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Abstract

Invasive group A streptococcal infection has a 15% case fatality rate and a risk of secondary transmission. This retrospective study used two national data sources from England; enhanced surveillance (2009) and a case management system (2011–2013) to identify clusters of severe group A streptococcal disease. Twenty-four household pairs were identified. The median onset interval between cases was 2 days (range 0–28) with simultaneous onset in eight pairs. The attack rate during the 30 days after first exposure to a primary case was 4,520 per 100,000 person-years at risk (95% confidence interval (CI): 2,900–6,730) a 1,940 (95% CI: 1,240–2,880) fold elevation over the background incidence. The theoretical number needed to treat to prevent one secondary case using antibiotic prophylaxis was 271 overall (95% CI: 194–454), 50 for mother-neonate pairs (95% CI: 27–393) and 82 for couples aged 75 years and over (95% CI: 46–417). While a dramatically increased risk of infection was noted in all household contacts, increased risk was greatest for mother-neonate pairs and couples aged 75 and over, suggesting targeted prophylaxis could be considered. Offering prophylaxis is challenging due to the short time interval between cases emphasising the importance of immediate notification and assessment of contacts.

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/content/10.2807/1560-7917.ES.2017.22.19.30532
2017-05-11
2024-10-13
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2017.22.19.30532
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References

