An Outbreak of Invasive Group A Streptococcal Infections in Injection Drug Users

Gittzus, Jennifer; White, Josh C.; Caine, Lynda; Hansen, Katrina; Chan, Benjamin; Bowen, Hannah; Metcalf, Erin; Pierce, Lindsay; Kusch, Rachel; Benton, Christopher B.; Gao, Fenxiang; Talbot, Elizabeth A.; Noble, James M.

doi:10.1093/ofid/ofx163.511

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“…Risk factor data for iGAS in the First Nations population in our study frequently indicated nonsurgical wounds, addiction abuse (of which alcohol use and drug use are subsets), and homelessness. Other studies have noted high rates of GAS skin infections (e.g., cellulitis and abscesses) among persons who were experiencing homelessness and injected drugs ( 22 – 24 ). Recently, work by the Active Bacterial Core surveillance program in the United States showed that skin infections and skin breakdown were common among iGAS patients who were injection drug users or experiencing homelessness ( 25 ).…”

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

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Increasing Incidence of Invasive Group A Streptococcus Disease in First Nations Population, Alberta, Canada, 2003–2017

Tyrrell¹,

Bell²,

Bill³

et al. 2021

Emerg. Infect. Dis.

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G AS disease is caused by the gram-positive coccus bacterium Streptococcus pyogenes; invasive GAS (iGAS) disease is typically defined as identification of GAS from any sterile site, including blood, cerebrospinal fluid, brain, and deep tissues. GAS affects persons worldwide and causes a wide array of diseases including pharyngitis, skin infections (e.g., impetigo and cellulitis), bacteremia, pneumonia, septic arthritis, rheumatic fever, rheumatic heart disease, and the severe invasive diseases necrotizing fasciitis and streptococcal toxic shock syndrome (1,2). The epidemiology of many of these diseases varies by region; pharyngitis is more common in high-income countries, and diseases such as impetigo are more common in tropical climates and low-income countries (3,4). In 2005, the mortality rate associated with GAS disease (noninvasive and invasive) was ≈500,000 deaths/year (2). GAS bacteria can be typed by identifying variability in the DNA sequence at the tip of a coiled-coil protein on the bacteria's surface (the M protein), which is encoded by the emm gene. Worldwide, there are >240 emm types (5,6). Prevalence of emm types varies according to population and geography (7). In addition, the diversity of emm types is greater in developing countries and less in more developed countries (8-10). Previous studies have shown that rates of iGAS disease are higher for indigenous populations than for other populations (11-15). Examples include Native Americans in Arizona and Alaska and indigenous communities in parts of Australia and northwestern Ontario, Canada. For parts of the country such as western Canada, detailed descriptive data on iGAS in the indigenous population are lacking. We previously reported increased age-standardized rates of iGAS in Alberta's general population and increasing incidence from a low of 4.2 cases/100,000 persons in 2003 to a high of 10.2 cases/100,000 persons in 2017 (16). On the basis of that finding, we explored whether iGAS rates also increased for the First Nations population of Alberta during the same period. Methods Case and Population Data All iGAS cases were identified by diagnostic microbiology laboratories in Alberta, where iGAS disease is listed as a Public Health Notifiable Disease (https:// open.alberta.ca/publications/streptococcal-disease

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Increasing Incidence of Invasive Group A Streptococcus Disease in First Nations Population, Alberta, Canada, 2003–2017

Tyrrell¹,

Bell²,

Bill³

et al. 2021

Emerg. Infect. Dis.

View full text Add to dashboard Cite

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Invasive Group A Streptococcal Infections Among People Who Inject Drugs and People Experiencing Homelessness in the United States, 2010–2017

Valenciano

Onukwube

Spiller

et al. 2020

Clinical Infectious Diseases

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Background Reported outbreaks of invasive group A Streptococcus (iGAS) infections among people who inject drugs (PWID) and people experiencing homelessness (PEH) have increased, concurrent with rising U.S. iGAS rates. We describe epidemiology among iGAS patients with these risk factors. Methods We analyzed iGAS infections from population-based Active Bacterial Core surveillance (ABCs) at 10 U.S. sites from 2010–2017. Cases were defined as GAS isolated from a normally sterile site or from a wound in patients with necrotizing fasciitis or streptococcal toxic shock syndrome. GAS isolates were emm typed. We categorized iGAS patients into four categories: injection drug use (IDU) only, homelessness only, both, and neither. We calculated annual change in prevalence of these risk factors using log binomial regression models. We estimated national iGAS infection rates among PWID and PEH. Results We identified 12,386 iGAS cases; IDU, homelessness, or both were documented in ~13%. Skin infections and acute skin breakdown were common among iGAS patients with documented IDU or homelessness. Endocarditis was ten-fold more frequent among iGAS patients with documented IDU only vs those with neither risk factor. Average percentage yearly increase in prevalence of IDU and homelessness among iGAS patients was 17.5% and 20.0%, respectively. iGAS infection rates among people with documented IDU or homelessness were ~14-fold and 17-80-fold higher, respectively, than among people without those risks. Conclusions IDU and homelessness likely contribute to increases in U.S. incidence of iGAS infections. Improving management of skin breakdown and early recognition of skin infection could prevent iGAS infections in these patients.

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An Outbreak of Invasive Group A Streptococcal Infections in Injection Drug Users

Cited by 2 publications

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Increasing Incidence of Invasive Group A Streptococcus Disease in First Nations Population, Alberta, Canada, 2003–2017

Increasing Incidence of Invasive Group A Streptococcus Disease in First Nations Population, Alberta, Canada, 2003–2017

Invasive Group A Streptococcal Infections Among People Who Inject Drugs and People Experiencing Homelessness in the United States, 2010–2017

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