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Miller KM, Tanz RR, Shulman ST, Carapetis JR, Cherian T, Lamagni T, Bowen AC, Pickering J, Fulurija A, Moore HC, Cannon JW, Barnett TC, Van Beneden CA, Carapetis J, Van Beneden C, Kaslow DC, Cherian T, Lamagni T, Engel M, Cannon J, Moore HC, Bowen A, Seale A, Kang G, Watkins D, Kariuki S. Standardization of Epidemiological Surveillance of Group A Streptococcal Pharyngitis. Open Forum Infect Dis 2022; 9:S5-S14. [PMID: 36128410 PMCID: PMC9474939 DOI: 10.1093/ofid/ofac251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Pharyngitis, more commonly known as sore throat, is caused by viral and/or bacterial infections. Group A Streptococcus (Strep A) is the most common bacterial cause of pharyngitis. Strep A pharyngitis is an acute, self-limiting disease but if undertreated can lead to suppurative complications, nonsuppurative poststreptococcal immune-mediated diseases, and toxigenic presentations. We present a standardized surveillance protocol, including case definitions for pharyngitis and Strep A pharyngitis, as well as case classifications that can be used to differentiate between suspected, probable, and confirmed cases. We discuss the current tests used to detect Strep A among persons with pharyngitis, including throat culture and point-of-care tests. The type of surveillance methodology depends on the resources available and the objectives of surveillance. Active surveillance and laboratory confirmation is the preferred method for case detection. Participant eligibility, the surveillance population and additional considerations for surveillance of pharyngitis are addressed, including baseline sampling, community engagement, frequency of screening and season. Finally, we discuss the core elements of case report forms for pharyngitis and provide guidance for the recording of severity and pain associated with the course of an episode.
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Affiliation(s)
- Kate M Miller
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth , Australia
| | - Robert R Tanz
- Northwestern University Feinberg School of Medicine and Ann and Robert H. Lurie Children’s Hospital of Chicago , Chicago, Illinois , USA
| | - Stanford T Shulman
- Northwestern University Feinberg School of Medicine and Ann and Robert H. Lurie Children’s Hospital of Chicago , Chicago, Illinois , USA
| | - Jonathan R Carapetis
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth , Australia
- Perth Children’s Hospital , Perth , Australia
| | | | - Theresa Lamagni
- United Kingdom Health Security Agency , London , United Kingdom
| | - Asha C Bowen
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth , Australia
- Perth Children’s Hospital , Perth , Australia
| | - Janessa Pickering
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth , Australia
| | - Alma Fulurija
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth , Australia
| | - Hannah C Moore
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth , Australia
| | - Jeffrey W Cannon
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth , Australia
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health , Boston, Massachusetts , USA
| | - Timothy C Barnett
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth , Australia
| | - Chris A Van Beneden
- CDC Foundation, Centers for Disease Control and Prevention , Atlanta, Georgia , USA
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Miller KM, Carapetis JR, Cherian T, Hay R, Marks M, Pickering J, Cannon JW, Lamagni T, Romani L, Moore HC, Van Beneden CA, Barth DD, Bowen AC, Carapetis J, Van Beneden C, Kaslow D, Cherian T, Lamagni T, Engel M, Cannon J, Moore H, Bowen A, Seale A, Kang G, Watkins D, Kariuki S. Standardization of Epidemiological Surveillance of Group A Streptococcal Impetigo. Open Forum Infect Dis 2022; 9:S15-S24. [PMID: 36128409 PMCID: PMC9474945 DOI: 10.1093/ofid/ofac249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Impetigo is a highly contagious bacterial infection of the superficial layer of skin. Impetigo is caused by group A Streptococcus (Strep A) and Staphylococcus aureus, alone or in combination, with the former predominating in many tropical climates. Strep A impetigo occurs mainly in early childhood, and the burden varies worldwide. It is an acute, self-limited disease, but many children experience frequent recurrences that make it a chronic illness in some endemic settings. We present a standardized surveillance protocol including case definitions for impetigo including both active (purulent, crusted) and resolving (flat, dry) phases and discuss the current tests used to detect Strep A among persons with impetigo. Case classifications that can be applied are detailed, including differentiating between incident (new) and prevalent (existing) cases of Strep A impetigo. The type of surveillance methodology depends on the burden of impetigo in the community. Active surveillance and laboratory confirmation is the preferred method for case detection, particularly in endemic settings. Participant eligibility, surveillance population and additional considerations for surveillance of impetigo, including examination of lesions, use of photographs to document lesions, and staff training requirements (including cultural awareness), are addressed. Finally, the core elements of case report forms for impetigo are presented and guidance for recording the course and severity of impetigo provided.
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Affiliation(s)
- Kate M Miller
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth, Western Australia , Australia
| | - Jonathan R Carapetis
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth, Western Australia , Australia
- Perth Children’s Hospital , Perth, Western Australia , Australia
| | | | - Roderick Hay
- St John’s Institute of Dermatology, King’s College London , United Kingdom
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious Diseases, London School of Hygiene and Tropical Medicine , London , United Kingdom
- Hospital for Tropical Diseases, University College , London , United Kingdom
- Division of Infection and Immunity, University College London , London , United Kingdom
| | - Janessa Pickering
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth, Western Australia , Australia
| | - Jeffrey W Cannon
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth, Western Australia , Australia
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health , Boston, Massachusetts , USA
| | - Theresa Lamagni
- United Kingdom Health Security Agency , London , United Kingdom
| | - Lucia Romani
- The Kirby Institute, University of New South Wales Sydney , Sydney , Australia
- Murdoch Children’s Research Group , Melbourne , Australia
| | - Hannah C Moore
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth, Western Australia , Australia
| | - Chris A Van Beneden
- CDC Foundation, Centers for Disease Control and Prevention , Atlanta, Georgia , USA
| | - Dylan D Barth
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth, Western Australia , Australia
| | - Asha C Bowen
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth, Western Australia , Australia
- Perth Children’s Hospital , Perth, Western Australia , Australia
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3
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Scheel A, Beaton AZ, Katzenellenbogen J, Parks T, Miller KM, Cherian T, Van Beneden CA, Cannon JW, Moore HC, Bowen AC, Carapetis JR. Standardization of Epidemiological Surveillance of Acute Rheumatic Fever. Open Forum Infect Dis 2022; 9:S41-S49. [PMID: 36128408 PMCID: PMC9474936 DOI: 10.1093/ofid/ofac252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Acute rheumatic fever (ARF) is a multiorgan inflammatory disorder that results from the body’s autoimmune response to pharyngitis or a skin infection caused by Streptococcus pyogenes (Strep A). Acute rheumatic fever mainly affects those in low- and middle-income nations, as well as in indigenous populations in wealthy nations, where initial Strep A infections may go undetected. A single episode of ARF puts a person at increased risk of developing long-term cardiac damage known as rheumatic heart disease. We present case definitions for both definite and possible ARF, including initial and recurrent episodes, according to the 2015 Jones Criteria, and we discuss current tests available to aid in the diagnosis. We outline the considerations specific to ARF surveillance methodology, including discussion on where and how to conduct active or passive surveillance (eg, early childhood centers/schools, households, primary healthcare, administrative database review), participant eligibility, and the surveillance population. Additional considerations for ARF surveillance, including implications for secondary prophylaxis and follow-up, ARF registers, community engagement, and the impact of surveillance, are addressed. Finally, the core elements of case report forms for ARF, monitoring and audit requirements, quality control and assurance, and the ethics of conducting surveillance are discussed.
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Affiliation(s)
- Amy Scheel
- Emory University School of Medicine , Atlanta, Georgia , USA
| | - Andrea Z Beaton
- Cincinnati Children’s Hospital Medical Center, The Heart Institute , Cincinnati, Ohio , USA
| | | | - Tom Parks
- Department of Infectious Disease, Imperial College London, Hammersmith Hospital
| | - Kate M Miller
- Wesfarmers Centre of Vaccines and Telethon Kids Institute, The University of Western Australia , Nedlands , Western Australia
| | | | | | - Jeffrey W Cannon
- Wesfarmers Centre of Vaccines and Telethon Kids Institute, The University of Western Australia , Nedlands , Western Australia
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health , Boston, Massachusetts , USA
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Telethon Kids Institute, The University of Western Australia , Nedlands , Western Australia
| | - Asha C Bowen
- Wesfarmers Centre of Vaccines and Telethon Kids Institute, The University of Western Australia , Nedlands , Western Australia
- Perth Children’s Hospital , Nedlands , Western Australia
| | - Jonathan R Carapetis
- Wesfarmers Centre of Vaccines and Telethon Kids Institute, The University of Western Australia , Nedlands , Western Australia
- Perth Children’s Hospital , Nedlands , Western Australia
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Moore HC, Miller KM, Carapetis JR, Van Beneden CA. Harmonizing Surveillance Methodologies for Group A Streptococcal Diseases. Open Forum Infect Dis 2022; 9:S1-S4. [PMID: 36128412 PMCID: PMC9474938 DOI: 10.1093/ofid/ofac210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/13/2022] [Indexed: 11/14/2022] Open
Abstract
Group A Streptococcus (Strep A) is responsible for a significant global health and economic burden. The recent prioritization of Strep A vaccine development by the World Health Organization has prompted global research activities and collaborations. To progress this prioritization, establishment of robust surveillance for Strep A to generate updated regional disease burden estimates and to establish platforms for future impact evaluation is essential. Through the activities of the Strep A Vaccine Global Consortium (SAVAC), we have refined and harmonized surveillance protocols for 7 Strep A disease endpoints with a view that these will form part of surveillance standards for ongoing research and public health activities.
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Affiliation(s)
- Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth, Western Australia , Australia
| | - Kate M Miller
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth, Western Australia , Australia
| | - Jonathan R Carapetis
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth, Western Australia , Australia
- Perth Children’s Hospital , Perth, Western Australia , Australia
| | - Chris A Van Beneden
- Centers for Disease Control and Prevention Foundation , Atlanta, Georgia , USA
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Scheel A, Miller KM, Beaton A, Katzenellenbogen J, Parks T, Cherian T, Van Beneden CA, Cannon JW, Moore HC, Bowen AC, Carapetis JR. Standardization of Epidemiological Surveillance of Rheumatic Heart Disease. Open Forum Infect Dis 2022; 9:S50-S56. [PMID: 36128407 PMCID: PMC9474940 DOI: 10.1093/ofid/ofac250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Rheumatic heart disease (RHD) is a long-term sequela of acute rheumatic fever (ARF), which classically begins after an untreated or undertreated infection caused by Streptococcus pyogenes (Strep A). RHD develops after the heart valves are permanently damaged due to ARF. RHD remains a leading cause of morbidity and mortality in young adults in resource-limited and low- and middle-income countries. This article presents case definitions for latent, suspected, and clinical RHD for persons with and without a history of ARF, and details case classifications, including differentiating between definite or borderline according to the 2012 World Heart Federation echocardiographic diagnostic criteria. This article also covers considerations specific to RHD surveillance methodology, including discussions on echocardiographic screening, where and how to conduct active or passive surveillance (eg, early childhood centers/schools, households, primary healthcare), participant eligibility, and the surveillance population. Additional considerations for RHD surveillance, including implications for secondary prophylaxis and follow-up, RHD registers, community engagement, and the negative impact of surveillance, are addressed. Finally, the core elements of case report forms for RHD, monitoring and audit requirements, quality control and assurance, and the ethics of conducting surveillance are discussed.
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Affiliation(s)
- Amy Scheel
- Emory University School of Medicine , Atlanta, Georgia , USA
| | - Kate M Miller
- Wesfarmers Centre of Vaccines and Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia , Australia
- Perth Children’s Hospital , Nedlands, Western Australia , Australia
| | - Andrea Beaton
- The Heart Institute, Cincinnati Children’s Hospital Medical Center , Cincinnati, Ohio , USA
- Department of Pediatrics, University of Cincinnati College of Medicine , Cincinnati, Ohio , USA
| | - Judith Katzenellenbogen
- Wesfarmers Centre of Vaccines and Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia , Australia
- School of Population and Global Health, University of Western Australia , Nedlands, Western Australia , Australia
| | - Tom Parks
- Department of Infectious Disease, Imperial College London, Hammersmith Hospital , London , United Kingdom
| | | | - Chris A Van Beneden
- CDC Foundation, Centers for Disease Control and Prevention , Atlanta, Georgia , USA
| | - Jeffrey W Cannon
- Wesfarmers Centre of Vaccines and Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia , Australia
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health , Boston, Massachusetts , USA
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia , Australia
| | - Asha C Bowen
- Wesfarmers Centre of Vaccines and Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia , Australia
- Perth Children’s Hospital , Nedlands, Western Australia , Australia
| | - Jonathan R Carapetis
- Wesfarmers Centre of Vaccines and Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia , Australia
- Perth Children’s Hospital , Nedlands, Western Australia , Australia
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6
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Miller KM, Lamagni T, Cherian T, Cannon JW, Parks T, Adegbola RA, Pickering J, Barnett T, Engel ME, Manning L, Bowen AC, Carapetis JR, Moore HC, Barth DD, Kaslow DC, Van Beneden CA. Standardization of Epidemiological Surveillance of Invasive Group A Streptococcal Infections. Open Forum Infect Dis 2022; 9:S31-S40. [PMID: 36128405 PMCID: PMC9474937 DOI: 10.1093/ofid/ofac281] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 06/13/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Invasive group A streptococcal (Strep A) infections occur when Streptococcus pyogenes, also known as beta-hemolytic group A Streptococcus, invades a normally sterile site in the body. This article provides guidelines for establishing surveillance for invasive Strep A infections. The primary objective of invasive Strep A surveillance is to monitor trends in rates of infection and determine the demographic and clinical characteristics of patients with laboratory-confirmed invasive Strep A infection, the age- and sex-specific incidence in the population of a defined geographic area, trends in risk factors, and the mortality rates and rates of nonfatal sequelae caused by invasive Strep A infections.
