ABCs Report: Group A Streptococcus, 2013

May 18, 2015: Content on this page kept for historical reasons.

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 33,066,756 persons.

Source: National Center for Health Statistics bridged race vintage 2013 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 2013.

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. Strains were emm typed at CDC. 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 2013 from the bridged-race vintage 2013 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 2013 U.S. population. Cases with missing data, excluding ethnicity, were multiply imputed using sequential regression imputation methods.^¶

Reported ABCs Profiles

Race	No.	(Rate*)
White	911	(3.7)
Black	187	(3.5)
Other	109	(3.8)

^* Cases per 100,000 population for ABCs areas

Ethnicity	No.	(Rate*)
Hispanic	126	(2.9)
Non‑Hispanic	763	‑
Unknown	318	‑

^* Cases per 100,000 population for ABCs areas

Age (years)	Cases No. (Rate*)	Deaths No. (Rate*)
< 1	12 (3.0)	0 (0.00)
1	12 (2.9)	0 (0.00)
2‑4	26 (2.1)	0 (0.00)
5‑17	58 (1.0)	0 (0.00)
18‑34	152 (1.9)	7 (0.09)
35‑49	211 (3.1)	16 (0.24)
50‑64	333 (5.1)	30 (0.46)
65-74	195 (7.9)	27 (1.09)
75-84	133 (10.6)	22 (1.75)
≥ 85	75 (12.5)	18 (3.00)
Total	1,207 (3.7)	120 (0.36)

^* Cases or deaths per 100,000 population for ABCs areas

ABCs Area*	Most common emm types†	% of area isolates
California	92, 82, 12, 89, 1, 77	68.0
Colorado	1, 89, 12, 28, 77, 118, 75	68.4
Georgia	89, 1, 12, 28, 11, 3, 77	70.6
Maryland	1, 89, 28, 4, 87, 12, 77	76.3
Minnesota	1, 59, 89, 4, 28, 12	74.6
New Mexico	1, 82, 89, 12, 59, 2, 28, 118, 87	85.1
New York	89, 1, 12, 28, 4, 11, 118, 77	83.3
Oregon	89, 28, 92, 59, 1, 2, 12	73.7
Tennessee	89, 1, 12, 28, 77	68.8
Total	1, 89, 28, 12, 4, 77	60.0

^* Connecticut contributed cases but no isolates.
^† Minimum of >3 isolates and ≥ 5% of isolates typed

Syndrome	No.	(%)
Cellulitis	508	(42.1)
Necrotizing fasciitis	88	(7.3)
Pneumonia	166	(13.8)
Primary bacteremia	237	(19.7)
Streptococcal toxic shock	26	(2.2)

Note: Some cases had more than one syndrome.

Potentially preventable invasive group A streptococcal disease

During 2013, 1 case (aged 54 years) of invasive GAS disease was detected in patients with varicella.

National Estimates of Invasive Disease

Cases: 11,600 (3.7/100,000)
Deaths: 1,175 (0.37/100,000)

Citation

Centers for Disease Control and Prevention. 2013. Active Bacterial Core Surveillance Report, Emerging Infections Program Network, Group A Streptococcus, 2013.

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