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Abstract

We report a national 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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/content/10.2807/1560-7917.ES.2018.23.37.1700795
2018-09-13
2020-01-29
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2018.23.37.1700795
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References

  1. Kerr KG, Snelling AM. Pseudomonas aeruginosa: a formidable and ever-present adversary. J Hosp Infect. 2009;73(4):338-44.  https://doi.org/10.1016/j.jhin.2009.04.020  PMID: 19699552 
  2. Livermore DM, Mushtaq S, Warner M, James D, Kearns A, Woodford N. Pathogens of skin and skin-structure infections in the UK and their susceptibility to antibiotics, including ceftaroline. J Antimicrob Chemother. 2015;70(10):2844-53.  https://doi.org/10.1093/jac/dkv179  PMID: 26142478 
  3. Keene WE, Markum AC, Samadpour M. Outbreak of Pseudomonas aeruginosa infections caused by commercial piercing of upper ear cartilage. JAMA. 2004;291(8):981-5.  https://doi.org/10.1001/jama.291.8.981  PMID: 14982914 
  4. Hanif J, Frosh A, Marnane C, Ghufoor K, Rivron R, Sandhu G. Lesson of the week: "High" ear piercing and the rising incidence of perichondritis of the pinna. BMJ. 2001;322(7291):906-7.  https://doi.org/10.1136/bmj.322.7291.906  PMID: 11302908 
  5. Fisher CG, Kacica MA, Bennett NM. Risk factors for cartilage infections of the ear. Am J Prev Med. 2005;29(3):204-9.  https://doi.org/10.1016/j.amepre.2005.06.003  PMID: 16168869 
  6. More DR, Seidel JS, Bryan PA. Ear-piercing techniques as a cause of auricular chondritis. Pediatr Emerg Care. 1999;15(3):189-92.  https://doi.org/10.1097/00006565-199906000-00007  PMID: 10389956 
  7. Staley R, Fitzgibbon JJ, Anderson C. Auricular infections caused by high ear piercing in adolescents. Pediatrics. 1997;99(4):610-1.  https://doi.org/10.1542/peds.99.4.610  PMID: 9093311 
  8. Bone A, Ncube F, Nichols T, Noah ND. Body piercing in England: a survey of piercing at sites other than earlobe. BMJ. 2008;336(7658):1426-8.  https://doi.org/10.1136/bmj.39580.497176.25  PMID: 18556275 
  9. Clayton DHM. Statistical Models in Epidemiology. Oxford: Oxford University Press; 1993.
  10. Environment Agency. The Microbiology of Drinking Water (2010) - Part 8 -The isolation and enumeration of Aeromonas and Pseudomonas aeruginosa by membrane filtration. Standing Committee of Analysts (SCA) 2010.Available from:https://www.gov.uk/government/publications/standing-committee-of-analysts-sca-blue-books
  11. Martin K, Baddal B, Mustafa N, Perry C, Underwood A, Constantidou C, et al. Clusters of genetically similar isolates of Pseudomonas aeruginosa from multiple hospitals in the UK. J Med Microbiol. 2013;62(Pt 7):988-1000.  https://doi.org/10.1099/jmm.0.054841-0  PMID: 23558134 
  12. Turton JF, Turton SE, Yearwood L, Yarde S, Kaufmann ME, Pitt TL. Evaluation of a nine-locus variable-number tandem-repeat scheme for typing of Pseudomonas aeruginosa. Clin Microbiol Infect. 2010;16(8):1111-6.  https://doi.org/10.1111/j.1469-0691.2009.03049.x  PMID: 19732093 
  13. The European Committee on Antimicrobial Susceptibility Testing. Breakpoint tables for interpretation of MICs and zone diameters 2018. Version 8.0. Available from: http://www.eucast.org
  14. Department of Health. Health Technical Memorandum 04-01: Safe water in healthcare premises. Part B: Operational management. 2016. Available from:https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/524882/DH_HTM_0401_PART_B_acc.pdf
  15. Pool Water Treatment Advisory Group (PWTAG). Swimming Pool Water - Treatment and Quality Standards for Pools and Spas. Tamworth: PWTAG; 2009.
  16. Margulis A, Bauer BS, Alizadeh K. Ear reconstruction after auricular chondritis secondary to ear piercing. Plast Reconstr Surg. 2003;111(2):891-7, discussion 898.  https://doi.org/10.1097/01.PRS.0000041535.81094.EB  PMID: 12560718 
  17. European Commission (EC). No 1223/2009 of the European Parliament and the Council of 30 November 2009 on cosmetic products Off Journal of the European Union. Luxembourg: Publication Office of the European Union; 30 Nov 2009: L342:59-209. Available from:http://eur-lex.europa.eu/legal-content/EN/TXT/HTML/?uri=CELEX:02009R1223-20150416&from=EN)
  18. Scientific Committee on Consumer Safety. The Scientific Committee on Consumer Safety Notes of Guidance for the Testing of Cosmetic Ingredients and Their Safety Evaluation. 7th Revision. Brussels: European Commission; 2010. Available from:http://ec.europa.eu/health//sites/health/files/scientific_committees/consumer_safety/docs/sccs_s_004.pdf)
National outbreak of Pseudomonas aeruginosa associated with an aftercare solution following piercings, July to September 2016, England
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Hannah+Evans&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Evans Hannah</a>, <a href="/search?value1=Hikaru+Bolt&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Bolt Hikaru</a>, <a href="/search?value1=Ellen+Heinsbroek&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Heinsbroek Ellen</a>, <a href="/search?value1=Bryony+Lloyd&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Lloyd Bryony</a>, <a href="/search?value1=Peter+English&option1=author&noRedirect=true" class="nonDisambigAuthorLink">English Peter</a>, <a href="/search?value1=Samia+Latif&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Latif Samia</a>, <a href="/search?value1=Nicola+Elviss&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Elviss Nicola</a>, <a href="/search?value1=Jane+Turton&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Turton Jane</a>, <a href="/search?value1=Peter+Hoffman&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Hoffman Peter</a>, <a href="/search?value1=Paul+Crook&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Crook Paul</a>, <a href="/search?value1=Richard+Puleston&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Puleston Richard</a>, <a href="/search?value1=on+behalf+of+the+Outbreak+Control+Team&option1=author&noRedirect=true" class="nonDisambigAuthorLink">on behalf of the Outbreak Control Team</a></span>. National outbreak of Pseudomonas aeruginosa associated with an aftercare solution following piercings, July to September 2016, England. <a href="/content/ecdc">Euro Surveill.</a> 2018;23(37):pii=1700795. <a href="https://doi.org/10.2807/1560-7917.ES.2018.23.37.1700795" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2018.23.37.1700795</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 30 Nov 2018;&nbsp;&nbsp; <span class="generated">Accepted</span>: 13 May 2018 </span> </p>
/content/10.2807/1560-7917.ES.2018.23.37.1700795
/content/10.2807/1560-7917.ES.2018.23.37.1700795
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