When it comes to "walking pneumonia," Bowdoin is not out of the woods yet. According to Geoff Beckett, assistant state epidemiologist for the Maine Center for Disease Control and Prevention (Maine CDC), although the numbers have not increased this week, it does not mean that the outbreak is coming to an end.
"I wouldn't venture to say that they [the number of cases] have peaked," Beckett cautioned. "I would be very hesitant to say at this point that it is going away."
Although no new students had been diagnosed with the illness as of last Thursday, six specimens are still pending test results for Mycoplasma pneumoniae?the bacteria that causes walking pneumonia?at the Centers for Disease Control and Prevention (CDC) laboratory in Atlanta, Georgia.
Dr. Eric Tongren, an epidemic intelligence service officer with the U.S. CDC, who is also the lead investigator on campus, said other outbreaks in similar settings have tended to last a couple months.
"A previous outbreak in Rhode Island lasted about two months," he said.
Though the College has been working with state health officials since mid-September to control the outbreak, a more thorough epidemiological investigation is just getting underway on campus.
The unusually high number of cases at Bowdoin presents a valuable opportunity to better understand the transmission of Mycoplasma pneumoniae during outbreak situations.
"This is a unique opportunity because these outbreaks are extremely rare. You don't usually find out about a Mycoplasma outbreak that is ongoing," he said. "It is very rare to come in when transmission is occurring."
In addition, Tongren said that the CDC is "using a new diagnostic approach" for Mycoplasma and the campus investigation "offers a possibility to refine this technique."
"It will help us figure out where we are in the outbreak," Beckett said.
As part of the investigation, the CDC is trying to learn more about students who have been diagnosed with pneumonia. On Thursday afternoon, students received an e-mail with a link to an online survey with questions about their activities and their health. The e-mail from the CDC encouraged students to complete the 10-minute survey in order "to help protect others from future infections."
The survey is intended to better understand healthy students, who have not been diagnosed with pneumonia, but could unknowingly be carriers of the Mycoplasma bacteria.
"We are trying to get collect controls. We would like everyone to complete the survey," Tongren said.
In addition to the online survey, the CDC is trying to collect approximately 40 blood samples and throat swabs for testing at the CDC lab in Atlanta. So far, specimens have been collected from only three students.
Tongren emphasized that the survey was confidential and that the collected data would be protected by HIPAA.
According to Tongren, Bowdoin officials have cooperated with the CDC in its investigation.
"Everybody has their recommendations, and we have worked together very well," he said.
Dr. Dora Anne Mills, the state's public health director, said that Bowdoin has been very accommodating during the investigation.
"My understanding from staff is that they have had excellent cooperation," she said.
She also noted that during the investigation her staff has had to work with a variety of people, including contract providers from Parkview and both the medical and non-medical staff at Bowdoin.
The incubation period of Mycoplasma coupled with the difficulties of diagnosing the illness have made managing the outbreak challenging.
"It has been a difficult situation because the Mycoplasma as a bacteria is challenging for two reasons. One is it's difficult to identify," she said. "And the second reason it is challenging is that it can have the potential to fester for a number of weeks and months."
Mills said that the lengthy incubation period?anywhere from five to 25 days?means that a person who has been exposed can potentially be contagious before showing any symptoms of the illness. In addition, she said that there is evidence that some people remain contagious even after taking antibiotics.
"It is frustrating to be faced with an outbreak because it's difficult to completely control these two factors," Mills said.