Epidemiology of Invasive Group A Streptococcal Infections in the United States, 2005-2012
- PMID: 27105747
- PMCID: PMC5776658
- DOI: 10.1093/cid/ciw248
Epidemiology of Invasive Group A Streptococcal Infections in the United States, 2005-2012
Abstract
Background: Invasive group A Streptococcus (GAS) infections are associated with significant morbidity and mortality rates. We report the epidemiology and trends of invasive GAS over 8 years of surveillance.
Methods: From January 2005 through December 2012, we collected data from the Centers for Disease Control and Prevention's Active Bacterial Core surveillance, a population-based network of 10 geographically diverse US sites (2012 population, 32.8 million). We defined invasive GAS as isolation of GAS from a normally sterile site or from a wound in a patient with necrotizing fasciitis (NF) or streptococcal toxic shock syndrome (STSS). Available isolates were emm typed. We calculated rates and made age- and race-adjusted national projections using census data.
Results: We identified 9557 cases (3.8 cases per 100 000 persons per year) with 1116 deaths (case-fatality rate, 11.7%). The case-fatality rates for septic shock, STSS, and NF were 45%, 38%, and 29%, respectively. The annual incidence was highest among persons aged ≥65 years (9.4/100 000) or <1 year (5.3) and among blacks (4.7/100 000). National rates remained steady over 8 years of surveillance. Factors independently associated with death included increasing age, residence in a nursing home, recent surgery, septic shock, NF, meningitis, isolated bacteremia, pneumonia, emm type 1 or 3, and underlying chronic illness or immunosuppression. An estimated 10 649-13 434 cases of invasive GAS infections occur in the United States annually, resulting in 1136-1607 deaths. In a 30-valent M-protein vaccine, emm types accounted for 91% of isolates.
Conclusions: The burden of invasive GAS infection in the United States remains substantial. Vaccines under development could have a considerable public health impact.
Keywords: epidemiology; group A Streptococcus; streptococcal toxic shock syndrome; surveillance; vaccine.
© The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.
Conflict of interest statement
Figures
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References
-
- O’Brien KL, Beall B, Barrett NL, et al. Epidemiology of invasive group A Streptococcus disease in the United States, 1995–1999. Clin Infect Dis. 2002;35:268–76. - PubMed
-
- O’Loughlin RE, Roberson A, Cieslak PR, et al. The epidemiology of invasive group A streptococcal infection and potential vaccine implications: United States, 2000–2004. Clin Infect Dis. 2007;45:853–62. - PubMed
-
- Department of Child and Adolescent Health and Development, World Health Organization. The current evidence for the burden of group A streptococcal diseases. Geneva, Switzerland: World Health Organization; 2005.
-
- Carapetis JR, Steer AC, Mulholland EK, Weber M. The global burden of group A streptococcal diseases. Lancet Infect Dis. 2005;5:685–94. - PubMed
-
- Anaya DA, Dellinger EP. Necrotizing soft-tissue infection: diagnosis and management. Clin Infect Dis. 2007;44:705–10. - PubMed
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