Over the past few months, a wave of staph infections have been reported in Jefferson County. Methicillin-resistant Staphylococcus Aureus (MRSA) is a type of staph that is resistant to certain antibiotics. Staph infections, including MRSA, occur most frequently among patients in hospitals and healthcare facilities, but they are becoming more common in the community.

In October 2007, Ashton Bonds, a 17-year-old senior at Staunton River High School in Moneta, Va., died after being diagnosed with MRSA. The same month, 12-year-old Omar Rivera died of MRSA in Brooklyn, N.Y. These deaths have raised awareness of MRSA as well as general anxiety about the disease and its consequences.

Shepherdstown Elementary

On October 31, 2007, a student at Shepherdstown Elementary School was found to be infected with the MRSA virus.

Judith Rice of Jefferson County Health Department received a phone call from the nurse at Shepherdstown Elementary that day about the student. Rice says the nurse asked her if they should shut the school down. Rice told her this was not necessary. They discussed cleaning the crayons in the classroom, but then agreed to throw them away because they didn’t cost much, and keeping them might cause concern. Rice told the nurse to inform the parents of the friends closest to the student with MRSA that same day.

The school sent a letter to all parents of Shepherdstown Elementary students on the evening of November 1. In this note, principal Suzanne Offutt confirmed that “one of our students does have a sore on her arm that’s been diagnosed as MRSA.”

Some teachers and parents questioned how slowly the school dealt with the case. It was discovered mid-morning October 31 but not announced to parents until the evening of the next day—the same day the child with the infection returned to school.

When asked why parents were not informed about the MRSA at Shepherdstown Elementary until 24 hours after the case was reported, Gayle Woods, spokeswoman for the Jefferson County Board of Education, said that it took time to write accurate letters and have them sent out to the parents. Offutt says part of the reason for the delay was that the Jefferson County Health Department did not get back to her on the text of the letter to the parents until 2.20 pm on October 31—too late to notify parents that day.

 “MRSA is readily treated with common antibiotics and appropriate incision and drainage of wounds, if necessary,” said Dr. David Didden, a family physician at Shenandoah Community Health Center. “While severe complications are possible, they are rare, and consultation with a primary care provider regarding any suspicious rashes or skin lesions is an appropriate first step.” Didden added, “There is no need to panic, and family physicians and pediatricians are thoroughly capable of answering questions.”

School board spokeswoman Woods said that this was the second time that MRSA has been reported in a Jefferson County School. The first time was in September of this year at the ninth grade complex next to Jefferson High School. As to the MRSA at Shepherdstown Elementary, Woods said, “This is not an epidemic. It has been taken care of. There’s no story here.”

Lisa Carper, coordinator of student support and social services for the Jefferson County board of education, was similarly dismissive of any talk of a crisis. “Our protocol is this: when a case is diagnosed, the student receives treatment, and they cover their wound. That’s the beginning and the end.”

Not Ducking the Question

Incidents of MRSA have also been reported at Shepherd University in Shepherdstown. According to Sam Stanley-Alden, director of student health services at Shepherd, there have been two confirmed cases, one in August, the second in September of this year. Both students were referred to a hospital and treated. Once released, the students were then allowed to return to school to resume their studies.

 “A lot of the panic of MRSA has been because of media labeling,” said Stanley-Alden. “They talk about ‘super-bugs’ and ‘flesh eating bacteria.’ There is reason for concern, but there is no reason for panic.”

Some school boards across the country have shut down their campuses to disinfect entire facilities. Indeed, after the death of the student in Virginia, 22 schools in Bedford County were closed for cleaning.

According to Stanley-Alden, this “closing and hosing” is ineffective. She believes a better strategy is to organize classes on MRSA to teach about the importance of hand-washing, refraining from sharing towels and grooming items, and not sharing clothing. “You can wipe down a school entirely,” says Stanley-Alden, “but as soon as the students come back, if they are not properly educated, it may become contaminated again.”

Shepherd University has had seven other students who have been treated for MRSA. Cultures from these students were not sent to hospitals and therefore they are not confirmed as MRSA cases. But, Sam Stanley-Alden says, “If it walks like a duck, and it quacks like a duck, we will treat it like it’s a duck.”

Stanley-Alden said that the treatment of MRSA at Shepherd University will continue according to the present protocol unless a cluster of cases develops. If this happens, she said, the environment associated with the cluster will be isolated, and cleaning will take place. She would characterize a cluster as two or three cases stemming from the same locker room or residence hall.

The bigger picture

According to the county health department’s Judith Rice, there have been 12 confirmed cases of MRSA in Jefferson County: the four already described at Shepherd University, one at the ninth grade complex and Shepherdstown Elementary; two at the Harpers Ferry Medical Center; one at a day care center; three at Jefferson Memorial Hospital; and three at an urgent care facility. The patients with MRSA ranged in age from three to 73.

State Epidemiologist Dr. Loretta Haddy of the West Virginia Health Department said there were 11 clusters or “outbreaks” of MRSA in West Virginia between 2003 and 2006. They affected 127 people. These numbers do not include individual cases not reported to the state health department because they are not considered clusters. These individual cases are dealt with at a local level by county health departments. No state agency tallies up these local numbers, she said.

Haddy says she understands that when there is a great deal of pressure from parents, especially when people hear that someone has died from the disease, it is hard for a school system to resist bowing to public pressure. “The important thing has been education, that is where our focus has been,” she said. The department has distributed posters about MRSA and other information to institutions around the state. She adds that, unlike neighboring states that close schools to clean for infections like MRSA, West Virginia has a policy of keeping schools open. “After all,” she says, “where will the students go if the schools are closed?”

Some people believe that the rise of MRSA is due to overuse of antibiotics, which has led to resistance by the virus. Physician Didden says that he hopes for a silver lining in this recent spate of cases. It is a good opportunity, he says, for people think about judicious use of antibiotics in the future.

To learn more about MRSA, go to:
www.wvObserver.com.
Cdc - http://www.cdc.gov/ncidod/dhqp/ar_mrsa.html
Shepherd University - http://www.shepherd.edu/university/healthinfo.html
Wv state health dept - http://www.wvdhhr.org/phs/