Outbreaks of Invasive XXXX in Closed Communities.

@entity1 @entity281 @entity2259
OBJECTIVES: To describe the results of the epidemiologic investigation of outbreaks of invasive @entity281 among attendees at daycare facilities located in 4 closed communities in Israel. STUDY DESIGN: The preschool-aged population of communities with clusters of Kingella cases had oropharyngeal cultures performed. K kingae isolates from infected @entity1 and healthy contacts were genotyped by pulsed field gel electrophoresis to determine the spread of outbreak strains. RESULTS: The affected closed communities (3 military bases and 1 "kibbutz" commune) were characterized by tight social and family networks and intensive mingling. The outbreaks affected 9 of 51 attendees (attack rate: 17.6%) age 8-19  months (median: 12  months), within a 21-day period. Cases included skeletal system infections (n  =  8) and @entity2259 (n  =  1); K kingae isolates were confirmed by the use of blood culture vials and selective media. Clinical presentation was mild and acute-phase reactants were usually normal or only moderately elevated. Thirty out of 55 (54.5%) asymptomatic @entity1 carried the outbreak strains. Analysis of the 3 clusters in which the entire preschool-aged population was cultured revealed that 31 of 71 (43.7%) @entity1 younger than 24  months of age were colonized with K kingae organisms compared with 8 of 105 (7.6%) older @entity1 (P  <  .001). CONCLUSIONS: Clusters of invasive @entity281 characterized by sudden onset, high attack rate, and wide dissemination of the outbreak strain can occur in daycare facilities and closed communities. Because the mild clinical presentation of invasive @entity281 and the fastidious nature of the organism, a high index of suspicion and use of sensitive detection methods are recommended.
