Intended for healthcare professionals

Practice Lesson of the Week

Outbreak of Streptococcus pneumoniae serotype 1 pneumonia in a United Kingdom school

BMJ 2008; 337 doi: (Published 31 December 2008) Cite this as: BMJ 2008;337:a2964
  1. Atul Gupta, specialist registrar, paediatric respiratory medicine1,
  2. F-M Khaw, consultant in health protection2,
  3. E L Stokle, senior health protection nurse2,
  4. R C George, consultant medical microbiologist3,
  5. R Pebody, consultant3,
  6. R E Stansfield, consultant microbiologist4,
  7. C L Sheppard, advanced healthcare scientist3,
  8. M Slack, consultant medical microbiologist3,
  9. R Gorton, consultant regional epidemiologist2,
  10. D A Spencer, consultant paediatric respiratory medicine1
  1. 1Paediatric Respiratory Unit, Freeman Hospital, Newcastle upon Tyne NE7 7DN
  2. 2Health Protection Agency North East, Northern Office, Citygate, Newcastle upon Tyne NE1 4WH
  3. 3Health Protection Agency, Centre for Infections, London NW9 5EQ
  4. 4Microbiology Laboratory Service, Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields NE29 8NH
  1. Correspondence to: F-M Khaw Meng.khaw{at}
  • Accepted 29 November 2008

Healthcare workers and teachers should report suspected outbreaks of serotype 1 pneumococcal disease early, and childhood immunisation should be considered

Pneumococcal pneumonia is not generally regarded as contagious.1 Although epidemics of pneumococcal disease have been reported (in sub-Saharan Africa2 3 and Canada4), outbreaks of pneumococcal infection are uncommon and are generally restricted to high risk individuals such as alcoholics,5 residents in shelters for the homeless,6 and people living in close groups7 including military camps,8 prisons,9 day care centres,10 and nursing homes.11 Recent reports have indicated that serotype 1 pneumococcus is largely responsible for the exponential increase in the incidence of empyema and complicated pneumonia seen in children in several countries over the past decade.12 13 14 There is also evidence of outbreaks of other forms of invasive serotype 1 disease in many countries.2 15 16 In contrast to most other invasive serotypes, carriage of serotype 1 is rarely detected in the nasopharynx of either adults or children, suggesting short duration of carriage or high virulence.17 18

There have been no reports of outbreaks of pneumococcal pneumonia among UK children, but they have been reported in other countries.7 19 We describe an outbreak of serotype 1 pneumococcal pneumonia among young children in a school in northeast England.

Case reports

Clinical summary

Three cases of pneumococcal pneumonia in young children were initially reported in a primary school in North Tyneside. The dates of onset of illness were between 10 and 13 October 2006, and all three children, aged 4-5 years, attended the same reception class at the school and all were admitted to hospital with radiologically confirmed lobar pneumonia. The course of the disease was uncomplicated in two children, whose blood …

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