PNEUMOCOCCAL OUTBREAK IN TEXAS
Description of the Outbreak
In 1989, a major outbreak had taken place in Texas. During that year, between September 6th and October 2nd, an invasive pneumococcal disease outbreak occurred in an urban Texas jail (Centers for Disease Control and Prevention, 2001). While this outbreak took place, two inmates died because of the disease and five inmates with pneumonia were secluded. These inmates were isolated due to a bacterium called streptococcus pneumoniae (Disease Outbreak Control Division, 2019). Tests were done to understand the inmates’ health levels and acquired vaccinations. Fourteen inmates already had conditions like substance abuse, cirrhosis (chronic liver disease), and asplenia (absence of normal spleen function) (Centers for Disease Control and Prevention, 2001). After looking into these inmates’ health records, it was found that only one inmate had the pneumococcal vaccine (Centers for Disease Control and Prevention, 2001).
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The jail was built a 13-story building that was meant to hold 3500 inmates (Centers for Disease Control and Prevention, 2001). However, there were 3200 more inmates than the capacity that lived in this overcrowded building (Centers for Disease Control and Prevention, 2001). Of these 6700 inmates, 84% of them were males (Centers for Disease Control and Prevention, 2001). During this crisis, 950 of the staff were not affected in the outbreak (Centers for Disease Control and Prevention, 2001). Immunization was recommended for all inmates and staff in the jail. However, only 79% of this group agreed to get vaccinated (Centers for Disease Control and Prevention, 2001).
The ventilation in the jail building was assessed to measure the airflow in the living tight living spaces. The air quality and circulation were evaluated by measuring the carbon dioxide levels, as well as the air flow levels to all the living jail spaces. The carbon dioxide levels were 1100- 2500 ppm (Hoge, et al, 1994). A random group of inmates were selected to test the level of infection by culturing pharyngeal samples. The samples that were tested could help find the types and its immunity with an enzyme. In the process, four weeks later, 46 inmates were tested with acute pneumonia or invasive pneumococcal disease (Hoge, et al, 1994). The incident rate was higher in cells with the greatest amount of carbon dioxide levels and the lowest amount of outside air given by the ventilation system. This situation proves that overcrowding results in poor ventilation, especially in a tight space.
Pneumococcal disease can be mild or extremely dangerous. This disease can spread from a person’s throat and nose to their ears and sinuses. It then causes mild infections which eventually spread to other parts of the body. This can lead to severe health problems such as pneumonia (lung infection), meningitis (infection of the covering around the spinal cord and brain), and/ or blood infection (Disease Outbreak Control Division, 2019). In more serious cases, it can lead to deafness, brain damage, or loss of legs or arms (Disease Outbreak Control Division, 2019). In some cases, pneumococcal disease has also been life- threatening.
Pneumococcal disease is transmitted through droplet transmission (person- to- person). The infectious agent is the bacterium called streptococcus pneumoniae. The reservoir is the person’s nasopharynx and their body. The portal of exit is the mouth (saliva), nose, and skin. Streptococcus pneumoniae is transmitted through droplet transmission. It spreads though sneezing, speaking, and coughing. The portal of entry is through the human’s mouth, nose, and skin (usually the hand). Lastly, the susceptible hosts for this disease is primarily older adults and younger children. People that are more susceptible are adults over 65 years old, children under the age of 2, people with certain illnesses, with implants, with weakened immune system, and people who smoke (Disease Outbreak Control Division, 2019). Physicians have noticed that children from certain racial or ethical groups are also susceptible to this disease (Disease Outbreak Control Division, 2019).
Pneumococcal disease is caused by a bacterium called streptococcus pneumoniae (also known as pneumococcus) (Disease Outbreak Control Division, 2019). This bacterium causes many illnesses and infections like pneumonia, bacteremia, meningitis, and ear infection (Hoge, et al, 1994). Streptococcus pneumoniae can easily be transmitted through sneezing, coughing, or simply just having close contact with someone who is sick. A person’s symptoms differ depending on the body part that is infected. The symptoms include shortness of breath, disorientation, cough, sleeplessness, fever, sensitivity to light, and joint, ear, chest, or neck pain. In more serious cases the disease can lead to brain damage, loss of hearing, or even death.
