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Schools confront MRSA bacteria

POSTED: November 9, 2007 5:04 a.m.

GAINESVILLE — For some people, what scared them most in the weeks leading up to Halloween wasn’t a ghost or goblin. It was a monster called MRSA.

Local and national media have inundated the public with stories about methicillin-resistant Staphylococcus aureus, a bacterial skin infection that can’t be cured with some types of antibiotics.

Reports of cases at several metro Atlanta schools have made some parents nervous about their children’s safety. But medical professionals say there’s no reason to panic.

"There’s a lot of hysteria," said Dr. John Alsobrook, a sports medicine physician in South Hall. "School officials have gotten so paranoid. You hear on the news, all over the country, about schools being shut down."

Mamie Coker, health services coordinator for Hall County Schools, said it makes no sense to close a school or scrub everything inside, because the illness has nothing to do with buildings.

"Sanitizing an entire school is not recommended by the Centers for Disease Control," she said. "MRSA is transmitted by direct contact. You have to either touch the drainage (from an infected wound) or come into immediate contact with something that has touched it."

What initially scared people about drug-resistant staph was that originally such infections only occurred within hospitals. Patients entered the hospital for an unrelated reason, such as surgery, and developed MRSA while they were there. But hospital-acquired infections of any kind are extremely common. Many patients already have weakened immune systems, and during treatment their bodies are invaded by medical equipment, such as feeding tubes and urinary catheters, that can introduce infection.

What surprised everyone was when MRSA started showing up in people who had never been in the hospital. In the 1990s, doctors started seeing the infection in schools, athletic dormitories and other places where people come into close contact with each other.

Epidemiologists now refer to such cases as community-acquired MRSA. Alsobrook said you’re hearing more about the disease not simply because it’s being tested for and reported more often, but because it actually is more widespread than it used to be.

"Antibiotic-resistant skin infections are becoming more common, no question about it," he said. "In the last three months I’ve seen maybe five cases. Some were athletes, some not."

The good news is that if caught early, MRSA can be treated. It doesn’t respond to certain antibiotics, such as penicillin and erythromycin, but there are still a number of drugs that work.

In rare cases, MRSA spreads beyond the skin and enters the bloodstream, causing a life-threatening systemic infection. A student in Virginia recently died of the disease, and Coker believes that’s what triggered so much concern.

"When it first came out in the news, we were getting a lot of phone calls from parents," she said. "So we put together an informational letter and gave it to all the principals, and they can send it out to parents at their discretion."

Coker said the document explains what the schools are doing to help combat the disease.

"We first became aware of MRSA about three years ago, and we’ve had prevention guidelines in place since then," she said.

Coker said they try to keep all areas of schools clean, but some areas are more critical than others. For example, germ-killing cleansers are sprayed on items used by athletes, such as weight-lifting equipment.

"The weight rooms must be cleaned daily," she said. "We tell students that their athletic clothing should be washed in hot water, and there can be no sharing of towels or razors."

Athletes are at risk, Coker said, because they’re much more likely than the average person to get hurt.

"They have a lot of open wounds and a lot of abrasions such as turf burns," she said.

Infections can be transmitted during sports in which there is frequent skin-on-skin contact. "Wrestling is an especially high-risk activity," she said.

Still, MRSA is not highly contagious, and the vast majority of athletes will never get it. "We’ve had just a handful of cases this year, maybe four, which is about the same as last year," Coker said.

She bases that figure on what’s been reported to her by school nurses or parents. There is no official count, because schools are not required to report MRSA to the Georgia Division of Public Health. That’s the doctor’s responsibility.

"Community-acquired MRSA is only a reportable disease if it requires hospitalization," said Dave Palmer, spokesman for District 2 Public Health in Gainesville. "But the state is reviewing the way the reporting is done, to see if we can give schools better guidelines."

Palmer said in the 13-county District 2 area, only three severe cases of community-acquired MRSA have been reported so far this year. That compares to 18 cases in 2006.

Statewide, Georgia had 553 cases in 2006 and 375 so far this year.

Palmer said if an Atlanta TV station reports that a particular high school has had, for instance, three cases of MRSA, that information is based on what the families or local school officials are telling reporters. It is not coming from state health agencies, unless a student has been hospitalized.

Lumpkin County Schools superintendent Dewey Moye said Lumpkin County High School did have a case last year in which a football player was hospitalized with MRSA. The student is fine now, but the school changed some of its protocols as a result.

"We replaced closed lockers with open lockers, and we fog the room with antibacterial solution every night," Moye said. "We’re trying to be very proactive."

Paula Sawyer, health services coordinator for Gainesville City Schools, said as far as she knows there have not been any MRSA cases in the city school system this year.

"Certainly if we had a case, we would inform the students and parents," she said.

But if a letter is sent out to families, it would be aimed at helping them understand the disease, not to warn them that their child may have it. MRSA is not as contagious as, say, tuberculosis, where everyone in close proximity to the patient could be at risk for contracting it.

"When I talk to students, I try not to alarm them but just to make them aware," Sawyer said. "Faculty and staff at all our schools have been sent information about MRSA. Our coaches are well-educated about this, and they talk to their athletes about infection control. We do take precautions, especially in athletic facilities and locker rooms."

And of course, she said, proper hand-washing is essential to preventing any type of infection.

Staff members have also been told how to recognize a possible case of MRSA. "If they come across a student who seems to have an infection, they are to send them to the school nurse," Sawyer said.

Coker said MRSA usually has a distinctive presentation. "Years ago, it was often misdiagnosed as a brown recluse spider bite," she said. "It can start off as a small pimple or boil that quickly becomes swollen, angry, and red, and often has a discharge of pus."

Coker said some doctors are diagnosing MRSA based solely on how it looks. But Alsobrook is strongly opposed to this practice.

"The important thing is to culture the wound," he said. "I always take a culture first. Then I may start the patient on an antibiotic while we wait for the results. If the test comes back positive for MRSA, I call the patient and tell them we need to switch the antibiotic."

Alsobrook said sometimes patients question why a change in medication is necessary, since their wound seems to be healing.

"If the antibiotic is inappropriate, the patient may clinically seem to get better for a while, but it is not killing all the bugs," he said. "You run the risk of it coming back stronger and worse than before. MRSA is a bad bug, but only if it’s not treated appropriately."

And since MRSA germs do not travel through the air, someone who has the infection doesn’t need to be isolated from other people. All they have to do is keep the wound covered with a clean bandage, and no one is at risk.

"MRSA is not something to take lightly," Sawyer said. "But it’s nothing to get hysterical about."



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