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Any parent of a young child has likely spent time supervising ricocheting kids in an inflatable bouncy castle. But an outbreak report last week in Eurosurveillance might give them some second thoughts.

The report describes an outbreak of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections involving 48 children ages 5 to 16 years, all but one of whom attended a party on a humid and intermittently rainy day in a suburb of Dublin that included inflatable play structures, including three bouncy castles. 

Of the 47 children who attended the party, all played in the bouncy castles, with 19 telling investigators they had spent more than four hours in them. One infected child who did not attend the party had close, sustained contact with a child who was at the party and had symptoms. 

All case-patients reported skin or other soft-tissue symptoms such as spots, pustules, and blisters, most commonly on their legs but also on their abdomens, hips or buttocks, and arms and hands. All sought medical attention, with four hospitalized.

Whole-genome sequencing of bacteria isolated from 22 case-patients found that all belonged the same MRSA strain (ST22-MRSA-IV) and produced Pantone-Valentine leucocidin (PVL), a toxin that can make staph infections more severe. PVL-positive ST22-MRSA-IV has been linked to outbreaks in India, China, and Japan, but the strain has only been reported sporadically in Ireland, the study authors note.

A novel outbreak

The outbreak was contained through treatment, decolonization of household contacts, and communication with the company that provided the bouncy castles, which was advised that the equipment should not be reused until it was adequately cleaned and disinfected.

An estimated two in every 100 people carry MRSA on their skin, and CA-MRSA outbreaks are typically associated with close physical contact and crowded settings. But the authors say there’s been no documentation of outbreaks linked to bouncy castles.

“This is a novel mechanism for an outbreak of this size,” they wrote. “Public health practitioners should be aware of the risk of CA-MRSA outbreaks in contexts involving prolonged, close physical contact, such as play activities and contact sport.”