ABCs Report: Group A Streptococcus, 2016
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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 33,923,217 persons.
Source: National Center for Health Statistics bridged‑race vintage 2016 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 2016.
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. All group A Streptoccocus (GAS) isolates were subject to whole genome testing (WGS) to derive emm types and T types. A strategic subset was targeted for conventional MIC determination. 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 2016 from the bridged-race vintage 2016 postcensal file. 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 2016 U.S. population. Cases with missing data, excluding ethnicity, were multiply imputed using sequential regression imputation methods.¶
Reported ABCs Profiles
| Race | No. | (Rate*) |
|---|---|---|
| White | 1,433 | (5.7) |
| Black | 347 | (6.2) |
| Other | 179 | (5.7) |
* Per 100,000 population for ABCs areas
| Ethnicity | No. | (Rate*) |
|---|---|---|
| Hispanic | 226 | (4.9) |
| Non-Hispanic | 1,364 | — |
| Unknown | 369 | — |
* Per 100,000 population for ABCs areas
| Age (years) | Cases No. (Rate*) |
Deaths No. (Rate*) |
|---|---|---|
| < 1 | 20 (4.9) | 2 (0.49) |
| 1 | 24 (5.9) | 2 (0.49) |
| 2-4 | 26 (2.1) | 1 (0.08) |
| 5-17 | 79 (1.4) | 2 (0.04) |
| 18-34 | 297 (3.7) | 10 (0.13) |
| 35-49 | 377 (5.6) | 32 (0.48) |
| 50-64 | 555 (8.3) | 56 (0.83) |
| 65-74 | 289 (10.1) | 41 (1.44) |
| 75-84 | 181 (13.5) | 25 (1.86) |
| ≥ 85 | 111 (17.6) | 26 (4.12) |
| Total | 1,959 (5.8) | 197 (0.58) |
* Per 100,000 population for ABCs areas
| ABCs Area | Most common emm types* | % of area isolates |
|---|---|---|
| California | 49,82,1,92,12,60,4 | 74.2 |
| Colorado | 49,82,89,1,28,92,11,12 | 77.1 |
| Connecticut | 1,3,89,12,28,75,11,4 | 75.6 |
| Georgia | 1,3,12,4,89,28 | 70.3 |
| Maryland | 1,25,4,12,77,89,63,28 | 71.2 |
| Minnesota | 89,1,3,28,12,4,82,77 | 81.1 |
| New Mexico | 1,59,89,12 | 60.5 |
| New York | 1,89,12,28,11,3,4,75 | 78.9 |
| Oregon | 49,59,1,83,89 | 66.2 |
| Tennessee | 1,3,82,12,11,4,89,28 | 70.6 |
| Total | 1,89,49,12,3,82,4,28 | 64.6 |
* Requires ≥3 or more isolates and ≥ 5% of isolates typed
| Syndrome | No. | (%) |
|---|---|---|
| Cellulitis | 834 | (42.6) |
| Necrotizing fasciitis | 106 | (5.4) |
| Pneumonia | 267 | (13.6) |
| Primary bacteremia | 413 | (21.1) |
| Streptococcal toxic shock | 56 | (2.9) |
Note: Some cases had more than one syndrome.
Potentially preventable invasive group A streptococcal disease
During 2016, 1 case of invasive GAS disease was detected in a 44 year-old patient with varicella.
National Estimates of Invasive Disease
Cases: 18,500 (5.8/100,000)
Deaths: 1,850 (0.58/100,000)
Citation
Centers for Disease Control and Prevention. 2016. Active Bacterial Core Surveillance Report, Emerging Infections Program Network, Group A Streptococcus, 2016.