This article includes clinical descriptions followed by case definitions, based on clinical and laboratory evidence, and case classifications (confirmed or probable, if applicable) for invasive Strep A infections and for 3 Strep A syndromes: streptococcal toxic shock syndrome, necrotizing fasciitis, and pregnancy-associated Strep A infection.
Considerations of the type of surveillance are also presented, noting that most people who have invasive Strep A infections will present to hospital and that invasive Strep A is a notifiable disease in some countries. Minimal surveillance necessary for invasive Strep A infection is facility-based, passive surveillance. A resource-intensive but more informative approach is active case finding of laboratory-confirmed Strep A invasive infections among a large (eg, state-wide) and well defined population.
Participant eligibility, surveillance population, and additional surveillance components such as the use of International Classification of Disease diagnosis codes, follow-up, period of surveillance, seasonality, and sample size are discussed. Finally, the core data elements to be collected on case report forms are presented.
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Affiliation(s)
- Kate M Miller
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia
| | | | | | - Jeffrey W Cannon
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health , Boston, Massachusetts , USA
| | - Tom Parks
- Department of Infectious Disease, Imperial College London, Hammersmith Hospital , London , United Kingdom
| | | | - Janessa Pickering
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia
| | - Tim Barnett
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia
| | - Mark E Engel
- AFROStrep Research Initiative, Department of Medicine, University of Cape Town , Cape Town , South Africa
| | - Laurens Manning
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia
- Infectious Diseases Department, Fiona Stanley Hospital , Perth, Western Australia , Australia
- Medical School, University of Western Australia , Perth, Western Australia , Australia
| | - Asha C Bowen
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia
- Perth Children’s Hospital , Nedlands, Western Australia
- Faculty of Health and Medicine, University of Western Australia , Nedlands, Western Australia
| | - Jonathan R Carapetis
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia
- Faculty of Health and Medicine, University of Western Australia , Nedlands, Western Australia
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia
| | - Dylan D Barth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia
- Faculty of Health and Medicine, University of Western Australia , Nedlands, Western Australia
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Sherwood E, Steer AC, Van Beneden CA, Seale AC. Statistical concerns for meta-analysis of rare events and small sample sizes - Authors' reply. Lancet Infect Dis 2022; 22:1112. [PMID: 35870455 DOI: 10.1016/s1473-3099(22)00358-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Emma Sherwood
- Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.
| | - Andrew C Steer
- Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | | | - Anna C Seale
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
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Sherwood E, Vergnano S, Kakuchi I, Bruce MG, Chaurasia S, David S, Dramowski A, Georges S, Guy R, Lamagni T, Levy-Bruhl D, Lyytikäinen O, Naus M, Okaro JO, Oppegaard O, Vestrheim DF, Zulz T, Steer AC, Van Beneden CA, Seale AC. Invasive group A streptococcal disease in pregnant women and young children: a systematic review and meta-analysis. Lancet Infect Dis 2022; 22:1076-1088. [PMID: 35390294 PMCID: PMC9217756 DOI: 10.1016/s1473-3099(21)00672-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/28/2021] [Accepted: 10/12/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND The incidence of invasive disease caused by group A streptococcus (GAS) has increased in multiple countries in the past 15 years. However, despite these reports, to the best of our knowledge, no systematic reviews and combined estimates of the incidence of invasive GAS have been done in key high-risk groups. To address this, we estimated the incidence of invasive GAS disease, including death and disability outcomes, among two high-risk groups-namely, pregnant women and children younger than 5 years. METHODS We did a systematic review and meta-analyses on invasive GAS outcomes, including incidence, case fatality risks, and neurodevelopmental impairment risk, among pregnant women, neonates (younger than 28 days), infants (younger than 1 year), and children (younger than 5 years) worldwide and by income region. We searched several databases for articles published from Jan 1, 2000, to June 3, 2020, for publications that reported invasive GAS outcomes, and we sought unpublished data from an investigator group of collaborators. We included studies with data on invasive GAS cases, defined as laboratory isolation of Streptococcus pyogenes from any normally sterile site, or isolation of S pyogenes from a non-sterile site in a patient with necrotising fasciitis or streptococcal toxic shock syndrome. For inclusion in pooled incidence estimates, studies had to report a population denominator, and for inclusion in pooled estimates of case fatality risk, studies had to report aggregate data on the outcome of interest and the total number of cases included as a denominator. We excluded studies focusing on groups at very high risk (eg, only preterm infants). We assessed heterogeneity with I2. FINDINGS Of the 950 published articles and 29 unpublished datasets identified, 20 studies (seven unpublished; 3829 cases of invasive GAS) from 12 countries provided sufficient data to be included in pooled estimates of outcomes. We did not identify studies reporting invasive GAS incidence among pregnant women in low-income and middle-income countries (LMICs) nor any reporting neurodevelopmental impairment after invasive GAS in LMICs. In nine studies from high-income countries (HICs) that reported invasive GAS in pregnancy and the post-partum period, invasive GAS incidence was 0·12 per 1000 livebirths (95% CI 0·11 to 0·14; I2=100%). Invasive GAS incidence was 0·04 per 1000 livebirths (0·03 to 0·05; I2=100%; 11 studies) for neonates, 0·13 per 1000 livebirths (0·10 to 0·16; I2=100%; ten studies) for infants, and 0·09 per 1000 person-years (95% CI 0·07 to 0·10; I2=100%; nine studies) for children worldwide; 0·12 per 1000 livebirths (95% CI 0·00 to 0·24; I2=100%; three studies) in neonates, 0·33 per 1000 livebirths (-0·22 to 0·88; I2=100%; two studies) in infants, and 0·22 per 1000 person-years (0·13 to 0·31; I2=100%; two studies) in children in LMICs; and 0·02 per 1000 livebirths (0·00 to 0·03; I2=100%; eight studies) in neonates, 0·08 per 1000 livebirths (0·05 to 0·11; I2=100%; eight studies) in infants, and 0·05 per 1000 person-years (0·03 to 0·06; I2=100%; seven studies) in children for HICs. Case fatality risks were high, particularly among neonates in LMICs (61% [95% CI 33 to 89]; I2=54%; two studies). INTERPRETATION We found a substantial burden of invasive GAS among young children. In LMICs, little data were available for neonates and children and no data were available for pregnant women. Incidences of invasive GAS are likely to be underestimates, particularly in LMICs, due to low GAS surveillance. It is essential to improve available data to inform development of prevention and management strategies for invasive GAS. FUNDING Wellcome Trust.
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Affiliation(s)
- Emma Sherwood
- Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
| | - Stefania Vergnano
- Paediatric Infectious Diseases, Bristol Royal Hospital for Children, University Hospitals Bristol NHS, Bristol, UK
| | - Isona Kakuchi
- Paediatric Infectious Diseases, Bristol Royal Hospital for Children, University Hospitals Bristol NHS, Bristol, UK
| | - Michael G Bruce
- Centers for Disease Control and Prevention, Arctic Investigations Program, Anchorage, Alaska, USA
| | - Suman Chaurasia
- Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Samara David
- British Columbia Centre for Disease Control, University of British Columbia, BC, Canada
| | - Angela Dramowski
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Scarlett Georges
- Infectious Diseases Department, Santé Publique France, French National Public Health Agency, St Maurice, France
| | - Rebecca Guy
- National Infection Service, UK Health Security Agency, London, UK
| | - Theresa Lamagni
- National Infection Service, UK Health Security Agency, London, UK
| | - Daniel Levy-Bruhl
- Infectious Diseases Department, Santé Publique France, French National Public Health Agency, St Maurice, France
| | - Outi Lyytikäinen
- National Institute for Health and Welfare, Department of Health Security, Infectious Disease Control and Vaccinations Unit, Helsinki, Finland
| | - Monika Naus
- British Columbia Centre for Disease Control, University of British Columbia, BC, Canada
| | | | - Oddvar Oppegaard
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Didrik F Vestrheim
- Department of Vaccine Preventable Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Tammy Zulz
- Centers for Disease Control and Prevention, Arctic Investigations Program, Anchorage, Alaska, USA
| | - Andrew C Steer
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | | | - Anna C Seale
- Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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9
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Miller KM, Carapetis JR, Van Beneden CA, Cadarette D, Daw JN, Moore HC, Bloom DE, Cannon JW. The global burden of sore throat and group A Streptococcus pharyngitis: A systematic review and meta-analysis. EClinicalMedicine 2022; 48:101458. [PMID: 35706486 PMCID: PMC9124702 DOI: 10.1016/j.eclinm.2022.101458] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Contemporary data for the global burden of sore throat and group A Streptococcus (Strep A) pharyngitis are required to understand the frequency of disease and develop value propositions for Strep A vaccines. METHODS We used Clarivate Analytics' Web of Science platform to search WoS core collection, PubMed, Medline, data citation index, KCI-Korean Journal Database, Russian Science Citation Index, and the SciELO Citation Index for articles published between Jan 1, 2000, and Feb 15, 2021, from any country and in any language. The risk of bias was assessed using the JBI critical appraisal checklist. We used random-effects meta-analyses to pool sore throat and Strep A sore throat incidence rates from community-based studies. Our study was registered with PROSPERO (CRD42020181103). FINDINGS Of 5,529 articles identified by the search strategy, 26 studies met the inclusion criteria, but only two included data to determine incidence among adults. The pooled incidence rate, calculated for children only, was 82.2 episodes per 100 child-years (95% CI 25.2-286.3, I2 = 100%) for sore throat (7 studies; 7,964 person years) and 22.1 episodes per 100 child-years (95% CI 14.7-33.1, I2 = 98%) for Strep A sore throat (9 studies; 15,696 person years). The pooled cumulative incidence rate of sore throat from five studies was 31.9 per 100 children. There was significant methodological and statistical heterogeneity among studies, and five of 26 studies had a risk of bias score less than five (range: nine [maximum score] to one). INTERPRETATION Strep A sore throat has a considerable global burden. However, methodologically standardised studies are required to quantify that burden, analyse differences in rates between populations, and evaluate the likely impact of future Strep A vaccines. FUNDING This study was funded by Wellcome Trust 215,490/Z/19/Z.
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Affiliation(s)
- Kate M. Miller
- Wesfarmers Centre of Vaccines and Telethon Kids Institute, University of Western Australia, PO Box 855, West Perth, Nedlands, WA 6872, Australia
- Corresponding author.
| | - Jonathan R. Carapetis
- Wesfarmers Centre of Vaccines and Telethon Kids Institute, University of Western Australia, PO Box 855, West Perth, Nedlands, WA 6872, Australia
- Perth Children's Hospital, Nedlands, WA, Australia
| | | | - Daniel Cadarette
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jessica N. Daw
- Wesfarmers Centre of Vaccines and Telethon Kids Institute, University of Western Australia, PO Box 855, West Perth, Nedlands, WA 6872, Australia
| | - Hannah C. Moore
- Wesfarmers Centre of Vaccines and Telethon Kids Institute, University of Western Australia, PO Box 855, West Perth, Nedlands, WA 6872, Australia
| | - David E. Bloom
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jeffrey W. Cannon
- Wesfarmers Centre of Vaccines and Telethon Kids Institute, University of Western Australia, PO Box 855, West Perth, Nedlands, WA 6872, Australia
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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10
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Li Y, Dominguez S, Nanduri SA, Rivers J, Mathis S, Li Z, McGee L, Chochua S, Metcalf BJ, Van Beneden CA, Beall B, Miller L. Genomic Characterization of Group A Streptococci Causing Pharyngitis and Invasive Disease in Colorado, USA, June 2016 - April 2017. J Infect Dis 2021; 225:1841-1851. [PMID: 34788828 PMCID: PMC9125432 DOI: 10.1093/infdis/jiab565] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/08/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The genomic features and transmission link of circulating Group A streptococcus (GAS) strains causing different disease types, such as pharyngitis and invasive disease, are not well understood. METHODS We used whole-genome sequencing (WGS) to characterize GAS isolates recovered from persons with pharyngitis and invasive disease in the Denver metropolitan area from June 2016 to April 2017. RESULTS GAS isolates were cultured from 236 invasive and 417 pharyngitis infections. WGS identified 34 emm types. Compared to pharyngitis isolates, invasive isolates were more likely to carry the erm family genes (23% vs. 7.4%, p<0.001), which confer resistance to erythromycin and clindamycin (including inducible resistance), and covS gene inactivation (7% vs. 0.5%, p<0.001). WGS identified 97 genomic clusters (433 isolates; 2-65 isolates per cluster) that consisted of genomically closely related isolates (median SNP (IQR) = 3 (1-4) within cluster). Thirty genomic clusters (200 isolates; 31% of all isolates) contained both pharyngitis and invasive isolates and were found in 11 emm types. CONCLUSIONS In the Denver metropolitan population, mixed disease types were commonly seen in clusters of closely related isolates, indicative of overlapping transmission networks. Antibiotic-resistance and covS inactivation was disproportionally associated with invasive disease.
