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ABCs Report: group A Streptococcus, 2004

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

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ABCs Areas

California (3 county San Francisco Bay area); Colorado (5 county Denver area); Connecticut; Georgia (20 county Atlanta area); Maryland (6 county Baltimore area); Minnesota; New Mexico; New York (15 county Rochester and Albany areas); Oregon (3 county Portland area); Tennessee (11 urban counties)

ABCs Population

The surveillance areas represent 29,710,610 persons. Source: National Center for Health Statistics bridged-race vintage 2004 postcensal file

ABCs Case Definition

Invasive group A streptococcal disease: isolation of group A Streptococcus 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 2004.

ABCs Methodology

ABCs personnel routinely contacted 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. Strains were emm-typed at CDC. Regular laboratory audits assessed completeness of active surveillance and detected additional cases.

All rates of invasive group A streptococcal disease were calculated using population estimates for 2004. For national projections of cases, race- and age-specific rates of disease were applied from the aggregate surveillance area to the age and racial distribution of the 2004 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 730 (3.1)
Black 193 (4.4)
Other 67 (3.2)

Unknown race (n=183) distributed amongst known

* Cases per 100,000 population for ABCs areas

Ethnicity No. (Rate*)
Hispanic 99 (3.0)
Non-Hispanic 395 ------
Unknown 496 ------

*Cases per 100,000 population for ABCs areas

Age (years) Cases
No. (Rate*)
Deaths
No. (Rate*)
<1 18 (4.3) 1 (0.24)
1 14 (3.4) 0 (0.0)
2-4 27 (2.2) 2 (0.17)
5-17 54 (1.0) 1 (0.02)
18-34 145 (2.1) 9 (0.13)
35-49 212 (3.0) 22 (0.31)
50-64 216 (4.3) 30 (0.60)
≥ 65 304 (9.2) 61 (1.8)
Total 990 (3.3) 126 (0.42)

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

ABCs Area* Most common emm types % of area
isolates
California 1, 49, 28, 12 53.4
Colorado 1, 28, 3, 89, 114, 12, 101 59.0
Georgia 1, 12, 6, 83 59.8
Maryland 1, 27G, 3, 87, 4, 102, 11 54.0
Minnesota 1, 3, 28, 12, 89 72.1
New Mexico 3, 1, 101, 6, 22, 28 73.8
New York 1, 28, 5, 4, 12, 2, 73 70.7
Oregon 1, 92, 12, 2, 11, 75 64.0
Tennessee 1, 3, 44, 12, 28 64.4
Total 1, 3, 28, 12 46.8

*Connecticut contributed cases but no isolates.

Requires a minimum of 3 or more isolates and ≥ 5% of isolates typed

Syndrome No. (%)
Cellulitis 314 (31.7)
Necrotizing fasciitis 74 (7.5)
Pneumonia 138 (13.9)
Primary bacteremia 298 (30.1)
Streptococcal toxic shock 56 (5.7)

Note: Some cases had more than one syndrome.

Potentially preventable invasive group A streptococcal disease

During 2004, 6 cases (ages 6, 9, 17, and 31 months and 66 and 86 years) of invasive GAS disease were detected in patients with varicella.

National Estimates of Invasive Disease

Cases: 9,900 (3.4/100,000)
Deaths: 1,275 (0.44/100,000)

Citation

Centers for Disease Control and Prevention. 2005. Active Bacterial Core Surveillance Report, Emerging Infections Program Network, Group A Streptococcus, 2004.

 

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