulted in a complete and immediate halt of the outbreak, and near-complete eradication of SP carriage (from ~40% to <1%). Recruits returned to base 6 days later, and no additional cases occurred in the following 2 months.

Discussion: Streptococcus pneumoniae is an important pathogen in SRDO in confined settings, even in previously healthy adult population. Prophylactic measures such as pre-exposure antibiotics or pneumococcal vaccination may be considered in these settings. Lesson learned from managing this unique outbreak will be discussed in detail.

Learning Objectives:

• 1. Describe the differential diagnosis in an outbreak of severe acute respiratory illness.
• 2. Recognize the attributes of respiratory illness outbreaks caused by streptococcus pneumonia, and the options for preventing similar events.
• 3. Discuss the public health decision-making dilemmas in the management of a severe respiratory disease outbreak.

Keywords: Outbreaks, Infectious Diseases

Presenting author's disclosure statement:

Not Answered