An Outbreak of Severe Infections with Community-Acquired MRSA Carrying the Panton-Valentine Leukocidin Following Vaccination

Background: Infections with community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) are emerging worldwide. We investigated an outbreak of severe CA-MRSA infections in children following out-patient vaccination. Methods and Findings: We carried out a field investigation after adverse events following immunization (AEFI) were reported. We reviewed the clinical data from all cases. S. aureus recovered from skin infections and from nasal and throat swabs were analyzed by pulse-field gel electrophoresis, multi locus sequence typing, PCR and microarray. In May 2006, nine children presented with AEFI, ranging from fatal toxic shock syndrome, necrotizing soft tissue infection, purulent abscesses, to fever with rash. All had received a vaccination injection in different health centres in one District of Ho Chi Minh City. Eight children had been vaccinated by the same health care worker (HCW). Deficiencies in vaccine quality, storage practices, or preparation and delivery were not found. Infection control practices were insufficient. CA-MRSA was cultured in four children and from nasal and throat swabs from the HCW. Strains from children and HCW were indistinguishable. All carried the Panton-Valentine leukocidine (PVL), the staphylococcal enterotoxin B gene, the gene complex for staphylococcal-cassette-chromosome mec type V, and were sequence type 59. Strain HCM3A is epidemiologically unrelated to a strain of ST59 prevalent in the USA, althoughthey belong to the same lineage. Conclusions. We describe an outbreak of infections with CA-MRSA in children, transmitted by an asymptomatic colonized HCW during immunization injection. Consistent adherence to injection practice guidelines is needed to prevent CA-MRSA transmission in both in- and outpatient settings

Genome sequence of a recently emerged, highly transmissible, multi-antibiotic- and antiseptic-resistant variant of methicillin-resistant Staphylococcus aureus, sequence type 239 (TW)

The Sanger Institute is core funded by the Wellcome Trust. Funding for the sequencing of the TW20 genome was provided by Guy’s and St. Thomas’ Charity. J.D.E. receives funding from the Department of Health via the NIHR comprehensive Biomedical Research Centre award to Guy’s and St Thomas’ NHS Foundation Trust in partnership with King’s College London.The 3.1-Mb genome of an outbreak methicillin-resistant Staphylococcus aureus (MRSA) strain (TW20) contains evidence of recently acquired DNA, including two large regions ( 635 kb and 127 kb). The strain is resistant to a wide range of antibiotics, antiseptics, and heavy metals due to resistance genes encoded on mobile genetic elements and also mutations in housekeeping genes.Publisher PDFPeer reviewe

Clinical characteristics and laboratory values of children on admission, and outcome

†<p>Date of vaccination unless otherwise stated.</p>‡<p>HBV: Hepatitis B virus. Both received Euvax B™; MMR: Measles, Mumps, Rubella. All received Priorix™; varicella: Varilrix^R.</p>§<p>swelling at injection site beyond the expected after routine vaccination.</p>∥<p>Inotropes used were dopamine, dobutamine, noradrenaline.</p>**<p>MRSA: methicillin-resistant <i>Staphylococcus aureus</i>. NA denotes not available, a plus sign positive or present, and a minus sign negative or absent.</p>*<p>Normal ranges are as follows: hemoglobin concentration, 105–135 g/L; leukocyte count, 6 to 17.5·10⁹/L; platelet count, 150 to 400·10⁹/L; alanine aminotransferase (ALT) level, below 37 U/L; aspartate aminotransferase (AST) level, below 40 U/L; creatine phosphokinase (CK) below 200 U/L; serum creatinine concentration, 18–80 µmol/L;</p

Rapidly progressive soft tissue infection after vaccination.

<p>Severe tissue necrosis around vaccination site in Child 4, two days following vaccination with MMR. MRSA was cultured from wound fluid.</p