Rhode Island Department of Health

Health Alert
12/30/06
Mycoplasma Related Illnesses Cluster at Greenwood Elementary, Warwick

The Department of Health (HEALTH) has been investigating a cluster of illness at the Greenwood Elementary School. The following epidemiological information is available. In mid November a 7 year old second grader had onset of respiratory symptoms, and an admission on Nov 30 th with encephalitis to which he succumbed on December 21st. Despite extensive post-mortem testing at CDC a pathogen has not been found. A 7-year-old classmate was admitted on December 13 th with an admitting diagnosis of aseptic/partially treated meningitis, which then took an encephalitic course with gradual recovery. Serology on this child is positive for Mycoplasma pneumoniae. This makes the case of encephalitis an epidemiologically linked case to a case of Mycoplasma associated disease. A third child, a fifth grader from the same school developed X-Ray confirmed pneumonia and was prescribed antibiotics and then developed Stevens Johnson syndrome resulting in a hospital admission. This child also had strong titers positive for Mycoplasma pneumoniae. Through active surveillance we have knowledge of at least 5 other children with X-Ray confirmed pneumonias. Serology and nasopharyngeal swabs on these children have been done and results are pending. No new cases have been reported in the last 2 weeks.

In response to the unusual presentations and the small size of the school and exerting an abundance of caution the Department of Health with consultation and support from the CDC is proposing the following actions which are being implemented by the City of Warwick .

1. Beginning Sunday, December 31 – Tuesday, January 2, 2007 antibiotic prophylaxis will be offered to all students, staff and their household members. A mass dispensing operation will be set up at the school and announced through the media and school communications channels. Zithromax suspension is the antibiotic of choice for children and adults (5 day course), and Doxycycline (10 day course) for those with contraindications.
2. School will remain closed from January 2 through the 5 th and re-open on the 8 th.
3. A pharyngeal carriage study and sero-prevalence study is planned to determine carriage rates and effectiveness of prophylaxis. Information to the parents about this will be integrated into the dispensing operation. HEALTH will conduct all aspects of the study.

There will be continued surveillance and support offered to the school as long as is necessary.

Physicians are advised to maintain a high index of suspicion and report cases of any febrile illness from Greenwood Elementary to HEALTH at 222 2577 (272 5952 after hours). Lab testing should be ordered after discussion with HEALTH for all Greenwood linked patients. Other patients not connected to Greenwood may be tested for serology (swabs should not be done) at commercial laboratories.

For more information on Mycoplasma see:
http://www.cdc.gov/ncidod/dbmd/diseaseinfo/mycoplasmapneum_t.htm

For the most current RI information, providers may call 401-462-7079 between 10:00 am and 4:00 pm on December 31 through January 2, 2007 . Members of the public may call 1-800-942-7434 (Family Health Information Line) or see http://www.health.ri.gov/