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Affiliation(s)
- Yuan Li
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Samuel Dominguez
- University of Colorado School of Medicine Aurora, CO, USA; Children's Hospital Colorado Aurora, CO, USA
| | - Srinivas A Nanduri
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Joy Rivers
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Saundra Mathis
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Zhongya Li
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lesley McGee
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sopio Chochua
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Benjamin J Metcalf
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Chris A Van Beneden
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Bernard Beall
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lisa Miller
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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11
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Woodruff RC, Eliapo-Unutoa I, Chiou H, Gayapa M, Noonan S, Podila PSB, Rayle V, Sanchez G, Tulafono R, Van Beneden CA, Ritchey M. Period Prevalence of Rheumatic Heart Disease and the Need for a Centralized Patient Registry in American Samoa, 2016 to 2018. J Am Heart Assoc 2021; 10:e020424. [PMID: 34612073 PMCID: PMC8751893 DOI: 10.1161/jaha.120.020424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Rheumatic heart disease (RHD) is a severe, chronic complication of acute rheumatic fever, triggered by group A streptococcal pharyngitis. Centralized patient registries are recommended for RHD prevention and control, but none exists in American Samoa. Using existing RHD tracking systems, we estimated RHD period prevalence and the proportion of people with RHD documented in the electronic health record. Methods and Results RHD cases were identified from a centralized electronic health record system, which retrieved clinical encounters with RHD International Classification of Diseases, Tenth Revision, Clinical Modification (ICD‐10‐CM) codes, clinical problem lists referencing RHD, and antibiotic prophylaxis administration records; 3 RHD patient tracking spreadsheets; and an all‐cause mortality database. RHD cases had ≥1 clinical encounter with RHD ICD‐10‐CM codes, a diagnostic echocardiogram, or RHD as a cause of death, or were included in RHD patient tracking spreadsheets. Period prevalence per 1000 population among children aged <18 years and adults aged ≥18 years from 2016 to 2018 and the proportion of people with RHD with ≥1 clinical encounter with an RHD ICD‐10‐CM code were estimated. From 2016 to 2018, RHD was documented in 327 people (57.2%: children aged <18 years). Overall RHD period prevalence was 6.3 cases per 1000 and varied by age (10.0 pediatric cases and 4.3 adult cases per 1000). Only 67% of people with RHD had ≥1 clinical encounter with an RHD ICD‐10‐CM code. Conclusions RHD remains a serious public health problem in American Samoa, and the existing electronic health record does not include all cases. A centralized patient registry could improve tracking people with RHD to ensure they receive necessary care.
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Affiliation(s)
- Rebecca C Woodruff
- Epidemic Intelligence Service Center for Surveillance, Epidemiology, and Laboratory Services Centers for Disease Control and Prevention Atlanta GA.,Division for Heart Disease and Stroke Prevention National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention Chamblee GA
| | | | - Howard Chiou
- Epidemic Intelligence Service Center for Surveillance, Epidemiology, and Laboratory Services Centers for Disease Control and Prevention Atlanta GA
| | - Maria Gayapa
- Lyndon B. Johnson Tropical Medical Centers Faga'alu American Samoa
| | - Sara Noonan
- RHDAustralia Menzies School of Health Research Casuarina Australia
| | - Pradeep S B Podila
- Public Health Informatics Fellowship Program Center for Surveillance, Epidemiology, and Laboratory Services Centers for Disease Control and Prevention Atlanta GA
| | - Victoria Rayle
- Office of Insular Affairs Center for State, Tribal, Local, and Territorial Support Centers for Disease Control and Prevention Atlanta GA
| | - Guillermo Sanchez
- Epidemic Intelligence Service Center for Surveillance, Epidemiology, and Laboratory Services Centers for Disease Control and Prevention Atlanta GA
| | - Ray Tulafono
- Lyndon B. Johnson Tropical Medical Centers Faga'alu American Samoa
| | - Chris A Van Beneden
- Division for Bacterial Diseases National Center for Immunization and Respiratory DiseasesCenters for Disease Control and Prevention Atlanta GA
| | - Matthew Ritchey
- Division for Heart Disease and Stroke Prevention National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention Chamblee GA
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12
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Francois Watkins LK, Milucky JL, McGee L, Siné St-Surin F, Liu P, Tran T, Chochua S, Joseph G, Shang N, Juin S, Dely P, Patel R, Van Beneden CA. Nasopharyngeal Carriage of Streptococcus pneumoniae Among Young Children in Haiti Before Pneumococcal Conjugate Vaccine Introduction. J Infect Dis 2021; 224:S248-S257. [PMID: 34469560 DOI: 10.1093/infdis/jiab119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Streptococcus pneumoniae, or pneumococcus, is a leading cause of morbidity and mortality in children worldwide. Pneumococcal conjugate vaccines (PCV) reduce carriage in the nasopharynx, preventing disease. We conducted a pneumococcal carriage study to estimate the prevalence of pneumococcal colonization, identify risk factors for colonization, and describe antimicrobial susceptibility patterns among pneumococci colonizing young children in Port-au-Prince, Haiti, before introduction of 13-valent PCV (PCV13). METHODS We conducted a cross-sectional study of children aged 6-24 months at an immunization clinic in Port-au-Prince between September 2015 and January 2016. Consenting parents were interviewed about factors associated with pneumococcal carriage; nasopharyngeal swabs were collected from each child and cultured for pneumococcus after broth enrichment. Pneumococcal isolates were serotyped and underwent antimicrobial susceptibility testing. We compared frequency of demographic, clinical, and environmental factors among pneumococcus-colonized children (carriers) to those who were not colonized (noncarriers) using unadjusted bivariate analysis and multivariate logistic regression. RESULTS Pneumococcus was isolated from 308 of the 685 (45.0%) children enrolled. Overall, 157 isolates (50.8%) were PCV13 vaccine-type serotypes; most common were 6A (13.3%), 19F (12.6%), 6B (9.7%), and 23F (6.1%). Vaccine-type isolates were significantly more likely to be nonsusceptible to ≥1 antimicrobial (63.1% vs 45.4%, P = .002). On bivariate analysis, carriers were significantly more likely than noncarriers to live in a household without electricity or running water, to share a bedroom with ≥3 people, to have a mother or father who did not complete secondary education, and to have respiratory symptoms in the 24 hours before enrollment (P < .05 for all comparisons). On multivariable analysis, completion of the pentavalent vaccination series (targeting diphtheria, pertussis, tetanus, hepatitis B, and Haemophilus influenzae type b) remained significantly more common among noncarriers. CONCLUSIONS Nearly a quarter of healthy children surveyed in Haiti were colonized with vaccine-type pneumococcal serotypes. This baseline carriage study will enable estimation of vaccine impact following nationwide introduction of PCV13.
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Affiliation(s)
- Louise K Francois Watkins
- Respiratory Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer L Milucky
- Respiratory Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lesley McGee
- Respiratory Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Pengbo Liu
- Respiratory Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Theresa Tran
- Respiratory Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sopio Chochua
- Respiratory Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Gerard Joseph
- Laboratoire National de Santé Publique, Port-au-Prince, Haiti
| | - Nong Shang
- Respiratory Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stanley Juin
- Centers for Disease Control and Prevention, Port-au-Prince, Haiti
| | - Patrick Dely
- Ministère de la Santé Publique et de la Population, Directorate of Epidemiology, Laboratory and Research, Port-au-Prince, Haiti
| | - Roopal Patel
- Centers for Disease Control and Prevention, Port-au-Prince, Haiti.,Global Fund to Fight AIDS, Tuberculosis, and Malaria, Grand-Saconnex, Switzerland
| | - Chris A Van Beneden
- Respiratory Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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13
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Kaboré L, Adebanjo T, Njanpop-Lafourcade BM, Ouangraoua S, Tarbangdo FT, Meda B, Velusamy S, Bicaba B, Aké F, McGee L, Yaro S, Betsem E, Gervaix A, Gessner BD, Whitney CG, Moïsi JC, Van Beneden CA. Pneumococcal Carriage in Burkina Faso After 13-Valent Pneumococcal Conjugate Vaccine Introduction: Results From 2 Cross-sectional Population-Based Surveys. J Infect Dis 2021; 224:S258-S266. [PMID: 34469552 PMCID: PMC8409529 DOI: 10.1093/infdis/jiab037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Burkina Faso, a country in Africa’s meningitis belt, introduced 13-valent pneumococcal conjugate vaccine (PCV13) in October 2013, with 3 primary doses given at 8, 12 and 16 weeks of age. To assess whether the new PCV13 program controlled pneumococcal carriage, we evaluated overall and serotype-specific colonization among children and adults during the first 3 years after introduction. Methods We conducted 2 population-based, cross-sectional, age-stratified surveys in 2015 and 2017 in the city of Bobo-Dioulasso. We used standardized questionnaires to collect sociodemographic, epidemiologic, and vaccination data. Consenting eligible participants provided nasopharyngeal (all ages) and oropharyngeal (≥5 years only) swab specimens. Swab specimens were plated onto blood agar either directly (2015) or after broth enrichment (2017). Pneumococci were serotyped by conventional multiplex polymerase chain reaction. We assessed vaccine effect by comparing the proportion of vaccine-type (VT) carriage among colonized individuals from a published baseline survey (2008) with each post-PCV survey. Results We recruited 992 (2015) and 1005 (2017) participants. Among children aged <5 years, 42.8% (2015) and 74.0% (2017) received ≥2 PCV13 doses. Among pneumococcal carriers aged <1 year, VT carriage declined from 55.8% in 2008 to 36.9% in 2017 (difference, 18.9%; 95% confidence interval, 1.9%–35.9%; P = .03); among carriers aged 1–4 years, VT carriage declined from 55.3% to 31.8% (difference, 23.5%; 6.8%–40.2%; P = .004); and among participants aged ≥5 years, no significant change was observed. Conclusion Within 3 years of PCV13 implementation in Burkina Faso, we documented substantial reductions in the percentage of pneumococcal carriers with a VT among children aged <5 years, but not among persons aged ≥5 years. More time, a change in the PCV13 schedule, or both, may be needed to better control pneumococcal carriage in this setting.
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Affiliation(s)
- Lassané Kaboré
- Agence de Médecine Préventive, Ouagadougou, Burkina Faso.,Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Tolulope Adebanjo
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | | | | | - Bertrand Meda
- Agence de Médecine Préventive, Ouagadougou, Burkina Faso
| | - Srinivasan Velusamy
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Brice Bicaba
- Ministère de la Santé, Ouagadougou, Burkina Faso
| | - Flavien Aké
- Davycas International, Ouagadougou, Burkina Faso
| | - Lesley McGee
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - Edouard Betsem
- Agence de Médecine Préventive, Ouagadougou, Burkina Faso.,Pfizer, Paris, France.,Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Alain Gervaix
- Department of Pediatrics, University Hospitals of Geneva, Geneva, Switzerland
| | - Bradford D Gessner
- Agence de Médecine Préventive, Paris, France.,Pfizer, Collegeville, Pennsylvania, USA
| | - Cynthia G Whitney
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jennifer C Moïsi
- Pfizer, Paris, France.,Agence de Médecine Préventive, Paris, France
| | - Chris A Van Beneden
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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14
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Lewnard JA, King LM, Fleming-Dutra KE, Link-Gelles R, Van Beneden CA. Incidence of Pharyngitis, Sinusitis, Acute Otitis Media, and Outpatient Antibiotic Prescribing Preventable by Vaccination Against Group A Streptococcus in the United States. Clin Infect Dis 2021; 73:e47-e58. [PMID: 32374829 DOI: 10.1093/cid/ciaa529] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 04/30/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Group A Streptococcus (GAS) is a leading cause of acute respiratory conditions that frequently result in antibiotic prescribing. Vaccines against GAS are currently in development. METHODS We estimated the incidence rates of healthcare visits and antibiotic prescribing for pharyngitis, sinusitis, and acute otitis media (AOM) in the United States using nationally representative surveys of outpatient care provision, supplemented by insurance claims data. We estimated the proportion of these episodes attributable to GAS and to GAS emm types included in a proposed 30-valent vaccine. We used these outputs to estimate the incidence rates of outpatient visits and antibiotic prescribing preventable by GAS vaccines with various efficacy profiles under infant and school-age dosing schedules. RESULTS GAS pharyngitis causes 19.1 (95% confidence interval [CI], 17.3-21.1) outpatient visits and 10.2 (95% CI, 9.0-11.5) antibiotic prescriptions per 1000 US persons aged 0-64 years, annually. GAS pharyngitis causes 93.2 (95% CI, 82.3-105.3) visits and 53.2 (95% CI, 45.2-62.5) antibiotic prescriptions per 1000 children ages 3-9 years, annually, representing 5.9% (95% CI, 5.1-7.0%) of all outpatient antibiotic prescribing in this age group. Collectively, GAS-attributable pharyngitis, sinusitis, and AOM cause 26.9 (95% CI, 23.9-30.8) outpatient visits and 16.1 (95% CI, 14.0-18.7) antibiotic prescriptions per 1000 population, annually. A 30-valent GAS vaccine meeting the World Health Organization's 80% efficacy target could prevent 5.4% (95% CI, 4.6-6.4%) of outpatient antibiotic prescriptions among children aged 3-9 years. If vaccine prevention of GAS pharyngitis made the routine antibiotic treatment of pharyngitis unnecessary, up to 17.1% (95% CI, 15.0-19.6%) of outpatient antibiotic prescriptions among children aged 3-9 years could be prevented. CONCLUSIONS An efficacious GAS vaccine could prevent substantial incidences of pharyngitis infections and associated antibiotic prescribing in the United States.
