ABCs Report: group A Streptococcus, 2009

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 31,516,458 persons.
Source: National Center for Health Statistics bridged race vintage 2009 postcensal file

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 2009.

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 2009.  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 2009 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	804	(3.3)
Black	213	(4.3)
Other	114	(4.8)

Unknown race (n=201) distributed amongst known
^* Cases per 100,000 population for ABCs areas

Ethnicity	No.	(Rate*)
Hispanic	112	(2.9)
Non-Hispanic	493	------
Unknown	526	------

^*Cases per 100,000 population for ABCs areas

Age (years)	Cases No. (Rate*)	Deaths No. (Rate*)
<1	24 (5.5)	1 (0.23)
1	22 (5.0)	0 (0.00)
2-4	28 (2.1)	1 (0.08)
5-17	68 (1.3)	2 (0.04)
18-34	131 (1.8)	8 (0.11)
35-49	254 (3.7)	26 (0.37)
50-64	276 (4.7)	29 (0.50)
≥ 65	328 (8.9)	62 (1.68)
Total	1,131 (3.6)	129 (0.41)

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

ABCs Area*	Most common emmtypes†	% of area isolates
California	1, 28, st3826, 11, 12	56.3
Colorado	1, 118, 4, 12, 11, 28	79.4
Georgia	1, 12, 28, 89, 3, 2, 11, 6	79.1
Maryland	89, 1, 12, 28, 3, 2	65.5
Minnesota	3, 118, 1, 12, 28, 4, 6, 75	77.4
New Mexico	1, 3, 12, 118, 28, 83	67.8
New York	89, 3, 28, 2, 1, 4	74.0
Oregon	1, 11, 12	47.4
Tennessee	3, 89, 12, 28, 1, 4, 6, 11	79.8
Total	1, 3, 12, 28, 89, 118, 11, 4	70.9

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

Syndrome	No.	(%)
Cellulitis	372	(32.9)
Necrotizing fasciitis	66	(5.8)
Pneumonia	178	(15.7)
Primary bacteremia	280	(24.8
Streptococcal toxic shock	63	(5.6)

Note: Some cases had more than one syndrome.

Potentially preventable invasive group A streptococcal disease

During 2009, 2 cases (ages 11 months and 66 years) of invasive GAS disease were detected in patients with varicella.

National Estimates of Invasive Disease

Cases: 11,000 (3.6/100,000)
Deaths: 1,300 (0.4/100,000)

Citation

Centers for Disease Control and Prevention. 2010. Active Bacterial Core Surveillance Report, Emerging Infections Program Network, group A Streptococcus, 2009.

 

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