The school nurse at an otherwise quiet, rural grammar school, found her usual week anything but usual. Of the student body total of 203, she had already had visits from 13 students by 9 o’clock Thursday. Even on the busiest days, she saw no more than 5 or 6 students; usually bumps, scrapes, or calls home to parents for tummy aches. This was different. The students complained of the same things: headache, fever, feeling cold, sore arms and legs, a cough. After taking several of the children’s temperatures, the school nurse found fevers of over 103. The same symptoms of the three children who had been sent home the previous day. When she returned on Monday, she learned from the principle that all 16 children were still absent. She learned from one of the parents that two of the students had been hospitalized. By Tuesday morning, January 13, five more children were hospitalized. Three children had pneumonia.
Two others, Alice Jones and Bobby Corian were so sick they had been transferred to the pediatric ICU. Alice was suffering from endocarditis; Bobby’s liver was failing. The children were experiencing different symptoms with few commonalities. Physicians at the rural hospital tested for influenza, and one of the children tested positive for influenza B. Hospital staff assumed what they had were very coincidental but different illnesses. The following day, another child, Michael Menendez, was hospitalized in the same ICU with pneumonia. Doctors were concerned about Michael, as he had been treated only six months previous for non-Hodgkin’s lymphoma. Michael’s health deteriorated rapidly despite physicians efforts, and he passed on Friday evening, January 16.
By the following morning, six more children from the grammar school had been hospitalized, four in pediatric ICU. Two of the children were complaining of bad stomach pain, and were found to have enlarged spleen. At this point, the attending physician, Dr. Parks, called the state epidemiologist office and reported an epidemic of unknown origin.
The epidemiologist from the health department, Dr. Wen, interviewed the parents, the physicians, and the school nurse. At the end of the first day, Dr. Wen had discovered nothing new. The children now hospitalized numbered 16. Every child seen in the nurse’s office the previous Wednesday and Thursday was now hospitalized. During the second visit to the grammar school, Dr. Wen happened to be speaking with Mrs. Jones when he noticed the janitor carrying a small box to a trash receptacle. One of the requirements for those working in epidemiology is the driving curiosity for unsolved puzzles. After a few questions to the janitor, the epidemiologist learned that the School had recently acquired three parakeets from the local pet shop that had closed due to the owner’s retirement.
One of the small birds had died. Further questions to school staff revealed that the parakeets were to be moved from room to room as the school had 10 classrooms and only three parakeets. It only seemed fair. The parakeets would be rotated on a month-to-month basis. This month, one parakeet went to Mrs. Jones third-grade class, one parakeet went to Mrs. Edmar’s fifth grade classroom, and the final parakeet went to Mrs. Smith’s first grade classroom. Of the children who had become ill, almost all were in Mrs. Jones room. Further questions to the janitor revealed that the dead parakeet had been in Mr. Flood’s classroom, and none of his students were ill.
The school nurse and the hospital staff had assumed that the children had become ill through exposure to each other as 14 of the students belong to the same classroom. However, two students were in Mrs. Damien’s classroom at the other end of the school. This was considered unimportant, and the school nurse assumed that the children infected each other during lunch or on the playground. Dr. Wen questioned the staff at the school and discovered that the two children who were ill and did not belong to Mrs. Jones classroom were siblings of two students who did. While it was possible that the two students could have contracted the illness from their siblings at any time, Dr. Wen’s questions to the teacher revealed something else of particular interest: both of the older siblings often spent morning recess inside her classroom to help their younger siblings with homework. And these same two were now very ill.
When asked what the children did while in the room during that recess, Mrs. Jones could not remember anything out of the ordinary. Dr. Wen’s further questions about where the students sat and what the students did during those recesses revealed one very interesting fact: both siblings sat next to the bird cage, and all the children had been fascinated by how tame the parakeets were, and often take them out of the cage to sit on their fingers. When asked if this occurred during the times when her student’s siblings were in her room during morning recess, Mrs. Jones thought that probably it had. One final question to the school nurse provided the final piece of the puzzle. When did the school obtain the parakeets? “Just before Christmas” was the answer.
Dr. Wen picked up his phone and made a call to Dr. Parks. “How were the children?” None had responded to the antivirals, and most seemed sicker. Two of the children were reported to be photophobic and having extreme pain in their elbows and knees. Upon hearing this, Dr. Wen called Dr. Park to consider beginning treatment with doxycycline, and to use an Enzyme-linked immunosorbent assay (ELISA) to confirm an infection of psittacosis.
Psittacosis is a zoonosis and is caused by infection with the obligate intracellular bacterium Chlamydophila Psittaci. The bacterium is found in the dust of the droppings of infected birds. All the parakeets were tested, and two were found to be positive for Psittacosis and destroyed. The bird that had died tested negative. As it turns out, a bird in the hand is not worth much at all.