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Affiliation(s)
- Joseph A Lewnard
- Division of Epidemiology, School of Public Health, University of California, Berkeley, California, USA.,Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, California, USA.,Center for Computational Biology, School of Engineering, University of California, Berkeley, California, USA
| | - Laura M King
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Katherine E Fleming-Dutra
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ruth Link-Gelles
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Chris A Van Beneden
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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15
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Fay K, Onukwube J, Chochua S, Schaffner W, Cieslak P, Lynfield R, Muse A, Smelser C, Harrison LH, Farley M, Petit S, Alden N, Apostal M, Vagnone PS, Nanduri S, Beall B, Van Beneden CA. Patterns of antibiotic nonsusceptibility among invasive group A Streptococcus infections-United States, 2006-2017. Clin Infect Dis 2021; 73:1957-1964. [PMID: 34170310 DOI: 10.1093/cid/ciab575] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Treatment of severe group A streptococcal infections requires timely and appropriate antibiotic therapy. We describe the epidemiology of antimicrobial-resistant invasive group A streptococcal (iGAS) infections in the U.S. METHODS We analyzed population-based iGAS surveillance data at 10 U.S. sites from 2006-2017. Cases were defined as infection with GAS isolated from normally sterile sites or wounds in patients with necrotizing fasciitis or streptococcal toxic shock syndrome. GAS isolates were emm typed. Antimicrobial susceptibility was determined using broth microdilution or whole genome sequencing. We compared characteristics among patients infected with erythromycin nonsusceptible (EryNS) and clindamycin nonsusceptible (CliNS) strains to those with susceptible infections. We analyzed proportions of EryNS and CliNS among isolates by site, year, risk factors and emm type. RESULTS Overall, 17,179 iGAS cases were reported; 14.5% were EryNS. Among isolates tested for both inducible and constitutive CliNS (2011-2017), 14.6% were CliNS. Most (99.8%) CliNS isolates were EryNS. Resistance was highest in 2017 (EryNS: 22.8%; CliNS: 22.0%). All isolates were susceptible to beta-lactams. EryNS and CliNS infections were most frequent among persons aged 18-34 years and in persons residing in long-term care facilities, experiencing homelessness, incarcerated, or who injected drugs. Patterns varied by site. Patients with nonsusceptible infections were significantly less likely to die. Emm types with >30% EryNS or CliNS included: 77, 58, 11, 83, 92. CONCLUSION Increasing prevalence of EryNS and CliNS iGAS infections in the U.S. is predominantly due to expansion of several emm types. Clinicians should consider local resistance patterns when treating iGAS infections.
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Affiliation(s)
- Katherine Fay
- Respiratory Diseases Branch, CDC, Atlanta, Georgia, USA
| | | | - Sopio Chochua
- Respiratory Diseases Branch, CDC, Atlanta, Georgia, USA
| | | | - Paul Cieslak
- Public Health Division, Oregon Health Authority, Portland, Oregon, USA
| | - Ruth Lynfield
- Minnesota Department of Health, St. Paul, Minnesota, USA
| | - Alison Muse
- New York State Department of Health, Emerging Infections Program, Rochester, New York, USA
| | - Chad Smelser
- New Mexico Department of Health, Santa Fe, New Mexico, USA
| | - Lee H Harrison
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Monica Farley
- Emerging Infections Program, Emory University, Atlanta, Georgia, USA
| | - Susan Petit
- Connecticut Department of Public Health, Hartford Connecticut, USA
| | - Nisha Alden
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | | | | | | | - Bernard Beall
- Respiratory Diseases Branch, CDC, Atlanta, Georgia, USA
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16
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Rahaman MR, Alroy KA, Van Beneden CA, Friedman MS, Kennedy ED, Rahman M, Balajee A, Muraduzzaman AKM, Shirin T, Flora MS, Azziz-Baumgartner E. Etiology of Severe Acute Respiratory Infections, Bangladesh, 2017. Emerg Infect Dis 2021; 27:324-326. [PMID: 33350930 PMCID: PMC7774577 DOI: 10.3201/eid2701.201347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
In April 2017, surveillance detected a surge in severe acute respiratory infections (SARI) in Bangladesh. We collected specimens from SARI patients and asymptomatic controls for analysis with multipathogen diagnostic tests. Influenza A(H1N1)pdm09 was associated with the SARI epidemic, suggesting that introducing vaccines and empiric antiviral drugs could be beneficial.
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17
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Nanduri SA, Onukwube J, Apostol M, Alden N, Petit S, Farley M, Harrison LH, Como-Sabetti K, Smelser C, Burzlaff K, Cieslak P, Schaffner W, Van Beneden CA. Challenges in Surveillance for Streptococcal Toxic Shock Syndrome: Active Bacterial Core Surveillance, United States, 2014-2017. Public Health Rep 2021; 137:687-694. [PMID: 33960856 DOI: 10.1177/00333549211013460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Routine surveillance for streptococcal toxic shock syndrome (STSS), a severe manifestation of invasive group A Streptococcus (GAS) infections, likely underestimates its true incidence. The objective of our study was to evaluate routine identification of STSS in a national surveillance system for invasive GAS infections. METHODS Active Bacterial Core surveillance (ABCs) conducts active population-based surveillance for invasive GAS disease in selected US counties in 10 states. We categorized invasive GAS cases with a diagnosis of STSS made by a physician as STSS-physician and cases that met the Council of State and Territorial Epidemiologists (CSTE) clinical criteria for STSS based on data in the medical record as STSS-CSTE. We evaluated agreement between the 2 methods for identifying STSS and compared the estimated national incidence of STSS when applying proportions of STSS-CSTE and STSS-physician among invasive GAS cases from this study with national invasive GAS estimates for 2017. RESULTS During 2014-2017, of 7572 invasive GAS cases in ABCs, we identified 1094 (14.4%) as STSS-CSTE and 203 (2.7%) as STSS-physician, a 5.3-fold difference. Of 1094 STSS-CSTE cases, we identified only 132 (12.1%) as STSS-physician cases. Agreement between the 2 methods for identifying STSS was low (κ = 0.17; 95% CI, 0.14-0.19). Using ABCs data, we estimated 591 cases of STSS-physician and 3618 cases of STSS-CSTE occurred nationally in 2017. CONCLUSIONS We found a large difference in estimates of incidence of STSS when applying different surveillance methods and definitions. These results should help with better use of currently available surveillance data to estimate the incidence of STSS and to evaluate disease prevention efforts, in addition to guiding future surveillance efforts for STSS.
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Affiliation(s)
- Srinivas Acharya Nanduri
- 1242 Respiratory Diseases Branch, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jennifer Onukwube
- 1242 Respiratory Diseases Branch, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mirasol Apostol
- 43885 California Emerging Infections Program, Oakland, CA, USA
| | - Nisha Alden
- 2915 Colorado Department of Public Health and Environment, Denver, CO, USA
| | - Susan Petit
- 3758 Connecticut Department of Public Health, Hartford, CT, USA
| | - Monica Farley
- 1371 Emory University School of Medicine, Atlanta, GA, USA.,Atlanta VA Medical Center, Atlanta, GA, USA
| | - Lee H Harrison
- 25802 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Chad Smelser
- 1107 New Mexico Department of Health, Santa Fe, NM, USA
| | - Kari Burzlaff
- 1094 New York State Department of Health, Albany, NY, USA
| | - Paul Cieslak
- 159301 Oregon Health Authority Public Health Division, Portland, OR, USA
| | | | - Chris A Van Beneden
- 1242 Respiratory Diseases Branch, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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18
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Vannice KS, Ricaldi J, Nanduri S, Fang FC, Lynch JB, Bryson-Cahn C, Wright T, Duchin J, Kay M, Chochua S, Van Beneden CA, Beall B. Streptococcus pyogenes pbp2x Mutation Confers Reduced Susceptibility to β-Lactam Antibiotics. Clin Infect Dis 2021; 71:201-204. [PMID: 31630171 DOI: 10.1093/cid/ciz1000] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 10/14/2019] [Indexed: 11/14/2022] Open
Abstract
Two near-identical clinical Streptococcus pyogenes isolates of emm subtype emm43.4 with a pbp2x missense mutation (T553K) were detected. Minimum inhibitory concentrations (MICs) for ampicillin and amoxicillin were 8-fold higher, and the MIC for cefotaxime was 3-fold higher than for near-isogenic control isolates, consistent with a first step in developing β-lactam resistance.
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Affiliation(s)
- Kirsten S Vannice
- Epidemiology Workforce Branch, Division of Scientific Education and Professional Development, Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Communicable Disease Epidemiology and Immunization, Prevention Division, Public Health-Seattle & King County, Seattle, Washington, USA
| | - Jessica Ricaldi
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Srinivas Nanduri
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - John B Lynch
- Harborview Medical Center, Seattle, Washington, USA
| | | | | | - Jeff Duchin
- Communicable Disease Epidemiology and Immunization, Prevention Division, Public Health-Seattle & King County, Seattle, Washington, USA
| | - Meagan Kay
- Communicable Disease Epidemiology and Immunization, Prevention Division, Public Health-Seattle & King County, Seattle, Washington, USA
| | - Sopio Chochua
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Chris A Van Beneden
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Bernard Beall
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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19
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Biggs HM, Van Beneden CA, Kurkjian K, Kobayashi M, Peret TCT, Watson JT, Schneider E, Gerber SI, Ravishankar J. Severe Human Metapneumovirus and Group A Streptococcus Pneumonia in an Immunocompetent Adult. Clin Infect Dis 2021; 70:2712-2714. [PMID: 31563939 DOI: 10.1093/cid/ciz961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 09/25/2019] [Indexed: 11/12/2022] Open
Abstract
An immunocompetent adult with asthma developed severe human metapneumovirus (HMPV) illness complicated by group A Streptococcus coinfection, progressing to acute respiratory distress syndrome and shock. Several coworkers had less severe HMPV infection. HMPV can cause severe respiratory illness in healthy adults and should be considered as a potential cause of community respiratory outbreaks.
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Affiliation(s)
- Holly M Biggs
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Chris A Van Beneden
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Katie Kurkjian
- Division of State and Local Readiness, Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Virginia Department of Health, Richmond, Virginia, USA
| | - Miwako Kobayashi
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Teresa C T Peret
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - John T Watson
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eileen Schneider
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Susan I Gerber
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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20
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Milucky J, Pondo T, Gregory CJ, Iuliano D, Chaves SS, McCracken J, Mansour A, Zhang Y, Aleem MA, Wolff B, Whitaker B, Whistler T, Onyango C, Lopez MR, Liu N, Rahman MZ, Shang N, Winchell J, Chittaganpitch M, Fields B, Maldonado H, Xie Z, Lindstrom S, Sturm-Ramirez K, Montgomery J, Wu KH, Van Beneden CA. The epidemiology and estimated etiology of pathogens detected from the upper respiratory tract of adults with severe acute respiratory infections in multiple countries, 2014-2015. PLoS One 2020; 15:e0240309. [PMID: 33075098 PMCID: PMC7571682 DOI: 10.1371/journal.pone.0240309] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 09/24/2020] [Indexed: 12/26/2022] Open
Abstract
Introduction Etiology studies of severe acute respiratory infections (SARI) in adults are limited. We studied potential etiologies of SARI among adults in six countries using multi-pathogen diagnostics. Methods We enrolled both adults with SARI (acute respiratory illness onset with fever and cough requiring hospitalization) and asymptomatic adults (adults hospitalized with non-infectious illnesses, non-household members accompanying SARI patients, adults enrolled from outpatient departments, and community members) in each country. Demographics, clinical data, and nasopharyngeal and oropharyngeal specimens were collected from both SARI patients and asymptomatic adults. Specimens were tested for presence of 29 pathogens utilizing the Taqman® Array Card platform. We applied a non-parametric Bayesian regression extension of a partially latent class model approach to estimate proportions of SARI caused by specific pathogens. Results We enrolled 2,388 SARI patients and 1,135 asymptomatic adults from October 2013 through October 2015. We detected ≥1 pathogen in 76% of SARI patients and 67% of asymptomatic adults. Haemophilus influenzae and Streptococcus pneumoniae were most commonly detected (≥23% of SARI patients and asymptomatic adults). Through modeling, etiology was attributed to a pathogen in most SARI patients (range among countries: 57.3–93.2%); pathogens commonly attributed to SARI etiology included influenza A (14.4–54.4%), influenza B (1.9–19.1%), rhino/enterovirus (1.8–42.6%), and RSV (3.6–14.6%). Conclusions Use of multi-pathogen diagnostics and modeling enabled attribution of etiology in most adult SARI patients, despite frequent detection of multiple pathogens in the upper respiratory tract. Seasonal flu vaccination and development of RSV vaccine would likely reduce the burden of SARI in these populations.
