ABCs Report: Group A Streptococcus, 2018

June 7, 2020: 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=262) 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 34,410,192 persons.

Source: National Center for Health Statistics bridged‑race vintage 2018 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 2018.

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 Streptococcus (GAS) isolates were subject to whole genome sequencing (WGS) to derive emm types and T types. A strategic subset was targeted for conventional minimum inhibitory concentration (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 2018 from the bridged-race vintage 2018 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 2018 U.S. population.  Cases with missing data, excluding ethnicity, were multiply imputed using sequential regression imputation methods.

Reported ABCs Profiles

Reported ABCs Profiles table 1
Race No. (Rate*)
Black 410 (7.1)
White 1983 (7.8)
Other 225 (6.7)

* Per 100,000 population for ABCs areas

Reported ABCs Profiles table 2
Ethnicity No. (Rate*)
Hispanic 337 (6.9)
Non‑Hispanic 1942
Unknown 339
Reported ABCs Profiles table 3
Age (years) Cases
No. (Rate*)
Deaths
No. (Rate*)
< 1 20 (5.1) 1 (0.25)
1 9 (2.2) 0 (0.00)
2‑4 33 (2.7) 0 (0.00)
5‑17 96 (1.7) 5 (0.09)
18‑34 415 (5.1) 8 (0.10)
35‑49 498 (7.3) 31 (0.45)
50‑64 679 (10.1) 71 (1.06)
65-74 412 (13.5) 55 (1.80)
75-84 280 (19.1) 38 (2.60)
≥ 85 176 (27.3) 30 (4.65)
Total 2618 (7.6) 239 (0.69)

* Per 100,000 population for ABCs areas

Reported ABCs Profiles table 4
ABCs Area Most common emm types* % of area isolates
California 43,92,1,49,59,12,82 66.4
Colorado 11,92,1,82,12,49,59,89,91,28 76.4
Connecticut 1,89,77,12,28 56.9
Georgia 1,89,12,4,28,3,11,87 70.8
Maryland 49,82,1,169,89 67.6
Minnesota 1,89,12,28,82 62.1
New Mexico 92,43,91,1,89,12,28 73.8
New York 1,28,3,89,6,11,2,4 76.8
Oregon 82,49,1,92,83,89,28,59 77.4
Tennessee 92,1,89,11,28 68.3
Total 1,92,89,82,49,12,28 58.3

Requires >3 or more isolates and ≥ 5% of isolates typed Based on reference lab testing of 2,281 isolates

Reported ABCs Profiles table 5
Syndrome No. (%)
Cellulitis 1,101 (42.1)
Necrotizing fasciitis 149 (5.7)
Pneumonia 381 (14.6)
Primary bacteremia 554 (21.2)
Streptococcal toxic shock syndrome 47 (1.8)

Note:  Some cases had more than one syndrome.

Potentially preventable invasive group A streptococcal disease

During 2018, 1 case of invasive GAS disease was detected in a female patient with varicella, age 74 years.

National Estimates of Invasive Disease

Cases: 25,160  (7.69/100,000)
Deaths: 2,320  (0.71/100,000)

Citation

Centers for Disease Control and Prevention. 2018. Active Bacterial Core Surveillance Report, Emerging Infections Program Network, Group A Streptococcus, 2018.

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