title: Epidemiology and emm types of invasive group A streptococcal infections in Finland, 2008-2013.
abstract: Invasive Streptococcus pyogenes (group A streptococcus, GAS) infections are a major global cause of morbidity and mortality. We analysed the surveillance data on invasive GAS and the microbiological characteristics of corresponding isolates to assess the incidence and emm type distribution of invasive GAS infections in Finland. Cases defined as patients with isolations of blood and cerebrospinal fluid S. pyogenes are mandatorily notified to the National Infectious Disease Registry and sent to the national reference laboratory for emm typing. Antimicrobial data were collected through the network including all clinical microbiology laboratories. Pulsed-field gel electrophoresis (PFGE) analysis was performed to assess clonality. In total, 1165 cases of invasive GAS were reported in Finland during 2008-2013; the median age was 52 years (range, 0-100) and 54% were male. The overall day 7 case fatality rate was 5.1% (59 cases). The average annual incidence was 3.6 cases per 100,000 population. A total of 1122 invasive GAS isolates (96%) were analysed by emm typing; 72 different emm types were identified, of which emm28 (297 isolates, 26%), emm89 (193 isolates, 12%) and emm1 (132 isolates, 12%) were the most common types. During 2008-2013, an increase of erythromycin resistance (1.9% to 8.7%) and clindamycin (0.9% to 9.2%) was observed. This resistance increase was in parallel with the introduction of a novel clone emm33 into Finland. The overall incidence of invasive GAS infections remained stable over the study period in Finland. We identified clonal spread of macrolide-resistant invasive emm33 GAS type, highlighting the importance of molecular surveillance.
authors: European Public Health Microbiology Training Programme (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden. pieterwsmit@gmail.com.|Department of Infectious Diseases, National Institute for Health and Welfare, Helsinki, Finland. pieterwsmit@gmail.com.
authors: P W
authors: http://orcid.org/0000-0003-1053-3591
authors: PW
authors: Smit
authors: Department of Infections, Bacterial Infections Unit, National Institute for Health and Welfare, Turku, Finland.
authors: L
authors: L
authors: Lindholm
authors: Department of Infections, Infectious Disease Control Unit, National Institute for Health and Welfare, Helsinki, Finland.
authors: O
authors: O
authors: Lyytikäinen
authors: Department of Infections, Bacterial Infections Unit, National Institute for Health and Welfare, Turku, Finland.
authors: J
authors: J
authors: Jalava
authors: Division of Clinical Microbiology, HUSLAB, Helsinki University Hospital, Helsinki, Finland.
authors: A
authors: A
authors: Pätäri-Sampo
authors: Department of Infections, Bacterial Infections Unit, National Institute for Health and Welfare, Turku, Finland.|Department of Medical Microbiology and Immunology, University of Turku, Turku, Finland.
authors: J
authors: J
authors: Vuopio
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000942:Antigens, Bacterial / Q000097:blood* / Q000134:cerebrospinal fluid*; D001425:Bacterial Outer Membrane Proteins / Q000097:blood* / Q000134:cerebrospinal fluid*; D002352:Carrier Proteins / Q000097:blood* / Q000134:cerebrospinal fluid*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D013290:Streptococcal Infections / Q000453:epidemiology*; D013297:Streptococcus pyogenes / Q000302:isolation & purification*; D055815:Young Adult
chemical_list: D000942:Antigens, Bacterial; D001425:Bacterial Outer Membrane Proteins; D002352:Carrier Proteins; C014689:streptococcal M protein