Ca. Zurawski et al., INVASIVE GROUP-A STREPTOCOCCAL DISEASE IN METROPOLITAN ATLANTA - A POPULATION-BASED ASSESSMENT, Clinical infectious diseases, 27(1), 1998, pp. 150-157
Active, population-based surveillance for invasive group A streptococc
al (GAS) disease was conducted in laboratories in metropolitan Atlanta
from 1 January 1994 through 30 June 1995. Clinical and laboratory rec
ords were reviewed and isolates characterized. One hundred and eighty-
three cases of invasive GAS disease were identified (annual incidence,
5.2 cases/100,000). The incidence was highest among blacks (9.7/100,0
00 per year; relative risk (RR), 1.92; confidence interval (CI), 1.69-
2.19; P <.0001) and the elderly, particularly nursing home residents (
RR, 13.66; CI, 7.07-26.40; P <.0001). The mean age of patients was 41.
3 years (range, 0-95 years). Skin and soft-tissue infections were most
common. Mortality was 14.4%; risk of death was significantly higher f
or patients with streptococcal toxic shock syndrome (STSS) (RR, 9.73;
CI, 3.34-29; P =.0008) and individuals infected with M-type 1 (RR, 7.4
0; CI, 1.5-16; P =.0084). Fourteen percent of invasive GAS infections
were STSS and 3% were necrotizing fasciitis. Invasive GAS disease was
associated with varicella infection in children (RR, 12.19; CI, 5.58-2
6.62; P <.0001). M (or emm) types included hll (16%), M12 (12%), and M
3 (11%). Continued study of GAS disease is essential to further define
risk factors and the risk of secondary cases and to develop effective
prevention strategies.