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1 October 2007

Volume 45, Number 7
Clinical Infectious Diseases 2007;45:853–862
© 2007 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2007/4507-0005$15.00
DOI: 10.1086/521264
MAJOR ARTICLE

The Epidemiology of Invasive Group A Streptococcal Infection and Potential Vaccine Implications: United States, 2000–2004

Rosalyn E. O’Loughlin,1,2

Angela Roberson,1

Paul R. Cieslak,5

Ruth Lynfield,6

Ken Gershman,7

Allen Craig,8

Bernadette A. Albanese,9

Monica M. Farley,3,4

Nancy L. Barrett,10

Nancy L. Spina,11

Bernard Beall,1

Lee H. Harrison,12

Arthur Reingold,13 and

Chris Van Beneden,1 for the

Active Bacterial Core Surveillance Team

1Respiratory Diseases Branch, National Center for Immunization and Respiratory Diseases, and 2Epidemic Intelligence Service, Centers for Disease Control and Prevention, 3Emory University School of Medicine, and 4Atlanta Veterans Affairs Medical Center, Atlanta, Georgia; 5Oregon Department of Human Services, Portland; 6Minnesota Department of Health, Minneapolis; 7Colorado Department Public Health and Environment, Denver; 8Tennessee Department of Health, Nashville; 9New Mexico Department of Health, Santa Fe; 10Connecticut Department of Public Health, Hartford; 11New York State Department of Health, Albany; 12Johns Hopkins Bloomberg School of Public Health, Baltimore; and 13University of California, Berkeley

Background.Invasive group A Streptococcus (GAS) infection causes significant morbidity and mortality in the United States. We report the current epidemiologic characteristics of invasive GAS infections and estimate the potential impact of a multivalent GAS vaccine.

Methods.From January 2000 through December 2004, we collected data from Centers for Disease Control and Prevention’s Active Bacterial Core surveillance (ABCs), a population‐based system operating at 10 US sites (2004 population, 29.7 million). We defined a case of invasive GAS disease as isolation of GAS from a normally sterile site or from a wound specimen obtained from a patient with necrotizing fasciitis or streptococcal toxic shock syndrome in a surveillance area resident. All available isolates were emm typed. We used US census data to calculate rates and to make age‐ and race‐adjusted national projections.

Results.We identified 5400 cases of invasive GAS infection (3.5 cases per 100,000 persons), with 735 deaths (case‐fatality rate, 13.7%). Case‐fatality rates for streptococcal toxic shock syndrome and necrotizing fasciitis were 36% and 24%, respectively. Incidences were highest among elderly persons (9.4 cases per 100,000 persons), infants (5.3 cases per 100,000 persons), and black persons (4.7 cases per 100,000 persons) and were stable over time. We estimate that 8950–11,500 cases of invasive GAS infection occur in the United States annually, resulting in 1050–1850 deaths. The emm types in a proposed 26‐valent vaccine accounted for 79% of all cases and deaths. Independent factors associated with death include increasing age; having streptococcal toxic shock syndrome, meningitis, necrotizing fasciitis, pneumonia, or bacteremia; and having emm types 1, 3, or 12.

Conclusions.GAS remains an important cause of severe disease in the United States. The introduction of a vaccine could significantly reduce morbidity and mortality due to these infections.

Received 9 February 2007; accepted 23 May 2007; electronically published 29 August 2007.

Reprints or correspondence: Dr. Rosalyn O’Loughlin, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, MS C‐23, Atlanta, GA 30333 ().

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