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APHA Scientific Session and Event Listing

Recorded presentation

Elquemedo Oscar Alleyne, MPH, Epidemiology, Rockland County Department of Health, 50 Sanatorium Road, Bldg D, Pomona, NY 10970, 8453642956, alleyneo@co.rockland.ny.us, Germaine Jacquette, MD, Director, TB and Communicable Diseases, Rockland County Department of Health, 50 Sanatorium Road, Pomona, NY 10970, and Robyn M. Atkinson, PhD, Director of Clinical Bacteriology, Wadsworth Center, New York State Department of Health, 120 New Scotland Ave., Albany, NY 120 New Scot.

Staphylococcus aureus (S. aureus) is a common cause of severe skin and soft tissue infections. Outbreaks of Methicillin-resistant S. aureus infections (MRSA) in community and correctional settings have sometimes noted the presence of Panton-Valentine Leukocidin (PVL) gene, a virulence factor in ~ 2% of S. aureus strains. To date the presence of this gene in MSSA outbreaks in the USA may have been overlooked. We report a cluster of severe infections caused by a PVL-containing strain of MSSA in a county jail. Between July 27 and Sept. 1, 2005, 24 inmates were evaluated following reports of rapidly progressing cellulitis and abscess lesions on the head, buttocks, and extremities. Wound cultures of 3 inmates revealed pure growth of S. aureus that was susceptible to oxacillin, intermediate to levofloxacin, and resistant to penicillin, quinolones, azithromycin, erythromycin, and cephalothin. Intensive infection control, environmental measures and work adjustments were required to curtail the outbreak. Wound isolates from 2 culture-confirmed cases and nasopharyngeal (NP) MSSA isolates from 5 probable/suspect cases were characterized by the NYS Wadsworth Center Bacteriology Laboratory. One NP and two wound isolates were positive for PVL, with indistinguishable DNA patterns on PFGE. Four other MSSA isolates from inmates with minor skin infections had different susceptibility patterns and were PVL-negative. We demonstrate the rapid spread of MSSA strains possessing the PVL gene in a correctional setting in the USA. Epidemiologic mapping of inmate movements suggested how spread occurred, and supported the measures that were instituted to curtail transmission of this highly aggressive strain.

Learning Objectives:

• Recognize need for differential diagnosis in outbreak investigation
• Describe and discuss epidemiologic, infection control and environmental strategies for outbreak investigations in a correctional setting

Keywords: Outbreaks, Infectious Diseases

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation