Outbreaks of serious pneumococcal disease in closed settings in the post-antibiotic era: a systematic review.
Ihekweazu C., Basarab M., Wilson D., Oliver I., Dance D., George R., Pebody R.
SUMMARY OBJECTIVES: Since the introduction of antibiotics, pneumococcal disease is predominantly sporadic, with occasional outbreaks. Our objective was to review the epidemiology of reported outbreaks of serious pneumococcal disease in closed settings to inform the development of guidelines to manage such outbreaks. METHODS: We systematically reviewed the literature for reported outbreaks of serious pneumococcal disease in closed settings to inform the development of guidelines in managing such outbreaks. RESULTS: We identified 42 outbreaks reported in 39 papers---14 in hospitals, 12 in long term care facilities, five outbreaks in households, four in military settings, three in child care settings and two each in homeless shelters and jails. The serotype/group most frequently associated with outbreaks was 14 (seven outbreaks) followed by 4 (five outbreaks) then serotypes/groups 1, 9 and 9V each causing four outbreaks. The median outbreak size was four cases (2 - 46). The median duration was eight days, with 84% of cases occurring within 14 days of the first case. CONCLUSION: Outbreaks of serious pneumococcal disease are likely to continue happening requiring early recognition and implementation of public health measures in order to interrupt transmission. This study facilitated the development of the first UK interim guidelines for managing such outbreaks.