Sandra J Valenciano1, Jennifer Onukwube2, Michael W Spiller2, Ann Thomas3, Kathryn Como-Sabetti4, William Schaffner5, Monica Farley6, Susan Petit7, James P Watt8, Nancy Spina9, Lee H Harrison10, Nisha B Alden11, Salina Torres12, Melissa L Arvay2, Bernard Beall2, Chris A Van Beneden2. 1. 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. 2. Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Respiratory Diseases Branch, Atlanta, Georgia, USA. 3. Oregon Health Authority, Portland, Oregon, USA. 4. Minnesota Department of Health, St. Paul, Minnesota, USA. 5. Vanderbilt University School of Medicine, Nashville, Tennessee, USA. 6. Emory University School of Medicine and the VA Medical Center, Atlanta, Georgia, USA. 7. Connecticut Department of Public Health, Hartford, Connecticut, USA. 8. California Department of Public Health, Richmond, California, USA. 9. New York State Department of Health, Albany, New York, USA. 10. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. 11. Colorado Department of Public Health and Environment, Denver, Colorado, USA. 12. New Mexico Department of Health, Santa Fe, New Mexico, USA.
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. Published by Oxford University Press for the Infectious Diseases Society of America 2020.
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. Published by Oxford University Press for the Infectious Diseases Society of America 2020.
Entities:
Keywords:
epidemiology; group A Streptococcus; homelessness; injection drug use; surveillance
Authors: S Metraux; D Culhane; S Raphael; M White; C Pearson; E Hirsch; P Ferrell; S Rice; B Ritter; J S Cleghorn Journal: Public Health Rep Date: 2001 Jul-Aug Impact factor: 2.792
Authors: Kathleen L Dooling; Matthew B Crist; Duc B Nguyen; Jennifer Bass; Lauren Lorentzson; Karrie-Ann Toews; Tracy Pondo; Nimalie D Stone; Bernard Beall; Chris Van Beneden Journal: Clin Infect Dis Date: 2013-09-09 Impact factor: 9.079
Authors: Pierre R Smeesters; Delphine Laho; Bernard Beall; Andrew C Steer; Chris A Van Beneden Journal: Clin Infect Dis Date: 2017-03-01 Impact factor: 9.079
Authors: Hannah T Jordan; Chesley L Richards; Deron C Burton; Michael C Thigpen; Chris A Van Beneden Journal: Clin Infect Dis Date: 2007-08-06 Impact factor: 9.079
Authors: Emily Mosites; Anna Frick; Prabhu Gounder; Louisa Castrodale; Yuan Li; Karen Rudolph; Debby Hurlburt; Kristen D Lecy; Tammy Zulz; Tolu Adebanjo; Jennifer Onukwube; Bernard Beall; Chris A Van Beneden; Thomas Hennessy; Joseph McLaughlin; Michael G Bruce Journal: Clin Infect Dis Date: 2018-03-19 Impact factor: 9.079
Authors: David M Engelthaler; Michael Valentine; Jolene Bowers; Jennifer Pistole; Elizabeth M Driebe; Joel Terriquez; Linus Nienstadt; Mark Carroll; Mare Schumacher; Mary Ellen Ormsby; Shane Brady; Eugene Livar; Del Yazzie; Victor Waddell; Marie Peoples; Kenneth Komatsu; Paul Keim Journal: Emerg Infect Dis Date: 2016-04 Impact factor: 6.883
Authors: Nick Bundle; Laura Bubba; Juliana Coelho; Rachel Kwiatkowska; Rachel Cloke; Sarah King; Jill Rajan-Iyer; Max Courtney-Pillinger; Charles R Beck; Vivian Hope; Theresa Lamagni; Colin S Brown; Daiga Jermacane; Rachel Glass; Monica Desai; Maya Gobin; Sooria Balasegaram; Charlotte Anderson Journal: Euro Surveill Date: 2017-01-19
Authors: Luis Alberto Vega; Misu A Sanson; María Belén Cubria; Shrijana Regmi; Brittany J Shah; Samuel A Shelburne; Anthony R Flores Journal: Infect Immun Date: 2022-08-01 Impact factor: 3.609
Authors: Yuan Li; Samuel Dominguez; Srinivas A Nanduri; Joy Rivers; Saundra Mathis; Zhongya Li; Lesley McGee; Sopio Chochua; Benjamin J Metcalf; Chris A Van Beneden; Bernard Beall; Lisa Miller Journal: J Infect Dis Date: 2022-05-16 Impact factor: 7.759
Authors: Emma Sherwood; Stefania Vergnano; Isona Kakuchi; Michael G Bruce; Suman Chaurasia; Samara David; Angela Dramowski; Scarlett Georges; Rebecca Guy; Theresa Lamagni; Daniel Levy-Bruhl; Outi Lyytikäinen; Monika Naus; Jennifer Onukwube Okaro; Oddvar Oppegaard; Didrik F Vestrheim; Tammy Zulz; Andrew C Steer; Chris A Van Beneden; Anna C Seale Journal: Lancet Infect Dis Date: 2022-04-04 Impact factor: 71.421
Authors: Emily Mosites; Blair Harrison; Martha P Montgomery; Ashley A Meehan; Joshua Leopold; Lindsey Barranco; Lauren Schwerzler; Andrea E Carmichael; Kristie E N Clarke; Jay C Butler Journal: Public Health Rep Date: 2022-04-29 Impact factor: 3.117
Authors: Misu A Sanson; Luis Alberto Vega; Brittany Shah; Shrijana Regmi; M Belen Cubria; Nicola Horstmann; Samuel A Shelburne; Anthony R Flores Journal: Infect Immun Date: 2021-08-09 Impact factor: 3.609