Rhode Island Department of Health

Health Alert
01/04/07 , 8:30 p.m.
Investigation of Mycoplasma pneumoniae
HEALTHCARE PROVIDER UPDATE

Clinical information on Mycoplasma and the details of the current investigation in RI, are available at: www.health.ri.gov/MycoplasmaPneumonia-physician070103.php. and updated regularly. CDC-based information is available at http://www.cdc.gov/ncidod/dbmd/diseaseinfo/mycoplasmapneum_t.htm

Is immediate diagnostic testing for Mycoplasma available for use on ill persons?

• No rapid test is available for Mycoplasma.
• Polymerase chain reaction assay (PCR) of or pharyngeal or nasopharyngeal swab for Mycoplasma is not recommended at this time by HEALTH or CDC in the evaluation of respiratory illness.
• HEALTH, in conjunction with CDC, is having some patients tested, not for immediate clinical purposes but as part of the epidemiologic investigation. Patients participating in this effort have had lab orders signed by Dr. Gifford.
• Clinical specimens for testing for Mycoplasma should not be sent to the DOH laboratory.

Should testing be done on well persons who may have been exposed to ill persons with possible Mycoplasma infection?

• No, testing of well persons for Mycoplasma infection is not recommended at this time. Such testing would not be anticipated to provide information relevant to immediate clinical decision-making.

Are prophylactic antibiotics being recommended?

• No, prophylactic antibiotics are not currently recommended, outside of the selected circumstances under which they were given to students, staff and immediate family members of Greenwood Elementary School . In previous Mycoplasma outbreaks where prophylactic antibiotics were used, a benefit in decreasing secondary cases was not consistently observed, and benefit was most evident when the outbreak occurred in a closed population setting such as a military barracks or long term care institution. HEALTH will continue to evaluate this and provide updated recommendations as supported by the findings from the outbreak investigation.

Can a well child, family member or worker from a closed school visit an elderly relative?

• Yes, as long as the person is not ill. Persons with any respiratory illness including cough, sinusitis or pneumonia should stay home and not visit others or go to work or school.

Should providers hospitalize persons with a suspected Mycoplasma infection?

• For pneumonia and sinusitis, the decision to hospitalize the patient should be based on the clinical severity of the illness and the ability to care for themselves or be cared for at home. Mycoplasma pneumonia often has more extensive radiographic abnormalities than findings on physical exam; bacterial super infection is infrequent. Pulse oximetry and respiratory rate are useful assessments both for determination of the need for hospitalization and for monitory response to therapy. Detailed information on diagnosis and management of community-acquired pneumonia is available in the guidelines on this topic from the Infectious Disease Society of America, (see www.idsociety.org under Practice Guidelines)
• For suspected meningitis and/or encephalitis, further evaluation and monitoring is most easily accomplished in a hospital setting. For mild symptoms, an observational short stay may be helpful to clarify if there is any need for further testing or longer hospitalization.

When can children or adults with respiratory infection (which may not necessarily be due to Mycoplasma) return to school, day care or work?

• This decision should be individualized and based primarily on the resolution of clinical symptoms, including fever, cough and general well-being.

Should health care providers and their staff take prophylactic antibiotics?

The focus should be on the following infection control measures:

• Respiratory etiquette (“Cover your cough”) for ill patients in the office, emergency department or clinic. Link to “Cover Your Cough” www.cdc.gov/flu/protect/covercough.htm
• Generous availability of alcohol hand gel or soap and water, with emphasis on hand washing.
• Ill health care providers should not work.

What illnesses should be reported and how should this be done?

• HEALTH has a sentinel surveillance system in place to track Mycoplasma related illness trends and therefore is not requesting reporting of routine respiratory illness from other community based providers. However, should a provider have an unusual presentation of suspected Mycoplasma illness; call the Family Health Information Line, 1-800-942-7434.

How should day care attendance be handled?

• Day care centers should implement and reinforce routine hand hygiene measures and cough etiquette.
• Daycare providers should apply routine policies for exclusion. Sick children should be sent home and remain home for 48 hours after symptoms subside.
• Testing (such as by PCR of nasal or throat swabs) is not recommended as a means to determine whether a previously ill child can return to day care, nor should it be used to screen well children for admission to day care.

Should patients with possible Mycoplasma infection receive any vaccines?

• There is no vaccine for Mycoplasma.
• Hemophilus influenza type b (HIB) vaccine does not provide protection against Mycoplasma.
• Meningococcal and pneumococcal vaccines are not recommended since there is no evidence that the risk for either meningococcal or pneumococcal infection is increased after Mycoplasma illness.
• Nothing here should be interpreted to contravene usual recommendation for age and condition appropriate vaccination.