Pneumococcal disease is diagnosed using samples of body fluids. Body fluids like blood or cerebrospinal fluid are taken and sent to laboratories to be tested (Murrell, 2018). These tests will check if the bacterium streptococcus pneumoniae is present. One test that is taken is an x-ray. The darker areas on an x-ray shows that there is pneumonia or fluid in the pleural cavity (Murrell, 2018). There are over 90 types of the bacterium streptococcus pneumoniae (Disease Outbreak Control Division, 2019). Unfortunately, there are no vaccines that help protect against all of them. Nevertheless, there are still vaccines that can help prevent infections by more common types of the bacteria. Physicians often recommend different age groups to get consistent vaccinations to help protect themselves from the disease. Antibiotics also help treat streptococcus pneumoniae infections (Murrell, 2018). People that travel get pneumococcal vaccine to prevent themselves from catching these infections around the world. Other steps that can be taken for protection are proper and regular hand washing, covering nose and mouth when sneezing or coughing, and avoiding close contact with people who are sick.
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There are two vaccines that are given to help prevent from pneumococcal disease. One stimulates a T-cell- independent reaction. This vaccine has no additional effect if the immunization is being repeated. The other vaccine has polysaccharides adhered to a protein which activates the immune response. This vaccine works efficiently for children because not only does it reduced pneumococcal rates, but it also promotes immune memory. Another positive aspect with immunizations, is that it reduces the rate of antibiotic- resistant pneumococci.
Impact on the Public Health
There are many different steps that can be taken to avoid the primary case of respiratory epidemics. Vaccination and revaccination are the best action that can be done to help protect from these infectious agents (Zivich, et al, 2018). Once an outbreak takes place, it is important to start vaccinations and take infection- prevention actions. Antibiotic precautions are taken with people who are exposed with high risks (Zivich, et al, 2018). During the outbreak, antibiotic resistances were being developed. Childhood immunization is the most effective heath measure for preventing pneumococcal disease especially at a young age.
There are many actions that can be taken to break the chain of transmission for pneumococcal disease. To avoid bacteria, vaccination would be a highly recommended precaution. Other daily things people can do to keep the bacteria from the portal of exit and portal of entry are keeping their hands clean all the time as well as covering their mouth and nose when coughing or sneezing by covering with tissue and not their hands. It is also important to avoid close contact with people who are sick (avoid kissing, hugging, sharing hygienic things such as cups, spoons, etc.). People who are susceptible to pneumococcal disease should keep away from people who are sick and always take the necessary precautions to protect themselves. Many individuals have streptococcus pneumoniae in their nose or throat even if they are not sick which can spread pneumococcal disease (Disease Outbreak Control Division, 2019).
Reflection and Analysis
After learning about the pneumococcal outbreak in Texas, I believe that this outbreak could have been prevented if the necessary procedures were taken from the beginning. Firstly, the jail was overcrowded which can lead to many health and safety hazards. Housing almost two times the number of inmates in the building should have not been permitted. The inmates were congested in a tight space with no proper ventilation. In this case, if there was not enough space to keep all the inmates, there should have been other decisions made. Vaccinations should have been mandatory. Vaccination is the best approach to take to prevent the initial incidence of the pneumococcal outbreak. This disease requires droplet safety measures which should have been severely considered to attempt infection prevention. Furthermore, I do not think there are any other procedures that could have taken place in this situation to help prevent this disease other than vaccination, adequate ventilation, and infection- prevention methods.
- Centers for Disease Control and Prevention. (2001, May 2). Epidemiologic notes and reports outbreak of invasive pneumococcal disease in a jail- Texas 1989. Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/00001490.htm
- Disease Outbreak Control Division. (2019, April). Pneumococcal Disease. Retrieved from https://health.hawaii.gov/docd/disease_listing/pneumococcal-disease/#diagnosis
- European Centre for Disease Prevention and Control. (n.d.). Prevention and control measures for pneumococcal disease. Retrieved from https://www.ecdc.europa.eu/en/pneumococcal-disease/prevention-and-control
- Hoge, C., Mary, R., Dominguez, E., John, C. (1994, September 8). An epidemic of pneumococcal disease in an overcrowded, inadequately ventilated jail. Retrieved from https://www.nejm.org/doi/10.1056/NEJM199409083311004
- Murrell, D. (2018, October 25). What is pneumococcal disease. Retrieved from https://www.medicalnewstoday.com/articles/323463.php
- Zivich, P., Grabenstein, J., Becker- Dreps, S., Weber, D. (2018, November 5). Streptococcus pneumonia outbreak and implications for transmission and control: a systematic review. Retrieved from https://pneumonia.biomedcentral.com/articles/10.1186/s41479-018-0055-4
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