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An Outbreak of Severe Infections with Community-Acquired MRSA Carrying the Panton-Valentine Leukocidin Following Vaccination

Tang, CT; Nguyen, DT; Ngo, TH; Nguyen, TM; Le, VT; To, SD; Lindsay, J; Nguyen, TD; Bach, VC; Le, QT; et al. Tang, CT; Nguyen, DT; Ngo, TH; Nguyen, TM; Le, VT; To, SD; Lindsay, J; Nguyen, TD; Bach, VC; Le, QT; Le, TH; Le, DL; Campbell, J; Nguyen, TK; Nguyen, VV; Cockfield, J; Le, TG; Phan, VN; Le, HS; Huynh, TS; Le, VP; Counahan, M; Bentsi-Enchill, A; Brown, R; Simmerman, J; Nguyen, TC; Tran, TH; Farrar, J; Schultsz, C (2007) An Outbreak of Severe Infections with Community-Acquired MRSA Carrying the Panton-Valentine Leukocidin Following Vaccination. PLOS ONE, 2 (9). e822 (1) - e822 (6). ISSN 1932-6203 https://doi.org/10.1371/journal.pone.0000822
SGUL Authors: Lindsay, Jodi Anne

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Abstract

Background: Infections with community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) are emerging worldwide. We investigated an outbreak of severe CA-MRSA infections in children following out-patient vaccination. Methods and Findings: We carried out a field investigation after adverse events following immunization (AEFI) were reported. We reviewed the clinical data from all cases. S. aureus recovered from skin infections and from nasal and throat swabs were analyzed by pulse-field gel electrophoresis, multi locus sequence typing, PCR and microarray. In May 2006, nine children presented with AEFI, ranging from fatal toxic shock syndrome, necrotizing soft tissue infection, purulent abscesses, to fever with rash. All had received a vaccination injection in different health centres in one District of Ho Chi Minh City. Eight children had been vaccinated by the same health care worker (HCW). Deficiencies in vaccine quality, storage practices, or preparation and delivery were not found. Infection control practices were insufficient. CA-MRSA was cultured in four children and from nasal and throat swabs from the HCW. Strains from children and HCW were indistinguishable. All carried the Panton-Valentine leukocidine (PVL), the staphylococcal enterotoxin B gene, the gene complex for staphylococcal-cassette-chromosome mec type V, and were sequence type 59. Strain HCM3A is epidemiologically unrelated to a strain of ST59 prevalent in the USA, althoughthey belong to the same lineage. Conclusions. We describe an outbreak of infections with CA-MRSA in children, transmitted by an asymptomatic colonized HCW during immunization injection. Consistent adherence to injection practice guidelines is needed to prevent CA-MRSA transmission in both in- and outpatient settings.

Item Type: Article
Additional Information: Copyright: © 2007 Chi Thuong et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Keywords: Adolescent, Bacterial Toxins, Bacterial Vaccines, Child, Child, Preschool, Community-Acquired Infections, Disease Outbreaks, Electrophoresis, Gel, Pulsed-Field, Exotoxins, Female, Humans, Leukocidins, Male, Methicillin-Resistant Staphylococcus aureus, Oligonucleotide Array Sequence Analysis, Polymerase Chain Reaction, Staphylococcal Infections, Vietnam, Science & Technology, Multidisciplinary Sciences, Science & Technology - Other Topics
SGUL Research Institute / Research Centre: Academic Structure > Infection and Immunity Research Institute (INII)
Journal or Publication Title: PLOS ONE
ISSN: 1932-6203
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Dates:
DateEvent
5 September 2007Published
Web of Science ID: WOS:000207455500006
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URI: http://openaccess.sgul.ac.uk/id/eprint/951
Publisher's version: https://doi.org/10.1371/journal.pone.0000822

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