To: Parents

From: Russell Rider, School Physician

Re: MRSA Concern

Date: October 26, 2007

Recently a skin infection was evaluated in one of the students from LLCS and on the basis of similar appearance to previous skin infections which had been cultured formally as being positive for Methicillin-Resistant Staphylococcus Aureus, the presumptive diagnosis was made. It was not formally confirmed by laboratory testing, which is the only way to conclusively prove the diagnosis. Therefore the “confirmed “ case in town actually was presumed and not proven. This leads to the question of what the significance of such a case would be, even if the presumption is correct. As a result I have several points that need to be kept in mind:

1. MRSA does not know that it’s special. It is just another bacterium.

2. I read just last night (10/25/07), that probably as many as 1/3 of Americans are carrying MRSA on their body, so to “wipe it out” is entirely impossible

3. Our skin and immune system are spectacularly helpful at avoiding infection with MRSA, and those individuals who do develop an infection will do so because of a failure of the integrity of the skin and/or immune system. I have not seen it documented but it is my understanding that the case(s) which have been widely publicized lately in which MRSA has led to death involved compromised immune systems (eg AIDS, leukemia, chemotherapy, etc).

4. MRSA does not start in your bloodstream or start as a “sickness”, but rather as a sore on your skin which does not heal as quickly as most sores do. In fact MRSA generally behaves like any other staph in causing a red spot with a yellow crusted scab, commonly referred to as a impetigo.

5. There is no practical sense in evaluating asymptomatic patients (adults or childrens) who do not have suspicious skin lesions.

6. It is not unreasonable to watch your own skin or that of your children to assess for sores that are not healing at a proper speed and have them evaluated, but this is also prudent care in a general sense even without the current MRSA scare taken into consideration.

7. It is not widely contagious being in the same room with another person who carries it, as evidenced by the fact that two weeks ago (before there was a scare) 1/3 of Americans still were carrying it, and no one came down with anything dreadful at that time either.

8. It has to be inoculated through a break in the skin (injury) in order to “contract” it. Therefore intact skin and an intact immune system should make it extremely unlikely to contract even if the child is in physical contact with another child who does carry it.

9. There is also no strategic reason to culture to see if a child is a carrier, because of the conclusions and implications of all the previously made points in this memo.

On behalf of the school system and anybody else in the process I would apologize for any inconvenience or concerns. I hope this helps. As we head into a holiday season I hope we can do so confidently and without fears out of proportion to reality.

Sincerely,

Russell Rider, MD

PS: If it helps, please be aware that one of my children was allowed by me to play with the “index case” the day after the diagnosis was made, and has shown no signs of disease.