ABCs Report: Group A Streptococcus, 2017

April 5, 2019: 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=251) 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 34,242,171 persons.

Source: National Center for Health Statistics bridged race vintage 2017 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 2017.

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 2017 from the bridged-race vintage 2017 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 2017 U.S. population.  Cases with missing data, excluding ethnicity, were multiply imputed using sequential regression imputation methods.

Reported ABCs Profiles

Race No. (Rate*)
White 1,853 (7.3)
Black 397 (6.9)
Other 216 (6.6)

* Per 100,000 population for ABCs areas

Ethnicity No. (Rate*)
Hispanic 307 (6.4)
Non-Hispanic 1,745
Unknown 414

* Per 100,000 population for ABCs areas

Age (years) Cases
No. (Rate*)
Deaths
No. (Rate*)
< 1 23 (5.7) 1 (0.25)
1 11 (2.7) 1 (0.25)
2-4 40 (3.2) 0 (0.00)
5-17 89 (1.6) 1 (0.02)
18-34 396 (4.9) 10 (0.12)
35-49 516 (7.6) 26 (0.38)
50-64 640 (9.5) 51 (0.76)
65-74 348 (11.7) 41 (1.38)
75-84 254 (18.3) 40 (2.87)
≥ 85 149 (23.4) 30 (4.70)
Total  2,466 (7.2) 201 (0.59)

* Per 100,000 population for ABCs areas

ABCs Area Most common emm types* % of area isolates
California 49,1,82,60,12,89,43,77,92 71.3
Colorado 49,89,92,1,11,82,76 73.8
Connecticut 1,6,89,11,3,12,4,2,28 76.0
Georgia 1,3,89,28,6,4,12 67.1
Maryland 82,1,49,12,77 62.7
Minnesota 1,89,12,28,82,6,77 71.2
New Mexico 92,1,89,59,4,12,83 72.8
New York 3,1,89,28,11,75 75.4
Oregon 49,83,1,89 65.9
Tennessee 92,1,89,12,11,6,3,28,77 77.5
Total 1,89,49,92,12,82,3,28 62.4

* Requires ≥3 or more isolates and ≥ 5% of isolates typed

Syndrome No. (%)
Cellulitis 1,097 (44.5)
Necrotizing fasciitis 121 (4.9)
Pneumonia 310 (12.6)
Primary bacteremia 499 (20.2)
Streptococcal toxic shock syndrome 59 (2.4)

Note: Some cases had more than one syndrome.

Potentially preventable invasive group A streptococcal disease

During 2017, 2 cases of invasive GAS disease were detected in two female patients with varicella, age 63 and 88 years.

National Estimates of Invasive Disease

Cases: 23,650 (7.26/100,000)
Deaths: 1,980 (0.61/100,000)

Citation

Centers for Disease Control and Prevention. 2017. Active Bacterial Core Surveillance Report, Emerging Infections Program Network, Group A Streptococcus, 2017.

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