ABCs Report: group A Streptococcus, 2000

Active Bacterial Core Surveillance (ABCs): Emerging Infections Program Network

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ABCs Areas

California (3 county San Francisco Bay area); Connecticut; Georgia; Maryland (6 county Baltimore area); Minnesota; NewYork (7 county Rochester and 8 county Albany area); Oregon (3 county Portland area); Tennessee (11 urban counties)

ABCs Population

The surveillance areas represent 28,565,842 persons. Source: U.S. Bureau of the Census, 2000

ABCs Case Definition

Invasive group A streptococcal disease: isolation of group A streptococcus (S. pyogenes) from a normally sterile site or from a wound culture accompanied by necrotizing fasciitis or Streptococcal Toxic Shock Syndrome in a resident of a surveillance area in 2000.

ABCs Methodology

Project personnel communicated at least monthly with contacts in all microbiology laboratories serving acute care hospitals in their area to identify cases. Standardized case report forms that include information on demographic characteristics, clinical syndrome, and outcome of illness were completed for each identified case. Strainswere typed by the emm system at CDC. Regular laboratory audits assess completeness of active surveillance and detect additional cases.

All rates of invasive group A Streptococcal disease were calculated using U.S. Bureau of the Census population
estimates for 2000. For national projections of cases, raceand age-specific rates of disease were applied from the
aggregate surveillance area to the age and racial distribution of the 2000 U. S. population. Cases with unknown race were distributed by site based on reported race distribution for known cases within the eight age categories.

Reported ABCs Profiles

Race	No.	(Rate*)
White	601	(2.9)
Black	256	(5.3)
Other	59	(2.1)

Unknown race (n=109) distributed among knowns

^* Cases per 100,000 population for ABCs areas

Ethnicity	No.	(Rate*)
Hispanic	42	(2.4)
Non-Hispanic	413	------
Unknown	461	------

^*Cases per 100,000 population for ABCs areas

Age (years)	Cases No. (Rate*)	Deaths No. (Rate*)
<1	20 (5.2)	1 (0.3)
1	23 (6.0)	0 (0.0)
2-4	20 (1.7)	0 (0.0)
5-17	82 (1.5)	5 (0.1)
18-34	123 (1.8)	4 (0.1)
35-49	223 (3.2)	18 (0.3)
50-64	149 (3.5)	20 (0.5)
≥ 65	276 (8.5)	59 (1.8)
Total	916 (3.2)	107 (0.4)

^*Cases or deaths per 100,000 population for ABCs areas

ABCs Area	Most common emm types*	% of area isolates
California	1, 12, 41, 114, 2, 3, 11, 31	56.8
Connecticut	1, 28, 3, 89, 12, 22	67.9
Georgia	1, 3, 12, 75, 22, 77, 73, 28	77.7
Maryland	82, 1, 28, 73, 89	60.5
Minnesota	1, 3, 28, 12	59.0
New York	1, 3, 4, 12, 28, 89, 83	70.1
Oregon	114, 1, 11, 3	63.3
Tennessee	1, 12	48.6
Total	1, 3, 12, 28, 82	50.4

^*Requires a minimum of 4 isolates and ≥ 5% of isolates typed

Syndrome	No.	(%)
Cellulitis	305	(33.3)
Necrotizing fasciitis	55	(6.0)
Pneumonia	128	(14.0)
Primary bacteremia	323	(35.3)
Streptococcal toxic shock	37	(4.0)

Note: Some cases had more than one syndrome.

Potentially preventable invasive group A streptococcal disease

During 2000, 16 cases (ages 4, 8, 10, and 11 months and 1, 4, 5, 6, 7, 9, 11, 12, 27, and 33 years) of invasive GAS disease were detected in patients with varicella.

National Estimates of Invasive Disease

Cases: 8,800 (3.1/100,000)
Deaths: 1,000 (0.4/100,000)

Citation

Centers for Disease Control and Prevention. 2001. Active Bacterial Core Surveillance Report, Emerging Infections Program Network, Group A Streptococcus, 2000.

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