Outbreak of Invasive Infections From Subtype emm26.3 Group A Streptococcus Among Homeless Adults—Anchorage, Alaska, 2016–2017

Mosites, Emily; Frick, Anna; Gounder, Prabhu; Castrodale, Louisa; Li, Yuan; Rudolph, Karen; Hurlburt, Debby; Lecy, Kristen D; Zulz, Tammy; Adebanjo, Tolu; Onukwube, Jennifer; Beall, Bernard; Beneden, Chris Van; Hennessy, Thomas W.; McLaughlin, Joseph; Bruce, Michael G.

doi:10.1093/cid/cix921

Cited by 33 publications

(50 citation statements)

References 24 publications

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“…However, while strain genetics is expected to play a role in the observed overabundance of skin and soft tissue infections among homeless patients, it is unlikely to be the only factor. For example, a recent outbreak among the homeless population in Alaska that was also characterized by a high incidence of soft tissue infections was caused by emm26 GAS strains (ie, a pattern A-C emm type with throat tropism) [12]. Thus, the poor environmental and hygienic conditions commonly associated with homelessness and homeless shelters (crowding, poor sanitation, frequent skin breakdown), the weak immune response to GAS in the skin [39], and/or the underlying alcohol and intravenous drug use are undoubtedly major contributors to the overabundance of soft tissue infections among homeless patients.…”

Section: Discussionmentioning

confidence: 99%

Canada-Wide Epidemic of emm74 Group A Streptococcus Invasive Disease

Teatero

McGeer

Tyrrell

et al. 2018

Open Forum Infectious Diseases

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BackgroundThe number of invasive group A Streptococcus (iGAS) infections due to hitherto extremely rare type emm74 strains has increased in several Canadian provinces since late 2015. We hypothesized that the cases recorded in the different provinces are linked and caused by strains of an emm74 clone that recently emerged and expanded explosively.MethodsWe analyzed both active and passive surveillance data for iGAS infections and used whole-genome sequencing to investigate the phylogenetic relationships of the emm74 strains responsible for these invasive infections country-wide.ResultsGenome analysis showed that highly clonal emm74 strains, genetically different from emm74 organisms previously circulating in Canada, were responsible for a country-wide epidemic of >160 invasive disease cases. The emerging clone belonged to multilocus sequence typing ST120. The analysis also revealed dissemination patterns of emm74 subclonal lineages across Canadian provinces. Clinical data analysis indicated that the emm74 epidemic disproportionally affected middle-aged or older male individuals. Homelessness, alcohol abuse, and intravenous drug usage were significantly associated with invasive emm74 infections.ConclusionsIn a period of 20 months, an emm74 GAS clone emerged and rapidly spread across several Canadian provinces located more than 4500 km apart, causing invasive infections primarily among disadvantaged persons.

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Section: Discussionmentioning

confidence: 99%

Canada-Wide Epidemic of emm74 Group A Streptococcus Invasive Disease

Teatero

McGeer

Tyrrell

et al. 2018

Open Forum Infectious Diseases

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“…However, recent outbreaks of both noninvasive and invasive GAS disease have been reported in community settings, often in marginalized populations. For example, there have been reports of GAS outbreaks in a homeless shelter in Toronto, Ontario (18), a homeless population in Alaska, United States (US) (19), persons who use drugs (PWUD) in England and Wales (20), and a population with a high prevalence of PWUD, alcohol abuse and homelessness in Thunder Bay, Ontario (21).…”

Section: The Public Health Agency Of Canada's 2006 Guidelines For Thementioning

confidence: 99%

Community outbreak of invasive group A streptococcus infection in Ontario, Canada

