PREVENTION OF INVASIVE GROUP-A STREPTOCOCCAL DISEASE AMONG HOUSEHOLD CONTACTS OF CASE-PATIENTS - IS PROPHYLAXIS WARRANTED

Objectives.-The Centers for Disease Control and Prevention (CDC) conve ned a Working Group in October 1995 to summarize the data regarding th e risk of invasive group A streptococcal (GAS) disease among household contacts of an index patient and the potential efficacy of chemoproph ylaxis. This statement on chemoprophylaxis for prevention of subsequen t cases among household contacts is intended for use by public health professionals and clinicians. Participants.-The CDC invited representa tives of the American Academy of Pediatrics, the Council of State and Territorial Epidemiologists, the Hospital Infection Control Practice A dvisory Committee, the Infectious Diseases Society of America, and exp erts from academia to participate. Evidence.-Data on the transmission of GAS and risk factors for severe infection were considered. Populati on-based surveillance data were used to estimate the risk of invasive GAS disease among household contacts of a case patient. The potential efficacy of chemoprophylaxis was considered using estimates of the eff icacy of various regimens in eradicating pharyngeal carriage. Consensu s Process.-This document summarizes the data considered by the Working Group to develop its position. The consensus achieved by group discus sion at the meeting was incorporated in a draft document, which was re viewed by all members and revised to include suggested changes. Conclu sions.-The Working Group concluded that no definite recommendations ca n be made at this time regarding chemoprophylaxis for household contac ts of persons with invasive GAS infection. More data are needed to ass ess the risk of subsequent cases and to determine an optimal regimen f or chemoprophylaxis. Until such data are available, physicians and hea lth departments should base decisions regarding chemoprophylaxis on th eir assessment of the risk associated with each individual case.