An outbreak of PVL-producing MRSA skin infections in children associated with bouncy castle use
Abstract
Background: We describe an outbreak of Panton-Valentine leucocidin (PVL) producing community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) in children in eastern Ireland, associated with bouncy castle use.
Methods: A regional department of public health was notified in autumn 2025 of several hospital presentations by children with skin and soft tissue infection (SSTI), associated with attendance at a recent community social gathering. An outbreak was declared. Phone interviews were conducted with a parent or guardian of each case, obtaining demographic, clinical and exposure information.
Results: A total of 48 children and no adults were identified as cases; of these, 47 attended the same outdoor social gathering in August 2025 which featured bouncy castle play. Most cases developed skin symptoms within two or three days of the gathering. All affected cases used the bouncy castles at the party, in some cases for multiple hours. The commonest affected body site was the legs, particularly the thighs. Thirty-three children were treated by their general practitioner (GP). A further 15 attended a hospital emergency department or day ward, of whom 4 were hospitalised, with no deaths. All confirmed cases exhibited an identical strain type, t016-ST22-MRSA-IV, which was PVL-producing. This strain has been described as hypervirulent but is rare in Ireland. The causal isolate exhibited a distinctive antibiogram. An epidemiological curve was created, which was suggestive of a point source outbreak. Infection control measures were enacted, including treatment and decolonisation of cases; decolonisation of asymptomatic household contacts; and communication with affected families and stakeholders such as the bouncy castle providers.
Conclusions: This CA-MRSA outbreak was the largest on record in Ireland. It highlights the risk of CA-MRSA infection in contexts involving prolonged, close physical contact, such as play involving bouncy castles.
Key messages: • We describe the management of a complex outbreak of methicillin-resistant Staphylococcus aureus (MRSA) in children in eastern Ireland, the largest outbreak on record, linked to bouncy castle use.
• The authors’ hypothesis is that the outbreak was due to close physical contact among children playing on bouncy castles. This mechanism has not been described before in the scientific literature.
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BibTeX
@article{mcglackenbyrne2026outbreak,
title = {{An outbreak of PVL-producing MRSA skin infections in children associated with bouncy castle use}},
author = {D McGlacken-Byrne and G Brennan and E Kitt and KI Quintyne and E Brannigan and M Boland and M Barrett and A King and N O’Loughlin and D Hickey},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.1599},
url = {https://doi.org/10.1093/eurpub/ckag169.1599},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - An outbreak of PVL-producing MRSA skin infections in children associated with bouncy castle use
AU - D McGlacken-Byrne
AU - G Brennan
AU - E Kitt
AU - KI Quintyne
AU - E Brannigan
AU - M Boland
AU - M Barrett
AU - A King
AU - N O’Loughlin
AU - D Hickey
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.1599
UR - https://doi.org/10.1093/eurpub/ckag169.1599
AB - Background: We describe an outbreak of Panton-Valentine leucocidin (PVL) producing community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) in children in eastern Ireland, associated with bouncy castle use. Methods: A regional department of public health was notified in autumn 2025 of several hospital presentations by children with skin and soft tissue infection (SSTI), associated with attendance at a recent community social gathering. An outbreak was declared. Phone interviews were conducted with a parent or guardian of each case, obtaining demographic, clinical and exposure information. Results: A total of 48 children and no adults were identified as cases; of these, 47 attended the same outdoor social gathering in August 2025 which featured bouncy castle play. Most cases developed skin symptoms within two or three days of the gathering. All affected cases used the bouncy castles at the party, in some cases for multiple hours. The commonest affected body site was the legs, particularly the thighs. Thirty-three children were treated by their general practitioner (GP). A further 15 attended a hospital emergency department or day ward, of whom 4 were hospitalised, with no deaths. All confirmed cases exhibited an identical strain type, t016-ST22-MRSA-IV, which was PVL-producing. This strain has been described as hypervirulent but is rare in Ireland. The causal isolate exhibited a distinctive antibiogram. An epidemiological curve was created, which was suggestive of a point source outbreak. Infection control measures were enacted, including treatment and decolonisation of cases; decolonisation of asymptomatic household contacts; and communication with affected families and stakeholders such as the bouncy castle providers. Conclusions: This CA-MRSA outbreak was the largest on record in Ireland. It highlights the risk of CA-MRSA infection in contexts involving prolonged, close physical contact, such as play involving bouncy castles. Key messages: • We describe the management of a complex outbreak of methicillin-resistant Staphylococcus aureus (MRSA) in children in eastern Ireland, the largest outbreak on record, linked to bouncy castle use. • The authors’ hypothesis is that the outbreak was due to close physical contact among children playing on bouncy castles. This mechanism has not been described before in the scientific literature.
SN - 1101-1262
SN - 1464-360X
ER -