An outbreak of PVL-producing MRSA skin infections in children associated with bouncy castle use

Background

We describe an outbreak of Panton-Valentine leucocidin (PVL) producing community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) in children in eastern Ireland, associated with bouncy castle use.

Methods

A regional department of public health was notified in autumn 2025 of several hospital presentations by children with skin and soft tissue infection (SSTI), associated with attendance at a recent community social gathering. An outbreak was declared. Phone interviews were conducted with a parent or guardian of each case, obtaining demographic, clinical and exposure information.

Results

A total of 48 children and no adults were identified as cases; of these, 47 attended the same outdoor social gathering in August 2025 which featured bouncy castle play. Most cases developed skin symptoms within two or three days of the gathering. All affected cases used the bouncy castles at the party, in some cases for multiple hours. The commonest affected body site was the legs, particularly the thighs. Thirty-three children were treated by their general practitioner (GP). A further 15 attended a hospital emergency department or day ward, of whom 4 were hospitalised, with no deaths. All confirmed cases exhibited an identical strain type, t016-ST22-MRSA-IV, which was PVL-producing. This strain has been described as hypervirulent but is rare in Ireland. The causal isolate exhibited a distinctive antibiogram. An epidemiological curve was created, which was suggestive of a point source outbreak. Infection control measures were enacted, including treatment and decolonisation of cases; decolonisation of asymptomatic household contacts; and communication with affected families and stakeholders such as the bouncy castle providers.

Conclusions

This CA-MRSA outbreak was the largest on record in Ireland. It highlights the risk of CA-MRSA infection in contexts involving prolonged, close physical contact, such as play involving bouncy castles.

Key messages

• We describe the management of a complex outbreak of methicillin-resistant Staphylococcus aureus (MRSA) in children in eastern Ireland, the largest outbreak on record, linked to bouncy castle use.

• The authors’ hypothesis is that the outbreak was due to close physical contact among children playing on bouncy castles. This mechanism has not been described before in the scientific literature.