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Affiliation(s)
- Jennifer Milucky
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, Georgia, United States of America
- * E-mail:
| | - Tracy Pondo
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, Georgia, United States of America
| | - Christopher J. Gregory
- Division of Global Health Protection, Centers for Disease Control and Prevention, Thailand Ministry of Public Health, Thailand
| | - Danielle Iuliano
- Influenza Division, Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, Georgia, United States of America
| | - Sandra S. Chaves
- Influenza Division, Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, CDC Kenya Office, Kenya
| | - John McCracken
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Adel Mansour
- Division of Global Health Protection, Centers for Disease Control and Prevention, Egypt
| | - Yuzhi Zhang
- Division of Global Health Protection, Centers for Disease Control and Prevention, China
| | | | - Bernard Wolff
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, Georgia, United States of America
| | - Brett Whitaker
- Division of Viral Diseases, Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, Georgia, United States of America
| | - Toni Whistler
- Division of Global Health Protection, Centers for Disease Control and Prevention, Thailand Ministry of Public Health, Thailand
| | - Clayton Onyango
- Kenya Medical Research Institute/Centers for Disease Control and Prevention Public Health Collaboration, Kisumu, Kenya
| | - Maria Renee Lopez
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Na Liu
- China Centers for Disease Control and Prevention, National Institute for Viral Disease, Beijing, China
| | | | - Nong Shang
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, Georgia, United States of America
| | - Jonas Winchell
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, Georgia, United States of America
| | | | - Barry Fields
- Division of Global Health Protection, Centers for Disease Control and Prevention, Kenya
| | - Herberth Maldonado
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Zhiping Xie
- China Centers for Disease Control and Prevention, National Institute for Viral Disease, Beijing, China
| | - Stephen Lindstrom
- Division of Viral Diseases, Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, Georgia, United States of America
| | - Katherine Sturm-Ramirez
- Influenza Division, Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, CDC Bangladesh Office, Bangladesh
| | - Joel Montgomery
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kai-Hui Wu
- Influenza Division, Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, CDC Bangladesh Office, Bangladesh
| | - Chris A. Van Beneden
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, Georgia, United States of America
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21
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Vekemans J, Gouvea-Reis F, Kim JH, Excler JL, Smeesters PR, O'Brien KL, Van Beneden CA, Steer AC, Carapetis JR, Kaslow DC. The Path to Group A Streptococcus Vaccines: World Health Organization Research and Development Technology Roadmap and Preferred Product Characteristics. Clin Infect Dis 2020; 69:877-883. [PMID: 30624673 PMCID: PMC6695511 DOI: 10.1093/cid/ciy1143] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 11/05/2018] [Accepted: 01/07/2019] [Indexed: 12/12/2022] Open
Abstract
Group A Streptococcus (GAS) infections result in a considerable underappreciated burden of acute and chronic disease globally. A 2018 World Health Assembly resolution calls for better control and prevention. Providing guidance on global health research needs is an important World Health Organization (WHO) activity, influencing prioritization of investments. Here, the role, status, and directions in GAS vaccines research are discussed. WHO preferred product characteristics and a research and development technology roadmap, briefly presented, offer an actionable framework for vaccine development to regulatory and policy decision making, availability, and use. GAS vaccines should be considered for global prevention of the range of clinical manifestations and associated antibiotic use. Impediments related to antigen diversity, safety concerns, and the difficulty to establish vaccine efficacy against rheumatic heart disease are discussed. Demonstration of vaccine efficacy against pharyngitis and skin infections constitutes a key near-term strategic goal. Investments and collaborative partnerships to diversify and advance vaccine candidates are needed.
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Affiliation(s)
- Johan Vekemans
- Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland
| | | | - Jerome H Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Pierre R Smeesters
- Molecular Bacteriology Laboratory, Université Libre de Bruxelles.,Department of Pediatrics, Academic Children Hospital Queen Fabiola, Brussels, Belgium.,Tropical Diseases Research Group, Murdoch Children's Research Institute.,Centre for International Child Health, University of Melbourne, Australia
| | | | - Chris A Van Beneden
- Respiratory Diseases Branch, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Andrew C Steer
- Tropical Diseases Research Group, Murdoch Children's Research Institute.,Department of Paediatrics, University of Melbourne.,Royal Children's Hospital, Melbourne
| | - Jonathan R Carapetis
- Telethon Kids Institute, University of Western Australia and Perth Children's Hospital, Australia
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22
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Li Y, Rivers J, Mathis S, Li Z, Velusamy S, Nanduri SA, Van Beneden CA, Snippes-Vagnone P, Lynfield R, McGee L, Chochua S, Metcalf BJ, Beall B. Genomic Surveillance of Streptococcus pyogenes Strains Causing Invasive Disease, United States, 2016-2017. Front Microbiol 2020; 11:1547. [PMID: 32849323 PMCID: PMC7396493 DOI: 10.3389/fmicb.2020.01547] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/16/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Streptococcus pyogenes is a major cause of severe, invasive infections in humans. The bacterial pathogen harbors a wide array of virulence factors and exhibits high genomic diversity. Rapid changes of circulating strains in a community are common. Understanding the current prevalence and dynamics of S. pyogenes lineages could inform vaccine development and disease control strategies. METHODS We used whole-genome sequencing (WGS) to characterize all invasive S. pyogenes isolates obtained through the United States Center for Disease Control and Prevention's Active Bacterial Core surveillance (ABCs) in 2016 and 2017. We determined the distribution of strain features, including emm type, antibiotic resistance determinants, and selected virulence factors. Changes in strain feature distribution between years 2016 and 2017 were evaluated. Phylogenetic analysis was used to identify expanding lineages within emm type. RESULTS Seventy-one emm types were identified from 3873 isolates characterized. The emm types targeted by a 30-valent M protein-based vaccine accounted for 3230 (89%) isolates. The relative frequencies of emm types collected during the 2 years were similar. While all isolates were penicillin-susceptible, erythromycin-resistant isolates increased from 273 (16% of 2016 isolates) to 432 (23% of 2017 isolates), mainly driven by increase of the erm-positive emm types 92 and 83. The prevalence of 24 virulence factors, including 11 streptococcal pyrogenic toxins, ranged from 6 to 90%. In each of three emm types (emm 49, 82, and 92), a subgroup of isolates significantly expanded between 2016 and 2017 compared to isolates outside of the subgroup (P-values < 0.0001). Specific genomic sequence changes were associated with these expanded lineages. CONCLUSIONS While the overall population structure of invasive S. pyogenes isolates in the United States remained stable, some lineages, including several that were antibiotic-resistant, increased between 2016 and 2017. Continued genomic surveillance can help monitor and characterize bacterial features associated with emerging strains from invasive infections.
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Affiliation(s)
- Yuan Li
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, United States Department of Health and Human Services, Atlanta, GA, United States
| | - Joy Rivers
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, United States Department of Health and Human Services, Atlanta, GA, United States
| | - Saundra Mathis
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, United States Department of Health and Human Services, Atlanta, GA, United States
| | - Zhongya Li
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, United States Department of Health and Human Services, Atlanta, GA, United States
| | - Srinivasan Velusamy
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, United States Department of Health and Human Services, Atlanta, GA, United States
| | - Srinivas A. Nanduri
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, United States Department of Health and Human Services, Atlanta, GA, United States
| | - Chris A. Van Beneden
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, United States Department of Health and Human Services, Atlanta, GA, United States
| | | | - Ruth Lynfield
- Minnesota Department of Health, St Paul, MN, United States
| | - Lesley McGee
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, United States Department of Health and Human Services, Atlanta, GA, United States
| | - Sopio Chochua
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, United States Department of Health and Human Services, Atlanta, GA, United States
| | - Benjamin J. Metcalf
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, United States Department of Health and Human Services, Atlanta, GA, United States
| | - Bernard Beall
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, United States Department of Health and Human Services, Atlanta, GA, United States
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23
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Valenciano SJ, Onukwube J, Spiller MW, Thomas A, Como-Sabetti K, Schaffner W, Farley M, Petit S, Watt JP, Spina N, Harrison LH, Alden NB, Torres S, Arvay ML, Beall B, Van Beneden CA. Invasive Group A Streptococcal Infections Among People Who Inject Drugs and People Experiencing Homelessness in the United States, 2010-2017. Clin Infect Dis 2020; 73:e3718-e3726. [PMID: 32803254 DOI: 10.1093/cid/ciaa787] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 06/12/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Reported outbreaks of invasive group A Streptococcus (iGAS) infections among people who inject drugs (PWID) and people experiencing homelessness (PEH) have increased, concurrent with rising US iGAS rates. We describe epidemiology among iGAS patients with these risk factors. METHODS We analyzed iGAS infections from population-based Active Bacterial Core surveillance (ABCs) at 10 US sites from 2010 to 2017. Cases were defined as GAS isolated from a normally sterile site or from a wound in patients with necrotizing fasciitis or streptococcal toxic shock syndrome. GAS isolates were emm typed. We categorized iGAS patients into four categories: injection drug use (IDU) only, homelessness only, both, and neither. We calculated annual change in prevalence of these risk factors using log binomial regression models. We estimated national iGAS infection rates among PWID and PEH. RESULTS We identified 12 386 iGAS cases; IDU, homelessness, or both were documented in ~13%. Skin infections and acute skin breakdown were common among iGAS patients with documented IDU or homelessness. Endocarditis was 10-fold more frequent among iGAS patients with documented IDU only versus those with neither risk factor. Average percentage yearly increase in prevalence of IDU and homelessness among iGAS patients was 17.5% and 20.0%, respectively. iGAS infection rates among people with documented IDU or homelessness were ~14-fold and 17- to 80-fold higher, respectively, than among people without those risks. CONCLUSIONS IDU and homelessness likely contribute to increases in US incidence of iGAS infections. Improving management of skin breakdown and early recognition of skin infection could prevent iGAS infections in these patients.
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Affiliation(s)
- Sandra J Valenciano
- Epidemic Intelligence Service assigned to National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer Onukwube
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Respiratory Diseases Branch, Atlanta, Georgia, USA
| | - Michael W Spiller
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Respiratory Diseases Branch, Atlanta, Georgia, USA
| | - Ann Thomas
- Oregon Health Authority, Portland, Oregon, USA
| | | | | | - Monica Farley
- Emory University School of Medicine and the VA Medical Center, Atlanta, Georgia, USA
| | - Susan Petit
- Connecticut Department of Public Health, Hartford, Connecticut, USA
| | - James P Watt
- California Department of Public Health, Richmond, California, USA
| | - Nancy Spina
- New York State Department of Health, Albany, New York, USA
| | - Lee H Harrison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nisha B Alden
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - Salina Torres
- New Mexico Department of Health, Santa Fe, New Mexico, USA
| | - Melissa L Arvay
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Respiratory Diseases Branch, Atlanta, Georgia, USA
| | - Bernard Beall
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Respiratory Diseases Branch, Atlanta, Georgia, USA
| | - Chris A Van Beneden
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Respiratory Diseases Branch, Atlanta, Georgia, USA
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24
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Idubor OI, Kobayashi M, Ndegwa L, Okeyo M, Galgalo T, Kalani R, Githii S, Hunsperger E, Balajee A, Verani JR, da Gloria Carvalho M, Winchell J, Van Beneden CA, Widdowson MA, Makayotto L, Chaves SS. Improving Detection and Response to Respiratory Events - Kenya, April 2016-April 2020. MMWR Morb Mortal Wkly Rep 2020; 69:540-544. [PMID: 32379727 PMCID: PMC7737949 DOI: 10.15585/mmwr.mm6918a2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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25
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Adebanjo T, Mosites E, Van Beneden CA, Onukwube J, Blum M, Harper M, Rudolph K, Frick A, Castrodale L, McLaughlin J, Bruce MG, Gounder P. Risk Factors for Group A Streptococcus Colonization During an Outbreak Among People Experiencing Homelessness in Anchorage, Alaska, 2017. Clin Infect Dis 2019; 67:1784-1787. [PMID: 29788094 DOI: 10.1093/cid/ciy429] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/15/2018] [Indexed: 01/28/2023] Open
Abstract
We identified risk factors for any emm type group A streptococcal (GAS) colonization while investigating an invasive emm26.3 GAS outbreak among people experiencing homelessness in Alaska. Risk factors included upper extremity skin breakdown, sleeping outdoors, sharing blankets, and infrequent tooth brushing. Our results may help guide control efforts in future outbreaks.
