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ABCs Report: group A Streptococcus, 2008

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 31,143,540 persons.
Source: National Center for Health Statistics bridged-race vintage 2008 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 2008.

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 2008.  For national estimates of cases, race- and age-specific rates of disease were applied from the aggregate surveillance area to the age and racial distribution of the 2008 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 866 (3.6)
Black 256 (5.3)
Other 83 (3.6)

Unknown race (n=239) distributed amongst known
* Cases per 100,000 population for ABCs areas

Ethnicity No. (Rate*)
Hispanic 113 (3.0)
Non-Hispanic 525 ------
Unknown 567 ------

*Cases per 100,000 population for ABCs areas

Age (years) Cases
No. (Rate*)
Deaths
No. (Rate*)
<1 28 (6.4) 0 (0.00)
1 23 (5.3) 1 (0.23)
2-4 31 (2.4) 2 (0.16)
5-17 80 (1.5) 4 (0.07)
18-34 140 (2.0) 6 (0.08)
35-49 268 (3.8) 27 (0.38)
50-64 306 (5.3) 51 (0.88)
≥ 65 329 (9.2) 67 (1.86)
Total 1,205 (3.9) 158 (0.51)

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

ABCs Area* Most common emmtypes % of area
isolates
California 1, 12, 28, 83, 59, 75, 76, 87 62.9
Colorado 1, 118, 28, 12, 89, 11 63.2
Georgia 12, 1, 28, 89, 2 69.7
Maryland 1, 83, 12, 89, 3, 28, 60 68.4
Minnesota 1, 118, 12, 28, 3 73.3
New Mexico 1, 76, 12, 83, 3, 22, 28 73.8
New York 1, 89, 28, 73, 2, 3, 12 82.4
Oregon 1, 3, 12, 28, 82, 89 76.8
Tennessee 1, 89, 12, 3, 28, 5 77.3
Total 1, 12, 28, 89, 3, 118 64.0

*Connecticut contributed cases but no isolates.
Requires a minimum of 3 or more isolates and ≥ 5% of isolates typed.

Syndrome No. (%)
Cellulitis 379 (31.5)
Necrotizing fasciitis 80 (6.6)
Pneumonia 205 (17.0)
Primary bacteremia 361 (30.0)
Streptococcal toxic shock 62 (5.2)

Note: Some cases had more than one syndrome.

Potentially preventable invasive group A streptococcal disease

During 2008, 2 cases (aged 41 and 79 years) of invasive GAS disease and 1 death (aged 41 years) were detected in patients with varicella.

National Estimates of Invasive Disease

Cases: 12,000 (3.9/100,000)
Deaths:1,600 (0.5/100,000)

Citation

Centers for Disease Control and Prevention. 2009. Active Bacterial Core Surveillance Report, Emerging Infections Program Network, Group A Streptococcus, 2008.

 

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