Pneumococcal conjunctivitis at an elementary school — Maine, September 20-December 6, 2002

Morbidity and Mortality Weekly Report, Jan 31, 2003

Reported by: C Leighton, Westbrook School District, Westbrook; D Piper, MS, NorDx Laboratories, Scarborough; J Gunderman-King, V Rea, MPH, K Gensheimer, MD, J Randolph, R Danforth, L Webber, E Pritchard, MS. G Beckett, MPH, Maine Bur of Health. V Shinde, MPH, R Facklam, PhD, C Whitney MD, Div of Bacterial and Mycotic Diseases, National Center for Infectious Diseases; N Hayes, MD, Div of Applied Public Health Training, Epidemiology Program Office; B Flannery PhD, EIS Officer, CDC.

Editorial note: This report describes an outbreak in an elementary school of conjunctivitis attributed to a nontypeable strain of S. pneumoniae. Nontypeable pneumococci have been implicated previously in outbreaks of conjunctivitis among university students (1,2) and military recruits (2,3) and in sporadic cases of conjunctivitis (4). This is the first report of an outbreak of conjunctivitis caused by nontypeable pneumococci involving young children, with documented transmission to persons in the community outside the institutional setting. Although children were not seriously ill, the outbreak resulted in lost school days for ill children and in economic losses and inconvenience for parents of ill children for healthcare provider visits and missed work.

The effectiveness of prevention measures for interrupting the transmission of conjunctivitis is not known. Person-to-person transmission of the outbreak strain is believed to occur through contact with eye secretions or respiratory droplets. In schools, ensuring regular hand washing might improve hygiene among students but might not be sufficient to stop transmission of a highly contagious organism, especially one transmitted through respiratory droplets. Use of alcohol-based hand gels has been shown to prevent the transfer of pathogens in health-care settings (5), but their use in schools has not yet been evaluated. Although the effectiveness of excluding students with symptoms of conjunctivitis from school to limit a recognized outbreak is not known, such exclusion is recommended during the acute phase of symptoms (6). In the absence of clinical signs of systemic infection, the American Academy of Pediatrics recommends readmission of school children with conjunctivitis after therapy is initiated (7). Althou gh antibiotic eye drops are prescribed commonly as empiric therapy for conjunctivitis, the effect of topical antibiotic therapy on transmission of pneumococcal conjunctivitis is unknown. The results from one trial indicated that persons treated with bacitracin/polymyxin opthalmic ointment were more likely to have eradication of eye pathogens at 3-5 days than persons treated with a placebo (8).

Health-care providers who see a substantial increase in visits for conjunctivitis should consider obtaining bacterial and viral cultures of eye secretions to determine the etiology. CDC is interested in evaluating the effectiveness of control measures and the usefulness of topical antibiotic therapy in future outbreaks caused by S. pneumoniae. Outbreaks of S. pneumoniae conjunctivitis should be reported to state health departments, which may contact CDC, telephone 404-639-2215, for additional assistance.