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Results from the first 6 months of enhanced surveillance of severe Streptococcus pyogenes disease in England and Wales

Abstract number: 10.1111/j.1198-743X.2004.902_o199.x

Lamagni T.

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Objectives:

Analyses from the first 6 months of enhanced surveillance of severe S. pyogenes infections in England and Wales, part of the EU FP-5 funded ‘strep-EURO’ programme, were undertaken to determine the burden, clinical presentation and risk factors for disease, and microbiological characteristics of strains.

Methods:

Two sources were used to identify cases: routine surveillance of microbiologically-confirmed S. pyogenes infection reported to the Communicable Disease Surveillance Centre; isolate referral to the national Streptococcus & Diphtheria Reference Unit. Reconciled data from both systems were analysed and described.

Results:

A total of 1055 confirmed cases of severe S. pyogenes disease were received between 1 January and 30 June 2003, a 6-monthly incidence of 2.01/100 000 population. Of these, 51% were in men, 10% in children (<15 years) and 31% in young adults (15–44 years). Eighty-nine per cent (942) had positive blood cultures, with 10% (105) diagnosed from other sterile sites. In eight cases, sterile site isolates were not reported, but because of their severe and characteristic disease presentation met the case definition. Serotyping results indicated M3 to be the most common type. Analysis of survey questionnaires entered to date indicated that 93% (433 of 455) of cases presented with bacteraemia, 8% (35) with streptococcal toxic shock syndrome, 9% (39) with septic arthritis, 6% (27) with pneumonia, 5% (21) with necrotising fasciitis, 3% (12) with puerperal sepsis and 1% (6) with meningitis. Twenty-one per cent of cases were admitted to intensive care units. Of cases whose outcome was reported (86%), over one-fifth (22%; 88 of 393) had died within 7 days of the microbiological diagnosis. Only in 2% of these was the infection not thought to have contributed to the patient's death, the majority (80%) being directly attributed to the S. pyogenes infection. In 22% (97 of 436) of cases, no predisposing risk factors were identified. Of the remainder, injecting drug use was the most common (21%; 91 of 436).

Conclusion:

Preliminary results from enhanced surveillance suggest the incidence of severe S. pyogenes disease in England and Wales to be considerably higher than previously estimated. Injecting drug use appears to have become a major risk factor for severe S. pyogenes disease. Early results affirm the high and rapid mortality associated with these diseases, one-fifth of cases having died within 7 days of initial diagnosis.

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Session Details

Date: 01/08/2007
Time: 00:00-00:00
Session name: XXIst ISTH Congress
Subject:
Location: Oxford, UK
Presentation type:
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