Rhode Island Department of Health

Health Alert
01/02/07
6:00 pm
Expanded Investigation of Mycoplasma pneumoniae
Provider/Facility Recommendations

Rhode Island Department of Health (HEALTH) is currently investigating a possible outbreak of Mycoplasma pneumoniae in Rhode Island. Two students at Greenwood Elementary School in Warwick who developed encephalitis were determined by CDC to have a Mycoplasma pneumoniae infection that was the “probable” cause of their illness. On December 31, January 1, and January 2, HEALTH provided a course of prophylactic antibiotics (primarily azithromycin) to students and staff of the Greenwood Elementary School in Warwick and to their immediate family members. This approach has been used in institutional settings in the past during outbreaks of Mycoplasma pneumoniae illness.

On December 31, we received preliminary data from the CDC suggesting a possible relationship between mycoplasma and a previously reported case of encephalitis in a student at the John F. Deering Middle School in West Warwick. On January 2, the CDC classified mycoplasma as the “probable” cause of this case of encephalitis. That child is recovering at home. HEALTH and the CDC are visiting the Deering Middle School to gather more data. We will review medical records from the school clinic and interview students, families and staff. Testing by the CDC will be conducted based upon the results of the epidemiologic investigation.

We are also investigating reports of higher than normal absenteeism in the past two months related to pneumonia in two Coventry schools: Black Rock Elementary and Oak Haven Elementary. HEALTH and CDC are also reviewing medical records and interviewing students, families and staff of these schools. Testing by the CDC will be conducted based upon the results of the epidemiologic investigation.

We have not confirmed an outbreak at the Deering School, Black Rock Elementary and Oak Haven Elementary. At this time, we are simply investigating whether an outbreak is occurring. We do not recommend a school closure or the distribution of antibiotics without evidence of a localized outbreak.

Common symptoms of mycoplasma infection are fever, cough, bronchitis, sore throat, and headache. Mycoplasma only rarely causes meningitis or encephalitis but caution dictates that mycoplasma be considered as part of the differential diagnosis for patients presenting with these symptoms.

It is likely that the increased attention this has received will result in patients asking about diagnostic testing and treatment. HEALTH is only paying for the costs of laboratory testing on blood samples as ordered by HEALTH as part of the CDC investigation. Parents of children participating in the CDC investigation should have lab orders signed by Dr. Gifford, Director of HEALTH. If a parent has misplaced their Department of Health laboratory orders, he/she should contact the Department of Health, Family Health Information Line, 1-800-942-7434. HEALTH has established an agreement with East Side Clinical Laboratories to perform CDC investigative blood tests.

Treatment of mycoplasma infection may be done with azithromycin type antibiotics (e.g., zithromax), tetracyclic type antibiotics or quinolones. Treatment decisions should be based upon clinical grounds. If ordered by a private provider, testing for mycoplasma should include serological titers (acute and convalescent) from a commercial laboratory. These results are not immediately available to guide treatment for an individual patient.

No lab specimens testing for Mycoplasma pneumoniae should be sent directly to the HEALTH state laboratory.

All patients should be instructed in routine prevention with good hand hygiene and cough etiquette. Children who are sick should stay home from school.

Staff from the Rhode Island Department of Health may be contacting your office or facility over the course of next several weeks to obtain additional information on specific children identified in school health records as possibly having had pneumonia over the past two months. We appreciate your assistance and cooperation with these efforts.

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

For the most current Rhode Island information, providers may call 1-800-942-7434 (Family Health Information Line) or see http://www.health.ri.gov/advisories/communicable.php