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Clin Infect Dis. Investigation of a Chlamydia pneumoniae Outbreak in a Federal Correctional Facility in Texas
[Source: Clinical Infectious Diseases Journal, full page: (LINK). Abstract, edited.]
Investigation of a Chlamydia pneumoniae Outbreak in a Federal Correctional Facility in Texas
Laura Conklin 1,a, Jennifer Adjemian 2,a, Jennifer Loo 1, Sema Mandal 1,4, Carol Davis 3, Sharyn Parks 3,4, Tina Parsons 2, Brian McDonough 2, Jorge Partida 2, Kathleen Thurman 1, Maureen H. Diaz 1, Alvaro Benitez 1, Tracy Pondo 1, Cynthia G. Whitney 1, Jonas M. Winchell 1, Newton Kendig 2, and Chris Van Beneden 1
Author Affiliations: <SUP>1</SUP>Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia <SUP>2</SUP>United States Federal Bureau of Prisons, Washington, District of Columbia <SUP>3</SUP>Emerging and Acute Infectious Diseases Branch, Texas Department of State Health Services, Austin; <SUP>4</SUP>Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia
Correspondence: Laura Conklin, MD, Division of Bacterial Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS C-25, Atlanta, GA 30333 (lconklin@cdc.gov).
a L. C. and J. A. contributed equally to this work.
Abstract
Background.
Chlamydia pneumoniae illness is poorly characterized, particularly as a sole causative pathogen. We investigated a C. pneumoniae outbreak at a federal correctional facility.
Methods.
We identified inmates with acute respiratory illness (ARI) from 1 November 2009 to 24 February 2010 through clinic self-referral and active case finding. We tested oropharyngeal and/or nasopharyngeal swabs for C. pneumoniae by real-time polymerase chain reaction (qPCR) and serum samples by microimmunofluorescence. Cases were inmates with ARI and radiologically confirmed pneumonia, positive qPCR, or serological evidence of recent infection. Swabs from 7 acutely ill inmates were tested for 18 respiratory pathogens using qPCR TaqMan Array Cards (TACs). Follow-up swabs from case patients were collected for up to 8 weeks.
Results.
Among 33 self-referred and 226 randomly selected inmates, 52 (20.1%) met the case definition; pneumonia was confirmed in 4 by radiology only, in 9 by qPCR only, in 17 by serology only, and in 22 by both qPCR and serology. The prison attack rate was 10.4% (95% confidence interval, 7.0%?13.8%). White inmates and residents of housing unit Y were at highest risk. TAC testing detected C. pneumoniae in 4 (57%) inmates; no other causative pathogens were identified. Among 40 inmates followed prospectively, C. pneumoniae was detected for up to 8 weeks. Thirteen (52%) of 25 inmates treated with azithromycin continued to be qPCR positive >2 weeks after treatment.
Conclusions.
Chlamydia pneumoniae was the causative pathogen of this outbreak. Higher risk among certain groups suggests that social interaction contributed to transmission. Persistence of C. pneumoniae in the oropharynx creates challenges for outbreak control measures.
Key words
Chlamydia pneumoniae ? Chlamydophila - atypical pneumonia - community-acquired pneumonia ? prison
Received February 7, 2013. Accepted May 1, 2013.
Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2013.
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Investigation of a Chlamydia pneumoniae Outbreak in a Federal Correctional Facility in Texas
Laura Conklin 1,a, Jennifer Adjemian 2,a, Jennifer Loo 1, Sema Mandal 1,4, Carol Davis 3, Sharyn Parks 3,4, Tina Parsons 2, Brian McDonough 2, Jorge Partida 2, Kathleen Thurman 1, Maureen H. Diaz 1, Alvaro Benitez 1, Tracy Pondo 1, Cynthia G. Whitney 1, Jonas M. Winchell 1, Newton Kendig 2, and Chris Van Beneden 1
Author Affiliations: <SUP>1</SUP>Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia <SUP>2</SUP>United States Federal Bureau of Prisons, Washington, District of Columbia <SUP>3</SUP>Emerging and Acute Infectious Diseases Branch, Texas Department of State Health Services, Austin; <SUP>4</SUP>Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia
Correspondence: Laura Conklin, MD, Division of Bacterial Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS C-25, Atlanta, GA 30333 (lconklin@cdc.gov).
a L. C. and J. A. contributed equally to this work.
Abstract
Background.
Chlamydia pneumoniae illness is poorly characterized, particularly as a sole causative pathogen. We investigated a C. pneumoniae outbreak at a federal correctional facility.
Methods.
We identified inmates with acute respiratory illness (ARI) from 1 November 2009 to 24 February 2010 through clinic self-referral and active case finding. We tested oropharyngeal and/or nasopharyngeal swabs for C. pneumoniae by real-time polymerase chain reaction (qPCR) and serum samples by microimmunofluorescence. Cases were inmates with ARI and radiologically confirmed pneumonia, positive qPCR, or serological evidence of recent infection. Swabs from 7 acutely ill inmates were tested for 18 respiratory pathogens using qPCR TaqMan Array Cards (TACs). Follow-up swabs from case patients were collected for up to 8 weeks.
Results.
Among 33 self-referred and 226 randomly selected inmates, 52 (20.1%) met the case definition; pneumonia was confirmed in 4 by radiology only, in 9 by qPCR only, in 17 by serology only, and in 22 by both qPCR and serology. The prison attack rate was 10.4% (95% confidence interval, 7.0%?13.8%). White inmates and residents of housing unit Y were at highest risk. TAC testing detected C. pneumoniae in 4 (57%) inmates; no other causative pathogens were identified. Among 40 inmates followed prospectively, C. pneumoniae was detected for up to 8 weeks. Thirteen (52%) of 25 inmates treated with azithromycin continued to be qPCR positive >2 weeks after treatment.
Conclusions.
Chlamydia pneumoniae was the causative pathogen of this outbreak. Higher risk among certain groups suggests that social interaction contributed to transmission. Persistence of C. pneumoniae in the oropharynx creates challenges for outbreak control measures.
Key words
Chlamydia pneumoniae ? Chlamydophila - atypical pneumonia - community-acquired pneumonia ? prison
Received February 7, 2013. Accepted May 1, 2013.
Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2013.
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