ABCs Report: Group A Streptococcus, 2016

April 4, 2018: Content on this page kept for historical reasons.

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

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Surveillance Note

Missing race (n=220) data were multiply imputed using sequential regression imputation methods.

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

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

Reported ABCs Profiles by ethnicity
Ethnicity No. (Rate*)
Hispanic 226 (4.9)
Non-Hispanic 1,364
Unknown 369

* Per 100,000 population for ABCs areas

Reported ABCs Profiles by age
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

Reported ABCs Profiles by area
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

Reported ABCs Profiles by syndrome
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.

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