- Hannah Evans1,2,3,4, Hikaru Bolt1,2,3,4, Ellen Heinsbroek2, Bryony Lloyd6, Peter English5, Samia Latif6, Nicola Elviss7, Jane Turton8, Peter Hoffman8, Paul Crook2, Richard Puleston1,2,9, on behalf of the Outbreak Control Team10
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View Affiliations Hide AffiliationsAffiliations: 1 United Kingdom Field Epidemiology Training Programme, Public Health England, London, United Kingdom 2 Field Epidemiology Services, National Infection Service, Public Health England, London and Nottingham, United Kingdom 3 European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden 4 These authors contributed equally to this work 5 Public Health England South East, Horsham, United Kingdom 6 Public Health England East Midlands, Nottingham, United Kingdom 7 Food Water and Environmental Microbiology Laboratory, National Infection Service, Public Health England, London, United Kingdom 8 Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, National Infection Service, Public Health England, London, United Kingdom 9 University of Nottingham, School of Medicine, Division of Epidemiology and Public Health, Nottingham, United Kingdom 10 The members of the Outbreak Control Team have been listed at the end of this articleHannah EvansHannah.Evans phe.gov.ukand Hikaru Bolthikaru.bolt phe.gov.uk
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Citation style for this article: Evans Hannah, Bolt Hikaru, Heinsbroek Ellen, Lloyd Bryony, English Peter, Latif Samia, Elviss Nicola, Turton Jane, Hoffman Peter, Crook Paul, Puleston Richard, on behalf of the Outbreak Control Team. National outbreak of Pseudomonas aeruginosa associated with an aftercare solution following piercings, July to September 2016, England. Euro Surveill. 2018;23(37):pii=1700795. https://doi.org/10.2807/1560-7917.ES.2018.23.37.1700795 Received: 30 Nov 2018; Accepted: 13 May 2018
National outbreak of Pseudomonas aeruginosa associated with an aftercare solution following piercings, July to September 2016, England
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Abstract
We report a national Pseudomonas aeruginosa outbreak from a common source following piercings between July and September 2016 in England. The multi-agency outbreak investigation included active case finding, microbiological testing of environmental samples and case specimens including Variable Number Tandem Repeat (VNTR) typing and a retrospective cohort study. Overall, 162 outbreak cases (29 confirmed, 14 probable and 119 possible) and 14 non-outbreak cases were identified; all confirmed cases had ear piercings (93% cartilage). Outbreak cases were predominantly female (95%) and had a median age of 18 years (interquartile range: 13–56 years). Nineteen outbreak cases required surgery under general anaesthetic The same outbreak VNTR type (11,3,5,3,3,3,6,4,7) was isolated from bottles of an aftercare solution from a single manufacturer and in specimens from confirmed cases who attended eight different piercing studios supplied with this product. In the cohort study, use of aftercare solution was associated with becoming a case (aOR: 4.60, 95% confidence interval: 1.65–12.90). Environmental, microbiological and epidemiological investigations confirmed that contamination during production of aftercare solution was the source of this national outbreak; highlighting challenges in the regulation of a cosmetic products used in the piercing industry and that guidance on piercing aftercare may need to be reviewed.

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