Rhode Island Department of Health

Health Alert
01/03/07, 4 p.m.
Expanded Investigation of Mycoplasma pneumoniae
HEALTHCARE PROVIDER UPDATE

Background

Rhode Island Department of Health (HEALTH) is investigating an outbreak of Mycoplasma pneumoniae. Two students at Greenwood Elementary School in Warwick who had encephalitis were determined by CDC to have a Mycoplasma pneumoniae infection that was the “probable” cause of their illness. Subsequently, HEALTH provided prophylactic antibiotics (primarily azithromycin) to students, staff and immediate family members of Greenwood School . On January 2, the CDC classified mycoplasma as the “probable” cause of a case of encephalitis at Deering Middle School in West Warwick .

Epidemiology

• As a result of the identified case of encephalitis, officials are visiting the Deering Middle School to gather data, review medical records and interview students, families and staff. Testing by the CDC will be conducted based upon the results of the epidemiologic investigation.
• Officials are also investigating reports of higher than normal absenteeism in November/December 2006 related to pneumonia at Black Rock Elementary and Oak Haven Elementary in Coventry . HEALTH and CDC officials are 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 investigation.
• 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.
• HEALTH is conducting active surveillance of current patients with respiratory illness/pneumonia.

There is not a confirmed outbreak at the Deering Middle School, Black Rock Elementary or Oak Haven Elementary Schools. We do not recommend a school closure or the distribution of antibiotics without evidence of a localized outbreak.

Diagnosis and Treatment

• Typical symptoms of mycoplasma infection include 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 in patients presenting with respiratory or neurologic illness.
• 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.
• All patients should be instructed in routine infection prevention with good hand hygiene and cough etiquette. Anyone who is sick should stay home from school or work.

Testing Information and Recommendations

• HEALTH is only paying for the costs of laboratory testing on blood samples that are ordered by HEALTH as part of the CDC investigation. Participants in the investigation should have lab orders signed by Dr. Gifford, Director of HEALTH. No lab specimens testing for Mycoplasma pneumoniae should be sent to the HEALTH state laboratory.
• No oropharyngeal or nasophareyngeal swab testing is recommended by HEALTH or CDC in the evaluation of patients with respiratory illness. (Note: This is a correction to previous guidance.)

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