title: The epidemiology of invasive group A streptococcal disease in Victoria, Australia.
abstract: OBJECTIVE
  To estimate the incidence and severity of invasive group A streptococcal infection in Victoria, Australia.
  
  
  METHODS
  Prospective active surveillance study.
  
  
  METHODS
  Public and private laboratories, hospitals and general practitioners throughout Victoria.
  
  
  METHODS
  People in Victoria diagnosed with group A streptococcal disease notified to the surveillance system between 1 March 2002 and 31 August 2004.
  
  
  METHODS
  Confirmed invasive group A streptococcal disease.
  
  
  RESULTS
  We identified 333 confirmed cases: an average annual incidence rate of 2.7 (95% CI, 2.3-3.2) per 100,000 population per year. Rates were highest in people aged 65 years and older and those younger than 5 years. The case-fatality rate was 7.8%. Streptococcal toxic shock syndrome occurred in 48 patients (14.4%), with a case-fatality rate of 23%. Thirty cases of necrotising fasciitis were reported; five (17%) of these patients died. Type 1 (23%) was the most frequently identified emm sequence type in all age groups. All tested isolates were susceptible to penicillin and clindamycin. Two isolates (4%) were resistant to erythromycin.
  
  
  CONCLUSIONS
  The incidence of invasive group A streptococcal disease in temperate Australia is greater than previously appreciated and warrants greater public health attention, including its designation as a notifiable disease.
authors.affiliation: School of Population Health, Department of Paediatrics, University of Melbourne, Melbourne, VIC. k.ogrady@unimelb.edu.au
authors.forename: Kerry-Ann F
authors.initials: KA
authors.lastname: O'Grady
authors.forename: Loraine
authors.initials: L
authors.lastname: Kelpie
authors.forename: Ross M
authors.initials: RM
authors.lastname: Andrews
authors.forename: Nigel
authors.initials: N
authors.lastname: Curtis
authors.forename: Terence M
authors.initials: TM
authors.lastname: Nolan
authors.forename: Gowri
authors.initials: G
authors.lastname: Selvaraj
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Passmore
authors.forename: Frances
authors.initials: F
authors.lastname: Oppedisano
authors.forename: John A
authors.initials: JA
authors.lastname: Carnie
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Carapetis
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005194:Family Practice / Q000706:statistics & numerical data; D019115:Fasciitis, Necrotizing / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology / Q000401:mortality / Q000473:pathology; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007755:Laboratories, Hospital / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013290:Streptococcal Infections / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology / Q000401:mortality / Q000473:pathology; D013297:Streptococcus pyogenes / Q000235:genetics / Q000302:isolation & purification*; D014739:Victoria / Q000453:epidemiology