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Affiliation(s)
- Tolulope Adebanjo
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Emily Mosites
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Zoonotic and Emerging Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Chris A Van Beneden
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer Onukwube
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Matthew Blum
- Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | - Karen Rudolph
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Zoonotic and Emerging Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Anna Frick
- Section of Epidemiology, Division of Public Health, Alaska Department of Health and Social Services, Anchorage
| | - Louisa Castrodale
- Section of Epidemiology, Division of Public Health, Alaska Department of Health and Social Services, Anchorage
| | - Joseph McLaughlin
- Section of Epidemiology, Division of Public Health, Alaska Department of Health and Social Services, Anchorage
| | - Michael G Bruce
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Zoonotic and Emerging Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Prabhu Gounder
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Zoonotic and Emerging Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
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26
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Mosites E, Frick A, Gounder P, Castrodale L, Li Y, Rudolph K, Hurlburt D, Lecy KD, Zulz T, Adebanjo T, Onukwube J, Beall B, Van Beneden CA, Hennessy T, McLaughlin J, Bruce MG. Outbreak of Invasive Infections From Subtype emm26.3 Group A Streptococcus Among Homeless Adults-Anchorage, Alaska, 2016-2017. Clin Infect Dis 2019; 66:1068-1074. [PMID: 29069346 DOI: 10.1093/cid/cix921] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 10/18/2017] [Indexed: 01/08/2023] Open
Abstract
Background In 2016, we detected an outbreak of group A Streptococcus (GAS) invasive infections among the estimated 1000 persons experiencing homelessness (PEH) in Anchorage, Alaska. We characterized the outbreak and implemented a mass antibiotic intervention at homeless service facilities. Methods We identified cases through the Alaska GAS laboratory-based surveillance system. We conducted emm typing, antimicrobial susceptibility testing, and whole-genome sequencing on all invasive isolates and compared medical record data of patients infected with emm26.3 and other emm types. In February 2017, we offered PEH at 6 facilities in Anchorage a single dose of 1 g of azithromycin. We collected oropharyngeal and nonintact skin swabs on a subset of participants concurrent with the intervention and 4 weeks afterward. Results From July 2016 through April 2017, we detected 42 invasive emm26.3 cases in Anchorage, 35 of which were in PEH. The emm26.3 isolates differed on average by only 2 single-nucleotide polymorphisms. Compared to other emm types, infection with emm26.3 was associated with cellulitis (odds ratio [OR], 2.5; P = .04) and necrotizing fasciitis (OR, 4.4; P = .02). We dispensed antibiotics to 391 PEH. Colonization with emm26.3 decreased from 4% of 277 at baseline to 1% of 287 at follow-up (P = .05). Invasive GAS incidence decreased from 1.5 cases per 1000 PEH/week in the 6 weeks prior to the intervention to 0.2 cases per 1000 PEH/week in the 6 weeks after (P = .01). Conclusions In an invasive GAS outbreak in PEH in Anchorage, mass antibiotic administration was temporally associated with reduced invasive disease cases and colonization prevalence.
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Affiliation(s)
- Emily Mosites
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Anna Frick
- Section of Epidemiology, Division of Public Health, Alaska Department of Health and Social Services, Anchorage, Atlanta, Georgia
| | - Prabhu Gounder
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Louisa Castrodale
- Section of Epidemiology, Division of Public Health, Alaska Department of Health and Social Services, Anchorage, Atlanta, Georgia
| | - Yuan Li
- Respiratory Disease Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Karen Rudolph
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Debby Hurlburt
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Kristen D Lecy
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Tammy Zulz
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Tolu Adebanjo
- Respiratory Disease Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer Onukwube
- Respiratory Disease Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Bernard Beall
- Respiratory Disease Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Chris A Van Beneden
- Respiratory Disease Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Thomas Hennessy
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Joseph McLaughlin
- Section of Epidemiology, Division of Public Health, Alaska Department of Health and Social Services, Anchorage, Atlanta, Georgia
| | - Michael G Bruce
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
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27
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Adebanjo T, Apostol M, Alden N, Petit S, Tunali A, Torres S, Hollick R, Bell A, Muse A, Poissant T, Schaffner W, Van Beneden CA. Evaluating Household Transmission of Invasive Group A Streptococcus Disease in the United States Using Population-based Surveillance Data, 2013–2016. Clin Infect Dis 2019; 70:1478-1481. [DOI: 10.1093/cid/ciz716] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 07/26/2019] [Indexed: 02/05/2023] Open
Abstract
Abstract
Using population-based surveillance data, we quantified the secondary invasive group A Streptococcus disease risk among household contacts. The disease risk in the 30 days postexposure to an index-case patient was highest among individuals aged ≥65 years, versus the annual background incidence of all ages.
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Affiliation(s)
- Tolulope Adebanjo
- Epidemic Intelligence Service and Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Nisha Alden
- Colorado Emerging Infections Program, Denver
| | - Susan Petit
- Connecticut Department of Public Health, Hartford
| | - Amy Tunali
- Georgia Emerging Infections Program, Atlanta
| | | | - Rosemary Hollick
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | | | | | - Chris A Van Beneden
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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28
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Hartnett KP, Jackson KA, Felsen C, McDonald R, Bardossy AC, Gokhale RH, Kracalik I, Lucas T, McGovern O, Van Beneden CA, Mendoza M, Bohm M, Brooks JT, Asher AK, Magill SS, Fiore A, Blog D, Dufort EM, See I, Dumyati G. Bacterial and Fungal Infections in Persons Who Inject Drugs - Western New York, 2017. MMWR Morb Mortal Wkly Rep 2019; 68:583-586. [PMID: 31269011 PMCID: PMC6613572 DOI: 10.15585/mmwr.mm6826a2] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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29
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Lu Y, Joseph L, Bélisle P, Sawatwong P, Jatapai A, Whistler T, Thamthitiwat S, Paveenkittiporn W, Khemla S, Van Beneden CA, Baggett HC, Gregory CJ. Pneumococcal pneumonia prevalence among adults with severe acute respiratory illness in Thailand - comparison of Bayesian latent class modeling and conventional analysis. BMC Infect Dis 2019; 19:423. [PMID: 31092207 PMCID: PMC6521483 DOI: 10.1186/s12879-019-4067-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 05/07/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Determining the etiology of pneumonia is essential to guide public health interventions. Diagnostic test results, including from polymerase chain reaction (PCR) assays of upper respiratory tract specimens, have been used to estimate prevalence of pneumococcal pneumonia. However limitations in test sensitivity and specificity and the specimen types available make establishing a definitive diagnosis challenging. Prevalence estimates for pneumococcal pneumonia could be biased in the absence of a true gold standard reference test for detecting Streptococcus pneumoniae. METHODS We conducted a case control study to identify etiologies of community acquired pneumonia (CAP) from April 2014 through August 2015 in Thailand. We estimated the prevalence of pneumococcal pneumonia among adults hospitalized for CAP using Bayesian latent class models (BLCMs) incorporating results of real-time polymerase chain reaction (qPCR) testing of upper respiratory tract specimens and a urine antigen test (UAT) from cases and controls. We compared the prevalence estimate to conventional analyses using only UAT as a reference test. RESULTS The estimated prevalence of pneumococcal pneumonia was 8% (95% CI: 5-11%) by conventional analyses. By BLCM, we estimated the prevalence to be 10% (95% CrI: 7-16%) using binary qPCR and UAT results, and 11% (95% CrI: 7-17%) using binary UAT results and qPCR cycle threshold (Ct) values. CONCLUSIONS BLCM suggests a > 25% higher prevalence of pneumococcal pneumonia than estimated by a conventional approach assuming UAT as a gold standard reference test. Higher quantities of pneumococcal DNA in the upper respiratory tract were associated with pneumococcal pneumonia in adults but the addition of a second specific pneumococcal test was required to accurately estimate disease status and prevalence. By incorporating the inherent uncertainty of diagnostic tests, BLCM can obtain more reliable estimates of disease status and improve understanding of underlying etiology.
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Affiliation(s)
- Ying Lu
- Division of Global Health Protection, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.
| | - Lawrence Joseph
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
| | - Patrick Bélisle
- Centre Hospitalier de l'Universite de Montreal,Montreal, Montreal, Canada
| | - Pongpun Sawatwong
- Division of Global Health Protection, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Anchalee Jatapai
- Division of Global Health Protection, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.,Office of Public Health, Regional Development Mission for Asia, US Agency for International Development, Bangkok, Thailand
| | - Toni Whistler
- Division of Global Health Protection, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Somsak Thamthitiwat
- Division of Global Health Protection, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Wantana Paveenkittiporn
- Department of Medical Sciences, Ministry of Public Health, National Institute of Health, Nonthaburi, Thailand
| | - Supphacoke Khemla
- Nakhon Phanom Provincial Hospital, Ministry of Public Health, Nakhon Phanom, Thailand
| | - Chris A Van Beneden
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Disease, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Henry C Baggett
- Division of Global Health Protection, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christopher J Gregory
- Division of Global Health Protection, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.,Present affiliation: Division of Vector-Borne Diseases, US Centers for Disease Control and Prevention, Fort Collins, CO, USA
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30
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Smeesters PR, Laho D, Beall B, Steer AC, Van Beneden CA. Seasonal, Geographic, and Temporal Trends of emm Clusters Associated With Invasive Group A Streptococcal Infections in US Multistate Surveillance. Clin Infect Dis 2019; 64:694-695. [PMID: 28184410 DOI: 10.1093/cid/ciw807] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Pierre R Smeesters
- Department of Pediatrics, Academic Children Hospital Queen Fabiola, Université Libre de Bruxelles, Brussels, Belgium.,Molecular Bacteriology Laboratory, Université Libre de Bruxelles, Brussels, Belgium.,Group A Streptococcus Research Group, Murdoch Childrens Research Institute, Melbourne, Australia.,Centre for International Child Health, University of Melbourne, Australia
| | - Delphine Laho
- Department of Pediatrics, Academic Children Hospital Queen Fabiola, Université Libre de Bruxelles, Brussels, Belgium.,Group A Streptococcus Research Group, Murdoch Childrens Research Institute, Melbourne, Australia
| | - Bernard Beall
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia. USA
| | - Andrew C Steer
- Group A Streptococcus Research Group, Murdoch Childrens Research Institute, Melbourne, Australia.,Centre for International Child Health, University of Melbourne, Australia.,Department of General Medicine, Royal Children's Hospital, Melbourne, Australia
| | - Chris A Van Beneden
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia. USA
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31
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Ahmed SS, Diebold KE, Brandvold JM, Ewaidah SS, Black S, Ogundimu A, Li Z, Stone ND, Van Beneden CA. The Role of Wound Care in 2 Group A Streptococcal Outbreaks in a Chicago Skilled Nursing Facility, 2015‒2016. Open Forum Infect Dis 2018; 5:ofy145. [PMID: 30680292 DOI: 10.1093/ofid/ofy145] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 06/22/2018] [Indexed: 02/03/2023] Open
Abstract
Two consecutive outbreaks of group A Streptococcus (GAS) infections occurred from 2015-2016 among residents of a Chicago skilled nursing facility. Evaluation of wound care practices proved crucial for identifying transmission factors and implementing prevention measures. We demonstrated shedding of GAS on settle plates during care of a colonized wound.
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Affiliation(s)
- Sana S Ahmed
- Communicable Diseases, Lake County Health Department and Community Health Center, Waukegan, Illinois
| | - Kasey E Diebold
- Division of Foodborne, Waterborne, and Environmental Diseases, Atlanta, Georgia
| | - Jacob M Brandvold
- College of Veterinary Medicine, Washington State University, Pullman, Washington
| | - Saadeh S Ewaidah
- Communicable Diseases Program, Chicago Department of Public Health, Chicago, Illinois
| | - Stephanie Black
- Communicable Diseases Program, Chicago Department of Public Health, Chicago, Illinois
| | - Abimbola Ogundimu
- Division of Health Quality and Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Zhongya Li
- Group A Streptococcus Laboratory, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nimalie D Stone
- Division of Health Quality and Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Chris A Van Beneden
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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32
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Nelson GE, Pondo T, Toews KA, Farley MM, Lindegren ML, Lynfield R, Aragon D, Zansky SM, Watt JP, Cieslak PR, Angeles K, Harrison LH, Petit S, Beall B, Van Beneden CA. Epidemiology of Invasive Group A Streptococcal Infections in the United States, 2005-2012. Clin Infect Dis 2016. [PMID: 27105747 DOI: 10.1093/cid/ciw248)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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.
