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ABCs Report: Group A Streptococcus, 2011

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 (20 urban counties)

ABCs Population

The surveillance areas represent 32,457,399 persons. Source: National Center for Health Statistics bridged race vintage 2011 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 2011.

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 2011. 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 2011 U.S. population. Cases with missing data, excluding ethnicity, were multiply imputed using the sequential regression imputation method.

Reported ABCs Profiles

Race No. (Rate*)
White 1,028 (4.2)
Black 211 (4.1)
Other 135 (5.0)

*Cases per 100,000 population for ABCs areas

Ethnicity No. (Rate*)
Hispanic 156 (3.7)
Non-Hispanic 790 -
Unknown 428 -

*Cases per 100,000 population for ABCs areas

Age (years) Cases
No. (Rate*)
Deaths
No. (Rate*)
<1 15 (3.7) 0 (0.00)
1 15 (3.7) 0 (0.00)
2-4 36 (2.8) 2 (0.16)
5-17 98 (1.8) 3 (0.05)
18-34 177 (2.3) 11 (0.14)
35-49 252 (3.7) 21 (0.31)
50-64 311 (4.9) 38 (0.60)
≥ 65 470 (11.8) 82 (2.06)
Total 1,374 (4.2) 157 (0.48)

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

ABCs Area* Most common emm types % of area
isolates
California 1, 82, 89, 28, 75, 11, 12 71.0
Colorado 1, 6, 3, 12, 2 65.6
Georgia 1, 12, 89, 3, 11, 2 78.0
Maryland 1, 89, 12, 92, 28, 6 63.3
Minnesota 1, 12, 59, 28, 89 65.7
New Mexico 1, 58, 82, 3, 12, 87, 6, 89 75.2
New York 1, 4, 6, 12, 89, 28, 44, 118, 3 77.9
Oregon 1, 12, 89, 28, 11, 59, 2, 77 84.6
Tennessee 1, 3, 89, 12, 4 70.6
Total 1, 12, 89, 3, 6, 28 60.9

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

Syndrome No. (%)
Cellulitis 540 (39.3)
Necrotizing fasciitis 100 (7.3)
Pneumonia 241 (17.5)
Primary bacteremia 277 (20.2)
Streptococcal toxic shock 48 (3.5)

Note: Some cases had more than one syndrome.

Potentially preventable invasive group A streptococcal disease

During 2011, 3 cases (ages 3 months, 76 and 82 years) of invasive GAS disease were detected in patients with varicella.

National Estimates of Invasive Disease

Cases: 13,300 (4.3/100,000)
Deaths: 1,550 (0.5/100,000)

Surveillance Note

At the start of this surveillance year (2011), missing race (n=215) data were multiply imputed using sequential regression imputation methods. Previously, missing race data were distributed in the same proportion as known cases.

Citation

Centers for Disease Control and Prevention. 2012. Active Bacterial Core Surveillance Report, Emerging Infections Program Network, Group A Streptococcus, 2011

 

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