Pneumococcal Disease Outbreak at a State Prison, Alabama, USA, September 1–October 10, 2018

Guillermo V. Sanchez; Constance L. Bourne; Sherri L. Davidson; Mark Ellis; Leora R. Feldstein; Katherine Fay; Nicole E. Brown; Evelyn F. Geeter; Lytasha L. Foster; Charlotte Gilmore; Mary G. McIntyre; Burnestine Taylor; Srinivasan Velusamy; Sopio Chochua; Almea M. Matanock


Emerging Infectious Diseases. 2021;27(7):1949-1952. 

In This Article

Abstract and Introduction


A pneumococcal disease outbreak caused by Streptococcus pneumoniae serotype 12F occurred in a state prison in Alabama, USA. Among 1,276 inmates, 40 cases were identified (3 confirmed, 2 probable, 35 suspected). Close living quarters, substance use, and underlying conditions likely contributed to disease risk. Prophylaxis for close contacts included azithromycin and 23-valent pneumococcal polysaccharide vaccine.


Streptococcus pneumoniae (pneumococcus) causes a spectrum of disease ranging from mild respiratory infections to severe disease, including meningitis, sepsis, and pneumonia.[1] Invasive pneumococcal disease (IPD) occurs when pneumococcus invades normally sterile sites. Pneumococcus is transmitted person-to-person primarily through respiratory droplets and is a leading cause of vaccine-preventable illness and death.[2] Pneumococcal colonization is a precursor to disease but does not always result in disease.[3] Pneumococcal conjugate vaccine (PCV) is highly effective in preventing pneumonia in adults,[4] and pneumococcal disease incidence has declined since the introduction of PCV.[5] IPD outbreaks are rare but can occur in settings with close person-to-person contact, such as homeless shelters[6] and healthcare facilities, in which underlying conditions can increase disease risk.[7]

On September 19, 2018, the Alabama Department of Public Health (Montgomery, AL) was notified of an IPD case after identification of S. pneumoniae in a blood culture from an ill patient incarcerated at a state prison. On September 24, a second case of IPD was reported in another inmate who received a diagnosis of meningitis and sepsis and died that morning. We investigated this outbreak to determine its extent, identify cases among staff and inmates, and recommend prophylactic measures to reduce spread.