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Affiliation(s)
- George E Nelson
- Epidemic Intelligence Service National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention Vanderbilt University, Nashville, Tennessee
| | - Tracy Pondo
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
| | - Karrie-Ann Toews
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
| | - Monica M Farley
- Emory University School of Medicine and the VA Medical Center, Atlanta, Georgia
| | | | | | - Deborah Aragon
- Colorado Department of Public Health and Environment, Denver
| | | | - James P Watt
- California Department of Public Health, Richmond
| | | | - Kathy Angeles
- New Mexico Emerging Infections Program, University of New Mexico, Las Cruces
| | - Lee H Harrison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Susan Petit
- Connecticut Department of Public Health, Hartford
| | - Bernard Beall
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
| | - Chris A Van Beneden
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
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33
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Van Beneden CA, Pietz H, Kirkcaldy RD, Koonin LM, Uyeki TM, Oster AM, Levy DA, Glover M, Arduino MJ, Merlin TL, Kuhar DT, Kosmos C, Bell BP. Early Identification and Prevention of the Spread of Ebola - United States. MMWR Suppl 2016; 65:75-84. [PMID: 27386933 DOI: 10.15585/mmwr.su6503a11] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
In response to the 2014-2016 Ebola virus disease (Ebola) epidemic in West Africa, CDC prepared for the potential introduction of Ebola into the United States. The immediate goals were to rapidly identify and isolate any cases of Ebola, prevent transmission, and promote timely treatment of affected patients. CDC's technical expertise and the collaboration of multiple partners in state, local, and municipal public health departments; health care facilities; emergency medical services; and U.S. government agencies were essential to the domestic preparedness and response to the Ebola epidemic and relied on longstanding partnerships. CDC established a comprehensive response that included two new strategies: 1) active monitoring of travelers arriving from countries affected by Ebola and other persons at risk for Ebola and 2) a tiered system of hospital facility preparedness that enabled prioritization of training. CDC rapidly deployed a diagnostic assay for Ebola virus (EBOV) to public health laboratories. Guidance was developed to assist in evaluation of patients possibly infected with EBOV, for appropriate infection control, to support emergency responders, and for handling of infectious waste. CDC rapid response teams were formed to provide assistance within 24 hours to a health care facility managing a patient with Ebola. As a result of the collaborations to rapidly identify, isolate, and manage Ebola patients and the extensive preparations to prevent spread of EBOV, the United States is now better prepared to address the next global infectious disease threat.The activities summarized in this report would not have been possible without collaboration with many U.S. and international partners (http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/partners.html).
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Affiliation(s)
- Chris A Van Beneden
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, CDC
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34
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Nelson GE, Pondo T, Toews KA, Farley MM, Lindegren ML, Lynfield R, Aragon D, Zansky SM, Watt JP, Cieslak PR, Angeles K, Harrison LH, Petit S, Beall B, Van Beneden CA. Epidemiology of Invasive Group A Streptococcal Infections in the United States, 2005-2012. Clin Infect Dis 2016; 63:478-86. [PMID: 27105747 DOI: 10.1093/cid/ciw248] [Citation(s) in RCA: 234] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 04/14/2016] [Indexed: 12/29/2022] Open
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.
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Affiliation(s)
- George E Nelson
- Epidemic Intelligence Service National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention Vanderbilt University, Nashville, Tennessee
| | - Tracy Pondo
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
| | - Karrie-Ann Toews
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
| | - Monica M Farley
- Emory University School of Medicine and the VA Medical Center, Atlanta, Georgia
| | | | | | - Deborah Aragon
- Colorado Department of Public Health and Environment, Denver
| | | | - James P Watt
- California Department of Public Health, Richmond
| | | | - Kathy Angeles
- New Mexico Emerging Infections Program, University of New Mexico, Las Cruces
| | - Lee H Harrison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Susan Petit
- Connecticut Department of Public Health, Hartford
| | - Bernard Beall
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
| | - Chris A Van Beneden
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
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35
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Koonin LM, Jamieson DJ, Jernigan JA, Van Beneden CA, Kosmos C, Harvey MC, Pietz H, Bertolli J, Perz JF, Whitney CG, Halpin ASL, Daley WR, Pesik N, Margolis GS, Tumpey A, Tappero J, Damon I. Systems for rapidly detecting and treating persons with ebola virus disease--United States. MMWR Morb Mortal Wkly Rep 2015; 64:222-5. [PMID: 25742383 PMCID: PMC4584719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
The U.S. Department of Health and Human Services (HHS), CDC, other U.S. government agencies, the World Health Organization (WHO), and international partners are taking multiple steps to respond to the current Ebola virus disease (Ebola) outbreak in West Africa to reduce its toll there and to reduce the chances of international spread. At the same time, CDC and HHS are working to ensure that persons who have a risk factor for exposure to Ebola and who develop symptoms while in the United States are rapidly identified and isolated, and safely receive treatment. HHS and CDC have actively worked with state and local public health authorities and other partners to accelerate health care preparedness to care for persons under investigation (PUI) for Ebola or with confirmed Ebola. This report describes some of these efforts and their impact.
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Affiliation(s)
- Lisa M. Koonin
- Influenza Coordination Unit, Office of Infectious Diseases, CDC,Corresponding author: Lisa M. Koonin, , 404-639-2293
| | - Denise J. Jamieson
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - John A. Jernigan
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Chris A. Van Beneden
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, CDC
| | - Christine Kosmos
- Division of State and Local Readiness, Office of Public Health Preparedness and Response, CDC
| | - Melissa Cole Harvey
- Division of National Healthcare Preparedness Programs, Office of the Assistant Secretary for Preparedness and Response, US Department of Health and Human Services
| | - Harald Pietz
- Division of Public Health Performance Improvement, Office for State, Tribal, Local, and Territorial Support, CDC
| | - Jeanne Bertolli
- Division of HIV/AIDS Prevention, Surveillance and Epidemiology, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Joseph F. Perz
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Cynthia G. Whitney
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, CDC
| | | | - W. Randolph Daley
- Division of State and Local Readiness, Office of Public Health Preparedness and Response, CDC
| | - Nicki Pesik
- Office of the Director, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Gregg S. Margolis
- Division of Health Systems Policy, Office of the Assistant Secretary for Preparedness and Response, US Department of Health and Human Services
| | - Abbigail Tumpey
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Jordan Tappero
- Division of Global Health Protection, Center for Global Health, CDC
| | - Inger Damon
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, CDC
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36
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Breiman RF, Van Beneden CA, Farnon EC. Surveillance for respiratory infections in low- and middle-income countries: experience from the Centers for Disease Control and Prevention's Global Disease Detection International Emerging Infections Program. J Infect Dis 2014; 208 Suppl 3:S167-72. [PMID: 24265474 PMCID: PMC7107375 DOI: 10.1093/infdis/jit462] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Robert F Breiman
- Global Disease Detection Regional Center, US Centers for Disease Control and Prevention, Kenya Office, Nairobi
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37
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Olsen RJ, Laucirica DR, Watkins ME, Feske ML, Garcia-Bustillos JR, Vu C, Cantu C, Shelburne SA, Fittipaldi N, Kumaraswami M, Shea P, Flores AR, Beres SB, Lovgren M, Tyrrell GJ, Efstratiou A, Low DE, Van Beneden CA, Musser JM. Polymorphisms in regulator of protease B (RopB) alter disease phenotype and strain virulence of serotype M3 Group A
Streptococcus. FASEB J 2012. [DOI: 10.1096/fasebj.26.1_supplement.1034.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Randall J Olsen
- Pathology and Genomic MedicineThe Methodist Hospital Research InstituteHoustonTX
| | - Daniel R Laucirica
- Pathology and Genomic MedicineThe Methodist Hospital Research InstituteHoustonTX
| | - Melanie E Watkins
- Pathology and Genomic MedicineThe Methodist Hospital Research InstituteHoustonTX
| | - Marsha L Feske
- Pathology and Genomic MedicineThe Methodist Hospital Research InstituteHoustonTX
| | | | - Chau Vu
- Pathology and Genomic MedicineThe Methodist Hospital Research InstituteHoustonTX
| | - Concepcion Cantu
- Pathology and Genomic MedicineThe Methodist Hospital Research InstituteHoustonTX
| | | | - Nahuel Fittipaldi
- Pathology and Genomic MedicineThe Methodist Hospital Research InstituteHoustonTX
| | - Muthiah Kumaraswami
- Pathology and Genomic MedicineThe Methodist Hospital Research InstituteHoustonTX
| | - Patrick Shea
- Pathology and Genomic MedicineThe Methodist Hospital Research InstituteHoustonTX
| | | | - Stephen B Beres
- Pathology and Genomic MedicineThe Methodist Hospital Research InstituteHoustonTX
| | | | | | | | | | | | - James M Musser
- Pathology and Genomic MedicineThe Methodist Hospital Research InstituteHoustonTX
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Olsen RJ, Laucirica DR, Watkins ME, Feske ML, Garcia-Bustillos JR, Vu C, Cantu C, Shelburne SA, Fittipaldi N, Kumaraswami M, Shea PR, Flores AR, Beres SB, Lovgren M, Tyrrell GJ, Efstratiou A, Low DE, Van Beneden CA, Musser JM. Polymorphisms in regulator of protease B (RopB) alter disease phenotype and strain virulence of serotype M3 group A Streptococcus. J Infect Dis 2012; 205:1719-29. [PMID: 22262791 DOI: 10.1093/infdis/jir825] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Whole-genome sequencing of serotype M3 group A streptococci (GAS) from oropharyngeal and invasive infections in Ontario recently showed that the gene encoding regulator of protease B (RopB) is highly polymorphic in this population. To test the hypothesis that ropB is under diversifying selective pressure among all serotype M3 GAS strains, we sequenced this gene in 1178 strains collected from different infection types, geographic regions, and time periods. The results confirmed our hypothesis and discovered a significant association between mutant ropB alleles, decreased activity of its major regulatory target SpeB, and pharyngitis. Additionally, isoallelic strains with ropB polymorphisms were significantly less virulent in a mouse model of necrotizing fasciitis. These studies provide a model strategy for applying whole-genome sequencing followed by deep single-gene sequencing to generate new insight to the rapid evolution and virulence regulation of human pathogens.
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Affiliation(s)
- Randall J Olsen
- Department of Pathology and Laboratory Medicine, The Methodist Hospital Research Institute, Houston, TX, USA.
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Deutscher M, Schillie S, Gould C, Baumbach J, Mueller M, Avery C, Van Beneden CA. Investigation of a group A streptococcal outbreak among residents of a long-term acute care hospital. Clin Infect Dis 2011; 52:988-94. [PMID: 21460311 DOI: 10.1093/cid/cir084] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In January 2008, a long-term acute care hospital (LTACH) in New Mexico reported a cluster of severe group A Streptococcus (GAS) infections. METHODS We defined a case as illness in a patient in the LTACH from 1 October 2007 through 3 February 2008 from whom GAS was isolated from a usually sterile site or with illness consistent with GAS infection and GAS isolated from a nonsterile site. To identify carriers, we swabbed the oropharynx and skin lesions of patients and staff. We observed facility procedures to assess possible transmission routes and adherence to infection control practices. We also conducted a case-control study to identify risk factors for infection with use of asymptomatic patients who were noncarriers as control subjects. RESULTS We identified 11 case patients and 11 carriers (8 patients and 3 staff). No carriers became case patients. Significant risk factors for infection in univariate analysis included sharing a room with an infected or colonized patient (6 [55%] of 11 case patients vs 3 [8%] of 39 control subjects), undergoing wound debridement (64% vs 13%), and receiving negative pressure wound therapy (73% vs 33%). Having an infected or colonized roommate remained associated with case patients in multivariable analysis (odds ratio, 15.3; 95% confidence interval, 2.5-110.9). Suboptimal infection control practices were widespread. CONCLUSIONS This large outbreak of GAS infection was the first reported in an LTACH, a setting that contains a highly susceptible patient population. Widespread infection control lapses likely allowed continued transmission. Similar to the situation in other care settings, appropriate infection control and case cohorting may help prevent and control outbreaks of GAS infection in LTACHs.
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Affiliation(s)
- Meredith Deutscher
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA
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Gerber MA, Brown HW, Lee G, Tanz RR, Temte JL, Van Beneden CA. Physicians' opinions about critical attributes of a potential group A streptococcal vaccine. Vaccine 2010; 28:7155-60. [PMID: 20817014 DOI: 10.1016/j.vaccine.2010.08.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Revised: 08/11/2010] [Accepted: 08/16/2010] [Indexed: 11/15/2022]
Abstract
A group A streptococcal (GAS) vaccine, while not currently available, offers the possibility of a more effective approach; however, barriers to its implementation are likely to exist. The objectives of this study were to describe the attitudes of physicians about the importance of preventing GAS-associated conditions and to identify potential barriers to vaccine implementation. Surveys were sent to randomly selected physicians from the AAP and the AAFP. The GAS conditions believed by respondents to be most important to prevent among pediatric patients were ARF (31%) followed by STSS (24%) and pharyngitis (20%). Pediatricians and family physicians identified similar factors that would encourage routine use of a GAS vaccine. Less than half of pediatricians and only a third of family physicians would recommend a GAS vaccine if it could not be given concurrently with other immunizations or if there were strong parental resistance to the vaccine. This descriptive study provides important information about the anticipated use of a GAS vaccine by primary care physicians in the United States.
