Risk for Emergence of Dengue and Chikungunya Virus in Israel

families (Figure). The MLVA type was determined in 1 contact; it also was MLVA type J, suggesting that carriage in this contact was related to spread of the same clone. Of interest, none of these 3 household members had respiratory symptoms. Nilsson et al. (10) also reported a high frequency of M. pneumoniae DNA carriage in household contacts; however, in contrast to contacts in our study, all of the household contacts in the study by Nilsson et al. had ongoing or recent respiratory tract symptoms. In summary, we report an outbreak of M. pneumoniae infections confi rmed by MLVA, a discriminatory typing method. MLVA typing revealed the clonal spread of a single M. pneumoniae type J strain in children attending the same primary school and in their household contacts. The cases we identifi ed may represent only a small proportion of the actual cases, which were likely underestimated due to mild symptoms, poor knowledge of M. pneumoniae infections by general practitioners, and lack of PCR availability. We showed that MLVA typing of M. pneumoniae can be used to detect clonal spread and outbreaks. This approach might also be useful for studying the worldwide emergence of M. pneumoniae macrolide resistance and for fi nding resistant clones with the potential for spreading.