Epidemiology of invasive group a streptococcal infections in the United States, 2005-2012

George E. Nelson, Tracy Pondo, Karrie Ann Toews, Monica M. Farley, Mary Lou Lindegren, Ruth Lynfield, Deborah Aragon, Shelley M. Zansky, James P. Watt, Paul R. Cieslak, Kathy Angeles, Lee H. Harrison, Susan Petit, Bernard Beall, Chris A. Van Beneden

Research output: Contribution to journalReview articlepeer-review

144 Scopus citations


Background. 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. Methods. 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. Results. 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. Conclusions. The burden of invasive GAS infection in the United States remains substantial. Vaccines under development could have a considerable public health impact.

Original languageEnglish (US)
Pages (from-to)478-486
Number of pages9
JournalClinical Infectious Diseases
Issue number4
StatePublished - Aug 15 2016
Externally publishedYes


  • Epidemiology
  • Group a Streptococcus
  • Streptococcal toxic shock syndrome
  • Surveillance
  • Vaccine

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases


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