Epidemiology of Invasive Group A Streptococcal Infections in the United States, 2005-2012.
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.



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.



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.



The burden of invasive GAS infection in the United States remains substantial. Vaccines under development could have a considerable public health impact.
Epidemic Intelligence Service National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention Vanderbilt University, Nashville, Tennessee.
George E
GE
Nelson
National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention.
Tracy
T
Pondo
National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention.
Karrie-Ann
KA
Toews
Emory University School of Medicine and the VA Medical Center, Atlanta, Georgia.
Monica M
MM
Farley
Vanderbilt University, Nashville, Tennessee.
Mary Lou
ML
Lindegren
Minnesota Department of Health, St Paul.
Ruth
R
Lynfield
Colorado Department of Public Health and Environment, Denver.
Deborah
D
Aragon
New York State Department of Health, Albany.
Shelley M
SM
Zansky
California Department of Public Health, Richmond.
James P
JP
Watt
Oregon Health Authority, Portland.
Paul R
PR
Cieslak
New Mexico Emerging Infections Program, University of New Mexico, Las Cruces.
Kathy
K
Angeles
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Lee H
LH
Harrison
Connecticut Department of Public Health, Hartford.
Susan
S
Petit
National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention.
Bernard
B
Beall
National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention.
Chris A
CA
Van Beneden
D000293:Adolescent; D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology; D002487:Centers for Disease Control and Prevention, U.S.; D062665:Epidemiological Monitoring; D019115:Fasciitis, Necrotizing / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D012772:Shock, Septic / Q000453:epidemiology* / Q000382:microbiology; D013290:Streptococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D013297:Streptococcus pyogenes / Q000145:classification* / Q000302:isolation & purification; D014481:United States / Q000453:epidemiology; D055815:Young Adult
epidemiology; group A Streptococcus; streptococcal toxic shock syndrome; surveillance; vaccine