An outbreak of Panton-Valentine leucocidin-producing meticillin-resistant Staphylococcus aureus skin and soft tissue infection associated with bouncy castle use, Ireland, 2025.

Abstract

We describe an outbreak of Panton-Valentine leucocidin (PVL) producing community-acquired meticillin-resistant Staphylococcus aureus (CA-MRSA) in children and adolescents in eastern Ireland, associated with bouncy castle use. Regional public health authorities were notified in autumn 2025 of several hospital presentations by children and adolescents with skin and soft tissue infection (SSTI). An outbreak was declared. Phone interviews were conducted with a parent or guardian of each case, obtaining demographic, clinical and exposure information. All 48 identified cases were children and adolescents. Of these, 47 attended the same outdoor social gathering in autumn 2025 which featured bouncy castle play. Case definitions were drafted and iteratively refined. The commonest affected body site was the legs, particularly thighs. Thirty-three cases were treated by their general practitioner (GP). A further 15 attended a hospital emergency department or day ward, of whom four 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. Key control measures for this complex outbreak included early recognition of linked cases, rapid delivery of clinical care, and infection prevention and control measures.