An Outbreak of Acute Respiratory Disease Caused by Mycoplasma pneumoniae and Adenovirus at a Federal Service Training Academy: New Implications from an Old Scenario

Abstract

Outbreaks of Mycoplasma pneumoniae and adenovirus have been reported in military institutions for several decades. During a recent outbreak in a federal service training academy, we performed an epidemiological and laboratory investigation to better characterize and control the outbreak. Of 586 students responding to a questionnaire, 317 (54%) reported having a respiratory illness during the outbreak period. Among 42 students who underwent complete laboratory testing, 24 (57%) had evidence of M. pneumoniae infection, 8 (19%) had evidence of adenovirus infection, and 4 (10%) had evidence of both. Polymerase chain reaction testing of oropharyngeal swabs revealed more acute M. pneumoniae infections (57% positive) than did serology or culture. Multivariate analysis revealed that visiting the campus health clinic >3 times for a nonrespiratory condition, such as injury, was a significant risk factor for illness among freshmen early in the course of the outbreak, whereas having an ill roommate was a risk factor throughout the duration of the outbreak.

Mycoplasma pneumoniaeand Its Role as a Human Pathogen

“…Although the incidence of disease does not vary greatly by season, the proportion of patients with pneumonia due to M. pneumoniae is greatest during the summer in temperate climates due to the lower incidence of other respiratory pathogens at this time (5,283,334). Outbreaks of M. pneumoniae infections also tend to occur in the summer or early fall (5,131,403). The long incubation period and relatively low transmission rate have been implicated in the prolonged duration of epidemics of M. pneumoniae infections (137).…”

“…Numerous outbreaks of M. pneumoniae infections have been documented in the community or in closed or semiclosed settings such as military bases (120,131,167,168,292), hospitals (141,221,229), religious communities (253,299), and facilities for the mentally or developmentally disabled (197,228,391). In outbreaks where many more persons, usually living close together in military barracks or similar situations, are exposed to M. pneumoniae aerosols simultaneously, the rate of spread within a facility appears to be higher than in single-family households.…”

“…Attack rates of M. pneumoniae among military recruits and other closed or semiclosed populations can be quite high, with reports ranging from 25 to 71% in some settings (5,120,131,228). Some studies have shown M. pneumoniae to be the leading cause of bacterial pneumonia among hospitalized and nonhospitalized military personnel (168,170).…”

Macrolide-resistant Mycoplasma pneumoniae: characteristics of isolates and clinical aspects of community-acquired pneumonia

“…pneumoniae infection tends to show cyclic epidemics every 3-5 years; these outbreaks are particularly likely to occur in summer or early fall [42][43][44][45][46]. Although the incidence of M. pneumoniae pneumonia is highest in children 5-9 years old, such pneumonia also occurs frequently in younger children and in the elderly.…”

Mycoplasma pneumoniae Outbreaks on Navy Vessels

“…Indeed M. pneumoniae outbreaks have commonly been reported in military settings, being attributed mainly to the close proximity of army personnel and recruits (1,3,5,6). Two types of epidemics have been noted: smoldering epidemics that occur over several months and are generally harder to detect and investigate (2, 7) and abrupt outbreaks that last for very short periods of time (3).…”