National outbreak of Pseudomonas aeruginosa associated with an aftercare solution following piercings, July to September 2016, England.
Evans, Hannah;
Bolt, Hikaru;
Heinsbroek, Ellen;
Lloyd, Bryony;
English, Peter;
Latif, Samia;
Elviss, Nicola;
Turton, Jane;
Hoffman, Peter;
Crook, Paul;
+2 more...Puleston, Richard;
On Behalf Of The Outbreak Control Team;
(2018)
National outbreak of Pseudomonas aeruginosa associated with an aftercare solution following piercings, July to September 2016, England.
Eurosurveillance, 23 (37).
ISSN 1560-7917
DOI: https://doi.org/10.2807/1560-7917.ES.2018.23.37.1700795
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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.