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How to Investigate Unexplained Respiratory Disease Outbreaks (URDO)

References & Publications

Outbreak Investigations

  1. CDC. Acute Respiratory Disease Associated with Adenovirus Serotype 14 --- Four States, 2006—2007.  MMWR 2007 Nov 16; 56(45):1181-1184.
  1. CDC. Outbreaks of Respiratory Illness Mistakenly Attributed to Pertussis --- New Hampshire, Massachusetts, and Tennessee, 2004--2006.  MMWR 2007 Aug 24; 56(33): 837-842.
  1. CDC. Outbreak of Group A Streptococcal Pneumonia among Marine Corps Recruits-- California, November 1-December 20, 2002 (Feb 2003).  MMWR 2003 Feb 14; 52(06): 106-109.
  1. CDC. Outbreak of Invasive Group A Streptococcus Associated with Varicella in a Childcare Center -- Boston, Massachusetts, 1997 (October 1997).  MMWR 1997 Oct 10; 46(40): 944-948.

  2. CDC. Outbreaks of Mycoplasma pneumoniae Respiratory Infection – Ohio, Texas, and New York, 1993.  MMWR 1993 Dec 10; 42(48): 931, 937-939.
  1. CDC. Use of Pulsed-Field Gel Electrophoresis for Investigation of a Cluster of Invasive Group A Streptococcal Illness - Spokane, Washington, 1999.  MMWR 1999 Aug 13; 48(31): 681-683. 
  1. Reingold, A.L. Outbreak investigations--a perspective. Emerg Infect Dis 1998; 4(1): 21-7. 
  1. Feikin DR, Moroney JF, Talkington DF, et al. An outbreak of acute respiratory disease caused by Mycoplasma pneumoniae and adenovirus at a Federal service training academy: new implications from an old scenario. Clin Infect Dis 1999; 29: 1545-1550.
  1. Barker BM, Jewell KA, Kroken S, Orbach MJ. The population biology of Coccidioides: epidemiologic implications for disease outbreaks. Ann NY Acad Sci 2007; 1111: 147-63.
  1. O'Loughlin, R. E., L. Kightlinger, et al. (2007). Restaurant outbreak of Legionnaires' disease associated with a decorative fountain: an environmental and case-control study. BMC Infect Dis 2007; 7: 93.
  1. Phares, C. R., E. Russell, et al. Legionnaires' disease among residents of a long-term care facility: The sentinel event in a community outbreak. Am J Infect Control 2007; 35(5): 319-323.
  1. Burnsed, L. J., L. A. Hicks, et al. A large, travel-associated outbreak of legionellosis among hotel guests: utility of the urine antigen assay in confirming Pontiac fever. Clin Infect Dis 2007; 44(2): 222-8.

Useful tools

  1. Investigating clusters of group A streptococcal disease.

Disease Control & Prevention Measures

  1. CDC. Guidelines for Environmental Infection Control in Health-Care Facilities.  MMWR 2003 Jun 6; 52(RR10): 1-42.

  2. CDC. Compendium of Measures To Prevent Disease Associated with Animals in Public Settings, 2005.  MMWR 2005 Mar 25; 54(RR04): 1-12. CDC.

  3. CDC. Preventing Pneumococcal Disease Among Infants and Young Children Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2000 Oct 06; 49(RR09): 1-38. (Recommendations for use of pneumococcal conjugate vaccine among infants and young children)

  4. CDC. Updated Recommendation from the Advisory Committee on Immunization Practices (ACIP) for Use of 7-Valent Pneumococcal Conjugate Vaccine (PCV7) in Children Aged 24--59 Months Who Are Not Completely Vaccinated .  MMWR 2008 Apr 4; 57(13): 343-344.

  5. CDC. Prevention of Pneumococcal Disease: Recommendations of the Advisory Committee on Immunization Practices (ACIP) . MMWR 1997 Apr 04; 46(RR08): 1-24.    (Recommendations for use of the pneumococcal polysaccharide vaccine among persons age 2 years and older)

  6. CDC. Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2007 Prevention and Control of Influenza. MMWR 2007 July 13; 56(RR06): 1-54.  

  7. CDC. Hantavirus Pulmonary Syndrome-United States: Updated Recommendations for Risk Reduction .  MMWR 2002 July 26; 51(RR9): 1-14.

  8. CDC. Guidelines for preventing health-care-associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). MMWR 2004 Mar 26; 53(RR3): 1-179. 

  9. CDC. Guidelines for Preventing the Transmission of Mycobacterium tuberculosis
    in Health-Care Settings, 2005.
    MMWR 2005 Dec 30; 54(RR17): 1-141.

  10. CDC. Prevention of Plague: Recommendations of the Advisory Committee on Immunization Practices (ACIP).  MMWR 1996 Dec 13; 45(RR14); 1-15.

  11. Dupont, H.T., Raoult, D., Brouqui, P., Janbon, F., Peyramond, D., Weiller, P.J., Chicheportiche, C., Nezri, M., and Poirier, R. Epidemiologic features and clinical presentation of acute Q fever in hospitalized patients: 323 French cases. Amer J Med 1992; 93: 427-434.

  12. Prevention of Invasive Group A Streptococcal Disease among Household Contacts of Case Patients and among Postpartum and Postsurgical Patients: Recommendations from the Centers for Disease Control and Prevention.  Clin Infect Dis 2002:35.

Other References

  1. Compendium of Measures to Control Chlamydophila psittaci Infection Among Humans (Psittacosis) and Pet Birds (Avian Chlamydiosis), 2008.

  2. Guidelines for the Control of Pertussis Outbreaks.

Diagnosis & Treatment

  1. CDC. Treatment of Tuberculosis. MMWR 2003 Jun 20; 52(RR11): 1-77.
  1. Practice Guidelines for the Diagnosis and Management of Group A Streptococcal Pharyngitis Clin Infect Dis 2002; 35.
  1. Infectious Disease Society of American/ American Thoracic Society Consensus Guidelines on Management of Community-Acquired Pneumonia in Adults. Clin Infect Dis 2007; 44 (Suppl. 2).
  1. Heffelfinger, et al.  Management of Community-Acquired Pneumonia in the Era of Pneumococcal Resistance. Arch Intern Med. 2001;161(13):1681-2.
  1. Chapman SW, Bradsher RW, Campbell GD, et al. Practice guidelines for the management of patients with blastomycosis. Clin Infect Dis 2000; 30: 679-683.
  1. Hyde TB, Gilbert M, Zell ER et al. Azithromycin prophylaxis during a hospital outbreak of Mycoplasma pneumoniae pneumonia. J Infect Dis 2001; 183: 907-912.

Other References

  1. Vaccines and vaccine preventable diseases.  (Provides links to information on immunization to prevent influenza and pneumococcal infections among infants, children and adults.)

  2. Standards, Practice Guidelines, and Statements Developed and/or Endorsed by IDSA.

Media Toolkits

During an outbreak, you may be required to assist with communication, either to the public or to the media, or both. Here are some tools to assist you. The following are excerpts from the Influenza Media Toolkit.

See also:


Contact Us: - Prepare. Plan. Stay Informed. The U.S. Government's Official Web PortalDepartment of Health and Human Services
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800-CDC-INFO (800-232-4636) TTY: (888) 232-6348 - Contact CDC-INFO

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