Multistate Outbreak of Respiratory Infections among Unaccompanied Children, June-July 2014.

Tomczyk S1, Arriola CS2, Beall B3, Benitez A3, Benoit SR4, Berman L5, Bresee J5, da Gloria Carvalho M3, Cohn A6, Cross K3, Diaz MH3, Francois Watkins LK1,Gierke R3, Hagan JE7, Harris A3, Jain S5, Kim L3, Kobayashi M1, Lindstrom S5, McGee L3, McMorrow M8, Metcalf BL3, Moore MR3, Moura I3, Nix WA9,Nyangoma E10, Oberste MS9, Olsen SJ5, Pimenta F3, Socias C11, Thurman K3, Waller J3, Waterman SH4, Westercamp M1, Wharton M6, Whitney CG3, Winchell JM3, Wolff B3, Kim C12.

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Abstract

BACKGROUND:

From January-July 2014, >46,000 unaccompanied children (UC) from Central America crossed the U.S.-Mexico border. In June-July, UC aged 9-17 years in four shelters and a processing center in four U.S. states were hospitalized with acute respiratory illness. We conducted a multistate investigation to interrupt disease transmission.

METHODS:

Medical charts were abstracted for hospitalized UC. Non-hospitalized UC with influenza-like illness were interviewed, and nasopharyngeal and oropharyngeal swabs for PCR-based detection of respiratory pathogens were collected. Nasopharyngeal swabs were used to assess pneumococcal colonization in symptomatic and asymptomatic UC. Pneumococcal blood isolates from hospitalized UC and nasopharyngeal isolates were characterized by serotyping (Quellung) and whole-genome sequencing.

RESULTS:

Among the 15 hospitalized UC, 4 (44%) of 9 tested positive for influenza viruses, and 6 (43%) of 14 with blood cultures grew pneumococcus, all serotype 5. Among 48 non-hospitalized children with influenza-like illness, >1 respiratory pathogen was identified in 46 (96%). Among 774 non-hospitalized UC, 185 (24%) yielded pneumococcus, and 70 (38%) were serotype 5. UC who transferred through the processing center were more likely than others to be colonized with serotype 5 (OR 3.8; 95% CI, 2.1-6.9). Analysis of the core pneumococcal genomes detected two related, yet independent, clusters. No pneumococcus cases were reported after pneumococcal and influenza immunization campaigns were implemented.

CONCLUSIONS:

This outbreak of respiratory disease was due to multiple pathogens, including Streptococcus pneumoniae serotype 5 and influenza viruses. Pneumococcal and influenza vaccinations prevented further transmission. Future efforts to prevent similar outbreaks will benefit from use of both vaccines.

Published by Oxford University Press for the Infectious Diseases Society of America 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.