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The cases attributable to ST1559 arose later than Outbreak Lineage 1 (between September and December 2012); therefore, we named this group Outbreak Lineage 2. The 24 Outbreak Lineage 1 strains mainly originated from a range of patient samples in the NICU complex in May and June 2012, which is consistent with the timing of the first peak in K. pneumoniae isolations in the microbiology department.
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Three species-group outbreaks occurred in both ICUs simultaneously.
Figure 1 shows the presence and duration of species-group outbreaks in relation to the incidence of each species-group in each ICU.
There was no evidence of temporal clustering of species-group outbreaks during the study period after temporal adjustment for incidence trends (Table 3).
A preliminary analysis showed aggregation of species-group outbreaks within the first 4 years of the study, which disappeared with adjustment for underlying temporal trends.
Most of the additional species-group outbreaks detected in the analyses presumably reflect hospital or ICU transmission, but some outbreaks, such as those with streptococci and Haemophilus influenzae, may reflect both hospital and community transmission.
For any given serotype, the potential of within-group outbreaks to sustain transmission in the whole population is characterized by the average number of infectious contacts emanating from a single outbreak [ 21], the so called group-to-group reproduction number R*.
In 1992, another group A outbreak occurred in Mecca during Umra and Ramadan, but this outbreak was not known to have spread beyond Saudi Arabia (4).
Under the assumption of paraphyly, this would be the group of outbreak patients.
In addition to application of standard control measures, a third dose of MMR vaccine was administered to the most affected age group for outbreak control, not as PEP.
However, the proportion of sampled individuals from social groups after outbreak was higher in Lokoué than in Lossi (χ21 = 5.9, p = 0.014).
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