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MRSA is no cause for panic

| Monday, April 4, 2016, 6:45 p.m.

The key to infectious disease control is striking an appropriate balance between overreaction and under reaction. This was in plain evidence during the height of the West African Ebola outbreak and currently can be seen with respect to Zika virus. It is essential to get this balance as close to perfect as possible for one does not want to quarantine or isolate people unjustifiably — ask Kaci Hickox — on the one hand and, on the other, one does not want to expose people to risk or unduly instill fear and panic. This balance can sometimes be hard to find given the penchant of infectious disease to evoke the mysterious and unknown while relying on nuanced scientific, medical, and public health concepts.

Butler County Community College, the community college in my hometown, is one such example of striking the wrong balance.

Based on a single case of methicillin resistant Staphylococcus aureus (MRSA) infection in an employee, the college temporarily shuttered its doors for cleaning. This action went far beyond the guidance of the Centers for Disease Control and Prevention (CDC) and is reminiscent of the Community College of Allegheny County (CCAC) respose to bedbugs.

What strikes me as odd is the presumption that closing the school will have any substantial impact on MRSA at the school. While good sanitation and cleaning is important (and I don't know all the particulars of this situation), it cannot eliminate the risk of MRSA. This is a simple incontrovertible fact because the general population harbors MRSA on their bodies at a rate of around 1 percent. In this setting, MRSA, a drug-resistant form of the “staph bacteria that colonizes the skin, has found a home on the skin and lives there peacefully unless it finds a means to move deeper into the skin and cause damage resulting in a condition such as a boil. Colonized individuals can also pass the bacteria to others via skin-to-skin contact and the sharing of towels or razors, for example.

In the context of Butler Community College, with an enrollment of over 3800 students, colonization translates into more than three dozen students colonized with MRSA. Similar rates apply to the faculty and staff and higher colonization rates would be expected in students that have some degree of health care exposure such as nursing, medical assistant, EMT, or paramedic students as the rate in health care workers is, by contrast, about 5 percent. Those students and Butler Community College community members with chronic illnesses may have still higher rates. Because infection occurs primarily through skin-to-skin contact, this single case emerged amongst a larger group of MRSA colonized individuals and not primarily from a school facility or structure.

In effect, the confirmed case is the tip of the iceberg in a sea of the colonized. Additionally, for every case of confirmed MRSA there are likely many boils that resolve on their own and are never confirmed, but nonetheless are, caused by MRSA.

MRSA is nothing new — it has been around for decades — and is no cause for panic. In most people it may cause a minor skin infection (the “spider bite” for which there is no spider). Many people have minor MRSA skin infections that go unnoticed or undiagnosed and resolve on their own. Of course, in certain contexts, MRSA can cause more serious systemic infections such as pneumonia, bloodstream infections, infections of heart valves, or infections of bones/joints. But this is not what occurred at Butler Community College.

I worry that, by scrubbing down the school, a false sense of security will be instilled in the campus community and when the probable next case is announced a new round of panic and demands for more action will arise because the facts about MRSA's presence in the community (it can even be harbored by pets) were not part of the earlier discussion. Such an action, by an institution of higher learning, also sets the wrong example for the students of the college studying science, medicine, and health who, hopefully, are taught the correct evidence-based principles about infectious disease and public health.

While this may seem like a straightforward action and a “show of force” amidst the demands to do something, the negative repercussions of non-evidence based actions (“playing it safe” is the euphemism the college president used) will likely abound. By contrast, Freeport Area High School appropriately remained open when faced with almost the exact same situation. This action will not substantially protect against or change the risk of infection, as it is the campus community itself that harbors the microbe, and it sets the wrong precedent for dealing with similar situations.

Dr. Adalja is an infectious disease physician at UPMC. Follow him on twitter at @AmeshAA and read his personal blog at www.trackingzebra.com.

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