  1. World Health Organization (WHO). The current evidence for the burden of group a streptococcal diseases. Geneva: WHO; 2005; Available from: http://apps.who.int/iris/bitstream/10665/69063/1/WHO_FCH_CAH_05.07.pdf?ua=1
  2. Davies HD, McGeer A, Schwartz B, Green K, Cann D, Simor AE, et al. Invasive group A streptococcal infections in Ontario, Canada. N Engl J Med. 1996;335(8):547-54.  https://doi.org/10.1056/NEJM199608223350803  PMID: 8684408 
  3. Lamagni TL, Neal S, Keshishian C, Alhaddad N, George R, Duckworth G, et al. Severe Streptococcus pyogenes infections, United Kingdom, 2003-2004. Emerg Infect Dis. 2008;14(2):202-9.  https://doi.org/10.3201/eid1402.070888  PMID: 18258111 
  4. Carapetis JR, Jacoby P, Carville K, Ang SJ, Curtis N, Andrews R. Effectiveness of clindamycin and intravenous immunoglobulin, and risk of disease in contacts, in invasive group a streptococcal infections. Clin Infect Dis. 2014;59(3):358-65.  https://doi.org/10.1093/cid/ciu304  PMID: 24785239 
  5. Lamagni TL, Oliver I, Stuart JM. Global assessment of invasive group a streptococcus infection risk in household contacts. Clin Infect Dis. 2015;60(1):166-7.  https://doi.org/10.1093/cid/ciu752  PMID: 25258351 
  6. Robinson KA, Rothrock G, Phan Q, Sayler B, Stefonek K, Van Beneden C, et al. Risk for severe group A streptococcal disease among patients’ household contacts. Emerg Infect Dis. 2003;9(4):443-7.  https://doi.org/10.3201/eid0904.020369  PMID: 12702224 
  7. Health Protection Agency, Group A Streptococcus Working Group. Interim UK guidelines for management of close community contacts of invasive group A streptococcal disease. Commun Dis Public Health. 2004;7(4):354-61. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/344610/Interim_guidelines_for_management_of_close_contacts_of_iGAS.pdf PMID: 15786581 
  8. Health Protection Surveillance Centre (HPSC). The Managment of Invasive Group A Streptococcal Infections in Ireland. Invasive group A streptococcus Sub-Committee 2006. Dublin: HPSC; 2006. Available from: https://www.hpsc.ie/A-Z/Other/GroupAStreptococcalDiseaseGAS/Publications/File,2080,en.pdf
  9. Conseil Supérieur d'Hygiène Publique de France (CSHPF). Section des Maladies Transmissibles. Avis relatif à la conduite à tenir autour d'un ou de plusieurs cas, d'origine communautaire, d'infections invasives à Streptococcus pyogenes (ou streptocoques du groupe A) séance du 18 Novembre 2005. [Opinion on how to behave around one or more cases of Community origin of invasive Streptococcus pyogenes (or group A streptococci) meeting of 18 November 2005]. Paris: CSHPF; 18 Nov 2005. French. Available from: http://www.hcsp.fr/Explore.cgi/Telecharger?NomFichier=a_mt_181105_streptococcus.pdf
  10. Prevention of Invasive Group A Streptococcal Infections Workshop Participants. Prevention of invasive group A streptococcal disease among household contacts of case patients and among postpartum and postsurgical patients: recommendations from the Centers for Disease Control and Prevention. Clin Infect Dis. 2002;35(8):950-9.  https://doi.org/10.1086/342692  PMID: 12355382 
  11. Public Health Agency of Canada. Guidelines for the prevention and control of invasive group A streptococcal infections. Can Commun Dis Rep. 2006;32:1-26. Available from: http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/06vol32/32s2/index-eng.php
  12. Health Protection Agency (HPA). Enhanced surveillance initiated for group A streptococcal infections. Health Protection Report; London: HPA. 2009;3(8). Available from: http://webarchive.nationalarchives.gov.uk/20140714084352/http://www.hpa.org.uk/hpr/archives/2009/news0809.htm#enhancd
  13. Her Majesty’s Stationery Office (HMSO). Health Protection (Notification) Regulations 2010. London: HMSO; 2010. Available from: http://www.legislation.gov.uk/uksi/2010/659/pdfs/uksi_20100659_en.pdf
  14. Facklam R, Beall B, Efstratiou A, Fischetti V, Johnson D, Kaplan E, et al. emm typing and validation of provisional M types for group A streptococci. Emerg Infect Dis. 1999;5(2):247-53.  https://doi.org/10.3201/eid0502.990209  https://doi.org/10.3201/eid0502.990209  PMID: 10221877 
  15. Beall B, Facklam R, Thompson T. Sequencing emm-specific PCR products for routine and accurate typing of group A streptococci. J Clin Microbiol. 1996;34(4):953-8. PMID: 8815115 
  16. Office for National Statistics (ONS). Dataset: Families and Households. Release date: 4 Nov 2016; London: ONS. Available from: http://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/families/datasets/familiesandhouseholdsfamiliesandhouseholds.
  17. Daly LE. Confidence limits made easy: interval estimation using a substitution method. Am J Epidemiol. 1998;147(8):783-90.  https://doi.org/10.1093/oxfordjournals.aje.a009523  PMID: 9554420 
  18. Steer AC, Lamagni T, Curtis N, Carapetis JR. Invasive group a streptococcal disease: epidemiology, pathogenesis and management. Drugs. 2012;72(9):1213-27.  https://doi.org/10.2165/11634180-000000000-00000  PMID: 22686614 
  19. A household cluster of fulminant group A streptococcus pneumonia associated with toxic shock syndrome-Quebec. Can Commun Dis Rep. 1996;22(6):41-3. PMID: 8935389 
  20. Baba H, Iinuma Y, Imaizumi K, Hasegawa Y, Hasegawa T, Ohta M, et al. Transmission of bacterial infections to healthcare workers during intubation and respiratory care of patients with severe pneumonia. Infect Control Hosp Epidemiol. 2009;30(10):1019-21.  https://doi.org/10.1086/606043  PMID: 19719413 
  21. Lacy MD, Horn K. Nosocomial transmission of invasive group a streptococcus from patient to health care worker. Clin Infect Dis. 2009;49(3):354-7.  https://doi.org/10.1086/599832  PMID: 19580415 
  22. Roy S, Kaplan EL, Rodriguez B, Schreiber JR, Salata RA, Palavecino E, et al. A family cluster of five cases of group A streptococcal pneumonia. Pediatrics. 2003;112(1 Pt 1):e61-5.  https://doi.org/10.1542/peds.112.1.e61  PMID: 12837907 
  23. Turner CE, Dryden M, Holden MT, Davies FJ, Lawrenson RA, Farzaneh L, et al. Molecular analysis of an outbreak of lethal postpartum sepsis caused by Streptococcus pyogenes. J Clin Microbiol. 2013;51(7):2089-95.  https://doi.org/10.1128/JCM.00679-13  PMID: 23616448 
  24. European Centre for Disease Prevention and Control (ECDC). Public health management of sporadic cases of invasive meningococcal disease and their contacts. Stockholm: ECDC; Oct 2010. Available from: http://ecdc.europa.eu/en/publications/Publications/1010_GUI_Meningococcal_guidance.pdf.
  25. World Health Organization (WHO). Control of epidemic meningococcal disease. WHO practical guidelines 2nd edition. Geneva: WHO; [Accessed Nov 2016]. Available from: http://www.who.int/csr/resources/publications/meningitis/whoemcbac983.pdf.
  26. Ladhani SN, Flood JS, Ramsay ME, Campbell H, Gray SJ, Kaczmarski EB, et al. Invasive meningococcal disease in England and Wales: implications for the introduction of new vaccines. Vaccine. 2012;30(24):3710-6.  https://doi.org/10.1016/j.vaccine.2012.03.011  PMID: 22429756 
  27. Howard SJ, Stoker K, Foster K. Public health management of group A streptococcal infection in mother-baby pairs in England; a case series review. Antimicrob Resist Infect Control. 2015;4(Suppl 1):107.  https://doi.org/10.1186/2047-2994-4-S1-P107  https://doi.org/10.1186/2047-2994-4-S1-P107 
  28. Darenberg J, Henriques-Normark B, Lepp T, Tegmark-Wisell K, Tegnell A, Widgren K. Increased incidence of invasive group A streptococcal infections in Sweden, January 2012-February 2013. Euro Surveill. 2013;18(14):20443.  https://doi.org/10.2807/1560-7917.ES2013.18.14.20443  PMID: 23594518 
  29. O’Loughlin RE, Roberson A, Cieslak PR, Lynfield R, Gershman K, Craig A, et al. , Active Bacterial Core Surveillance Team. The epidemiology of invasive group A streptococcal infection and potential vaccine implications: United States, 2000-2004. Clin Infect Dis. 2007;45(7):853-62.  https://doi.org/10.1086/521264  PMID: 17806049 
  30. Keramarou M, Evans MR. Completeness of infectious disease notification in the United Kingdom: A systematic review. J Infect. 2012;64(6):555-64.  https://doi.org/10.1016/j.jinf.2012.03.005  PMID: 22414684 
  31. Bundle N, Bubba L, Coelho J, Kwiatkowska R, Cloke R, King S, et al. Ongoing outbreak of invasive and non-invasive disease due to group A Streptococcus (GAS) type emm66 among homeless and people who inject drugs in England and Wales, January to December 2016. Euro Surveill. 2017;22(3):30446.  https://doi.org/10.2807/1560-7917.ES.2017.22.3.30446  PMID: 28128090 
  32. Al-Shahib A, Underwood A, Afshar B, Turner CE, Lamagni T, Sriskandan S, et al. Emergence of a novel lineage containing a prophage in emm/M3 group A Streptococcus associated with upsurge in invasive disease in the UK. Microb Genom. 2016;2(6):e000059.  https://doi.org/10.1099/mgen.0.000059  PMID: 28348855 
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