{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T06:14:27Z","timestamp":1788243267690,"version":"build-2803163510"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      In December 2025, an outbreak of acute conjunctivitis emerged at a primary school in Hangzhou, China, affecting 48 students and yielding an attack rate of 2. 16%. The outbreak is of particular significance as it was attributed to\n                      <jats:italic>Streptococcus pneumoniae<\/jats:italic>\n                      , a pathogen seldom implicated in large-scale conjunctivitis outbreaks among school-aged children.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>An epidemiological investigation, a case-control study, and laboratory analyses\u2014comprising multiplex real-time PCR and bacterial culture\u2014were conducted to determine the etiological agent and the source of transmission.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A significant association was established between the outbreak and a recent educational field trip (OR = 6.42, 95% CI: 3.53\u201311.68), suggesting that such organized group activities may represent an important transmission setting for bacterial conjunctivitis. Laboratory analyses confirmed the presence of\n                      <jats:italic>S. pneumoniae<\/jats:italic>\n                      in conjunctival swabs and environmental samples collected from the field trip venue. Moreover, students treated with combination antibiotic therapy had a significantly shorter mean return-to-school time compared with those receiving monotherapy or no treatment (\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.01). However, as treatment allocation was not randomized, this association should be interpreted as an observational finding rather than evidence of causal effectiveness.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This investigation underscores the distinct transmission risks inherent to field trips and emphasizes the imperative of embedding comprehensive infection prevention and control measures into the foundational planning of such activities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1893282","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T05:26:36Z","timestamp":1788240396000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Uncommon pathogen, common activity: Streptococcus pneumoniae conjunctivitis outbreak traced to a primary school field trip"],"prefix":"10.3389","volume":"14","author":[{"given":"Xiaojian","family":"Duan","sequence":"first","affiliation":[{"name":"Hangzhou Center for Disease Control and Prevention (Hangzhou Health Supervision Institution), Institute of Infectious Disease Control and Prevention","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaobin","family":"Ren","sequence":"additional","affiliation":[{"name":"Hangzhou Center for Disease Control and Prevention (Hangzhou Health Supervision Institution), Institute of Infectious Disease Control and Prevention","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"Song","sequence":"additional","affiliation":[{"name":"Hangzhou Center for Disease Control and Prevention (Hangzhou Health Supervision Institution), Institute of Infectious Disease Control and Prevention","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiayun","family":"Wang","sequence":"additional","affiliation":[{"name":"Hangzhou Center for Disease Control and Prevention (Hangzhou Health Supervision Institution), Institute of Infectious Disease Control and Prevention","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Wang","sequence":"additional","affiliation":[{"name":"Hangzhou Center for Disease Control and Prevention (Hangzhou Health Supervision Institution), Institute of Infectious Disease Control and Prevention","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanming","family":"Zhang","sequence":"additional","affiliation":[{"name":"Qiantang District Center for Disease Control and Prevention, Institute of Infectious Disease Control and Prevention","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Ren","sequence":"additional","affiliation":[{"name":"Qiantang District Center for Disease Control and Prevention, Institute of Infectious Disease Control and Prevention","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liangliang","family":"Huo","sequence":"additional","affiliation":[{"name":"Hangzhou Center for Disease Control and Prevention (Hangzhou Health Supervision Institution), Institute of Infectious Disease Control and Prevention","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Wang","sequence":"additional","affiliation":[{"name":"Hangzhou Center for Disease Control and Prevention (Hangzhou Health Supervision Institution), Institute of Infectious Disease Control and Prevention","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"58041","DOI":"10.1007\/s11356-023-26335-4","article-title":"Long-term effects of meteorological factors and extreme weather on daily outpatient visits for conjunctivitis from 2013 to 2020: a time-series study in Urumqi, China","volume":"30","author":"Gui","year":"2023","journal-title":"Environ Sci Pollut Res Int."},{"key":"B2","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1016\/j.jtos.2021.05.003","article-title":"Ocular redness - 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