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Affiliation(s)
- Michael A Gerber
- University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Division of Infectious Diseases, MLC 5019, 3333 Burnet Avenue, Cincinnati, OH 45226, USA.
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Park SY, Van Beneden CA, Pilishvili T, Martin M, Facklam RR, Whitney CG. Invasive pneumococcal infections among vaccinated children in the United States. J Pediatr 2010; 156:478-483.e2. [PMID: 19962156 DOI: 10.1016/j.jpeds.2009.10.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Revised: 08/12/2009] [Accepted: 10/12/2009] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Because 7-valent pneumococcal conjugate vaccine (PCV7) is highly efficacious, pneumococcal infections in vaccinated children raise concerns about immunologic disorders. We characterized a case series of US children in whom invasive pneumococcal infections developed despite vaccination. STUDY DESIGN We reviewed invasive (sterile site) pneumococcal infections in children aged <5 years who had received > or =1 PCV7 dose as identified from October 2001 to February 2004 through national passive surveillance and the Centers for Disease Control and Prevention's Active Bacterial Core surveillance. Vaccine serotype infections were considered breakthrough cases; the subset of breakthrough cases occurring in children who completed an age-appropriate vaccination series were considered PCV7 failures. RESULTS We identified 753 invasive infections; 155 infections (21%) were breakthrough cases, predominantly caused by serotypes 6B (n = 50, 32%) and 19F (n = 45, 29%). The proportion of breakthrough cases decreased with the increasing number of PCV7 doses received (P < .001, Chi(2) for linear trend). Children with co-morbid conditions accounted for 31% of breakthrough infections. Twenty-seven cases (4%) were classified as vaccine failures. Most failures (71%) occurred in children who were vaccinated according to catch-up schedules; 37% had co-morbid conditions. CONCLUSION Invasive pneumococcal infections identified in vaccinated U.S. children were primarily caused by disease resulting from serotypes not covered with PCV7, rather than failure of the vaccine. Incomplete vaccination and co-morbid conditions likely contribute to breakthrough vaccine-type pneumococcal infections.
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Affiliation(s)
- Sarah Y Park
- Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Lessa F, Leparc GF, Benson K, Sanderson R, Van Beneden CA, Shewmaker PL, Jensen B, Arduino MJ, Kuehnert MJ. Fatal group C streptococcal infection due to transfusion of a bacterially contaminated pooled platelet unit despite routine bacterial culture screening. Transfusion 2008; 48:2177-83. [DOI: 10.1111/j.1537-2995.2008.01802.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Thigpen MC, Richards CL, Lynfield R, Barrett NL, Harrison LH, Arnold KE, Reingold A, Bennett NM, Craig AS, Gershman K, Cieslak PR, Lewis P, Greene CM, Beall B, Van Beneden CA. Invasive group A streptococcal infection in older adults in long-term care facilities and the community, United States, 1998-2003. Emerg Infect Dis 2008; 13:1852-9. [PMID: 18258035 PMCID: PMC2876747 DOI: 10.3201/eid1312.070303] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Invasive infection develops almost 6 times as frequently in the elderly in long-term care facilities. Limited information exists on the incidence and characteristics of invasive group A streptococcal (GAS) infections among residents of long-term care facilities (LTCFs). We reviewed cases of invasive GAS infections occurring among persons >65 years of age identified through active, population-based surveillance from 1998 through 2003. We identified 1,762 invasive GAS cases among persons >65 years, including 1,662 with known residence type (LTCF or community). Incidence of invasive GAS infection among LTCF residents compared to community-based elderly was 41.0 versus 6.9 cases per 100,000 population. LTCF case-patients were 1.5 times as likely to die from the infection as community-based case-patients (33% vs. 21%, p<0.01) but were less often hospitalized (90% vs. 95%, p<0.01). In multivariate logistic regression modeling, LTCF residence remained an independent predictor of death. Additional prevention strategies against GAS infection in this high-risk population are urgently needed.
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Jordan HT, Richards CL, Burton DC, Thigpen MC, Van Beneden CA. Group a streptococcal disease in long-term care facilities: descriptive epidemiology and potential control measures. Clin Infect Dis 2007; 45:742-52. [PMID: 17712760 DOI: 10.1086/520992] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2007] [Accepted: 05/21/2007] [Indexed: 01/13/2023] Open
Abstract
Group A streptococci (GAS) are an important cause of severe, life-threatening illness among the elderly population, particularly those individuals residing in long-term care facilities (LTCFs). Outbreaks of GAS infection are potentially devastating in this vulnerable population and often require large-scale control efforts involving LTCF staff, public health officials, and infectious diseases practitioners. Although multiple outbreaks of GAS infection in LTCFs have been described in the medical literature, this topic has not been reviewed for 15 years, and there is a need for updated guidance on how to approach GAS infection outbreak control. We reviewed published documents on GAS infection in LTCFs to describe the current understanding of the disease's epidemiology in this setting, identify techniques for outbreak investigation and prevention, and expose areas where additional research is needed. We highlight well-accepted prevention and control strategies that can be employed during investigation and control of GAS infection outbreaks in LTCFs.
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Affiliation(s)
- Hannah T Jordan
- Respiratory Diseases Branch, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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45
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Thigpen MC, Thomas DM, Gloss D, Park SY, Khan AJ, Fogelman VL, Beall B, Van Beneden CA, Todd RL, Greene CM. Nursing home outbreak of invasive group a streptococcal infections caused by 2 distinct strains. Infect Control Hosp Epidemiol 2006; 28:68-74. [PMID: 17230390 DOI: 10.1086/508821] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2006] [Accepted: 02/13/2006] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To identify factors contributing to a cluster of deaths from invasive group A streptococcus (GAS) infection in a nursing home facility and to prevent additional cases. DESIGN Outbreak investigation. SETTING A 146-bed nursing home facility in northern Nevada. METHODS We defined a case as the isolation of GAS from a normally sterile site in a resident of nursing home A. To identify case patients, we reviewed resident records from nursing home A, the local hospital, and the hospital laboratory. We obtained oropharyngeal and skin lesion swabs from staff and residents to assess GAS colonization and performed emm typing on available isolates. To identify potential risk factors for transmission, we performed a cohort study and investigated concurrent illness among residents and surveyed staff regarding infection control practices. RESULTS Six residents met the case patient definition; 3 (50%) of them died. Among invasive GAS isolates available for analysis, 2 distinct strains were identified: emm11 (3 isolates) and emm89 (2 isolates). The rate of GAS carriage was 6% among residents and 4% among staff; carriage isolates were emm89 (8 isolates), emm11 (2 isolates), and emm1 (1 isolate). Concurrently, 35 (24%) of the residents developed a respiratory illness of unknown etiology; 41% of these persons died. Twenty-one (30%) of the surveyed employees did not always wash their hands before patient contacts, and 27 (38%) did not always wash their hands between patient contacts. CONCLUSIONS Concurrent respiratory illness likely contributed to an outbreak of invasive GAS infection from 2 strains in a highly susceptible population. This outbreak highlights the importance of appropriate infection control measures, including respiratory hygiene practices, in nursing home facilities.
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Affiliation(s)
- Michael C Thigpen
- Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Atlanta, GA 30333, USA.
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Guarner J, Sumner J, Paddock CD, Shieh WJ, Greer PW, Reagan S, Fischer M, Van Beneden CA, Zaki SR. Diagnosis of invasive group a streptococcal infections by using immunohistochemical and molecular assays. Am J Clin Pathol 2006; 126:148-55. [PMID: 16753593 DOI: 10.1309/khgv-r72c-brm4-fq58] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022] Open
Abstract
Invasive group A streptococcus (GAS) infections cause 1,100 to 1,300 deaths annually in the United States. Diagnosis is made when Streptococcus pyogenes is isolated from pus or body fluids; however, cultures are not always obtained, and antibiotic treatment can preclude bacterial growth. An immunohistochemical assay for GAS was applied to formalin-fixed tissue samples from 122 patients with suspect GAS infection. Immunohistochemical staining of well-defined cocci and small, granular antigen fragments was observed in 27 cases. S pyogenes was isolated in 18 cases, whereas in 8 cases, immunohistochemical staining was confirmed by amplification of the sepB gene of S pyogenes from paraffin-embedded samples in a heminested polymerase chain reaction (PCR) assay. A primary focus of infection (respiratory, mucocutaneous, or gynecologic) was present in 22 patients, whereas 5 had no identifiable primary focus of infection. Eighteen patients had systemic infection. Immunohistochemical analysis and PCR can be used for diagnosis of GAS infections in formalin-fixed, paraffin-embedded samples.
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Affiliation(s)
- Jeannette Guarner
- Infectious Disease Pathology Activity, National Centers for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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Guarner J, Sumner J, Paddock CD, Shieh WJ, Greer PW, Reagan S, Fischer M, Van Beneden CA, Zaki SR. Diagnosis of Invasive Group A Streptococcal Infections by Using Immunohistochemical and Molecular Assays. Am J Clin Pathol 2006. [DOI: 10.1309/khgvr72cbrm4fq58] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Levine OS, Van Beneden CA, Jernigan DB. A New Old Opportunity for Preventing Serious Group A Streptococcal Infections. Clin Infect Dis 2005; 41:343-4. [PMID: 16007531 DOI: 10.1086/431598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2005] [Accepted: 04/10/2005] [Indexed: 11/03/2022] Open
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Greene CM, Van Beneden CA, Javadi M, Skoff TH, Beall B, Facklam R, Abercrombie DR, Kramer SL, Arnold KE. Cluster of deaths from group A streptococcus in a long-term care facility--Georgia, 2001. Am J Infect Control 2005; 33:108-13. [PMID: 15761411 DOI: 10.1016/j.ajic.2004.07.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Invasive group A streptococcus (GAS) affects approximately 10,500 persons annually; 1 in 5 patients >/=65 years die. In August 2001, CDC investigated a cluster of GAS deaths in a Georgia long-term care facility (LTCF). METHODS We screened LTCF residents and staff for GAS carriage and conducted a retrospective cohort study among residents. We defined a case as GAS isolation associated with clinical infection. RESULTS Eight cases were identified (median age: 79 years); 6 (75%) patients died. Carriage was similar in residents (10%) and staff (9%). All isolates among residents and 63% among staff were type emm 77. Risk factors for GAS disease or carriage among residents were receiving skin treatment (relative risk [RR] = 4.0, 95% confidence interval [CI] = 1.9-11.0) and having an infected or colonized roommate (RR = 2.0, 95% CI = 1.10-5.0). No wound care nurse carried GAS. Interventions included education about standardized infection control guidelines and appropriate hand hygiene; carriers were treated with antibiotics. No subsequent GAS cases were identified in the following year. CONCLUSIONS Transmission of GAS in this outbreak likely occurred during wound care and ended with improved hand hygiene. This investigation highlights additional research and policy needs for control of severe GAS infections among the high-risk LTCF population.
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Affiliation(s)
- Carolyn M Greene
- Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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50
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Van Beneden CA, Lexau C, Baughman W, Barnes B, Bennett N, Cassidy PM, Pass M, Gelling L, Barrett NL, Zell ER, Whitney CG. Aggregated antibiograms and monitoring of drug-resistant Streptococcus pneumoniae. Emerg Infect Dis 2003; 9:1089-95. [PMID: 14519245 PMCID: PMC3016770 DOI: 10.3201/eid0909.020620] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Community-specific antimicrobial susceptibility data may help monitor trends among drug-resistant Streptococcus pneumoniae and guide empiric therapy. Because active, population-based surveillance for invasive pneumococcal disease is accurate but resource intensive, we compared the proportion of penicillin-nonsusceptible isolates obtained from existing antibiograms, a less expensive system, to that obtained from 1 year of active surveillance for Georgia, Tennessee, California, Minnesota, Oregon, Maryland, Connecticut, and New York. For all sites, proportions of penicillin-nonsusceptible isolates from antibiograms were within 10 percentage points (median 3.65) of those from invasive-only isolates obtained through active surveillance. Only 23% of antibiograms distinguished between isolates intermediate and resistant to penicillin; 63% and 57% included susceptibility results for erythromycin and extended-spectrum cephalosporins, respectively. Aggregating existing hospital antibiograms is a simple and relatively accurate way to estimate local prevalence of penicillin-nonsusceptible pneumococcus; however, antibiograms offer limited data on isolates with intermediate and high-level penicillin resistance and isolates resistant to other agents.
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Affiliation(s)
- Chris A Van Beneden
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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