Dickson¹,

Pham²,

Nguyen³

et al. 2018

CCDR

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Background: Outbreaks of invasive group A streptococcal infection (iGAS) have historically occurred in institutional settings. Increasingly, community-based outbreaks have been reported, often among marginalized populations, yet few guidelines exist for managing iGAS outbreaks in such settings. Objective: To describe the ongoing outbreak of iGAS in Middlesex-London, Ontario, and the challenges that arose while applying current guidelines to a marginalized population in a community setting. Methods: The outbreak investigation included all iGAS cases in Middlesex-London with an onset date from April 1, 2016 to February 28, 2018. Clinical specimens were submitted to provincial and federal laboratories for typing. Public health management of the outbreak involved environmental health inspections, contact tracing, chemoprophylaxis of close contacts, swabbing to determine colonization rates of Streptococcus pyogenes, and communicating with stakeholders and the public. Results: A total of 156 confirmed cases of iGAS corresponding to 147 individuals were reported in less than two years. More than 60% of cases occurred in men (n=91) and almost half (n=71) of the total number of cases were persons who used drugs (PWUD) and/or were under-housed. Of the PWUD cases, 58 of 65 (89%) used injection drugs. Key challenges in controlling this outbreak included reaching PWUD and under-housed people; completing a case history and contact list; facilitating completion of treatment; dealing with concurrent infections such as human immunodeficiency virus (HIV) and hepatitis C virus (HCV); and optimizing environmental health conditions. Guidelines were adapted so contacts who shared drugs or injection drug equipment with a known iGAS case would be offered chemoprophylaxis regardless of the clinical severity of the case. To optimize treatment completion, a single-dose of azithromycin for individuals in close contact with PWUD and/or under-housed cases was given. Cases with macrolide-resistant strain emm9 have recently emerged. Conclusion: The application of institution-based guidelines for iGAS outbreaks has been ineffective in controlling this particular community outbreak. There is a need for guidelines on managing outbreaks of iGAS in the community especially when an outbreak involves marginalized populations.

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“…Cependant, les récentes éclosions d'infection au SGA, qu'elles soient invasives ou non, ont été signalées en milieu communautaire, souvent auprès de populations marginalisées. Par exemple, des éclosions de SGA ont été signées dans un refuge pour sans-abris de Toronto, en Ontario (18), dans une population de sans-abris de l'Alaska, aux États-Unis (19) Les lignes directrices canadiennes pour les éclosions d'iSGA en établissement comprennent une analyse rétrospective des dossiers, le recensement des personnes qui ont des contacts étroits avec les cas ciblés, la sensibilisation de ces personnes aux symptômes, l'application stricte des normes de pratique de lutte contre les infections ainsi qu'une chimioprophylaxie de 10 jours pour les personnes qui ont des contacts étroits avec un cas grave confirmé (15). Cependant, ces lignes directrices sont difficiles à mettre en oeuvre auprès des populations marginalisées.…”

Section: Contexteunclassified

“…Ce programme requiert un traitement d'une durée de 10 jours, ce qui peut être difficile à accomplir pour les personnes toxicomanes ou mal logées. Afin de contrôler une éclosion d'iSGA dans six centres pour sans-abris à Anchorage, en Alaska, les autorités de la santé publique ont offert un programme à dose unique (l'azithromycine) à la clientèle, au personnel et aux bénévoles (19). Au Canada, l'azithromycine n'est pas recommandée en traitement de première ou de deuxième ligne, car les données probantes démontrent qu'elle peut être sélectionnée plus fortement pour la résistance aux macrolides comparativement à l'érythromycine ou à la clarithromycine (15,27).…”

Section: éValuation Du Facteur De Risqueunclassified

Éclosion communautaire d'une infection invasive à streptocoque du groupe A en Ontario, Canada

Dickson¹,

Pham²,

Nguyen³

et al. 2018

RMTC

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Outbreak of Invasive Infections From Subtype emm26.3 Group A Streptococcus Among Homeless Adults—Anchorage, Alaska, 2016–2017

Abstract: In an invasive GAS outbreak in PEH in Anchorage, mass antibiotic administration was temporally associated with reduced invasive disease cases and colonization prevalence.

Cited by 33 publications

References 24 publications

Canada-Wide Epidemic of emm74 Group A Streptococcus Invasive Disease

Canada-Wide Epidemic of emm74 Group A Streptococcus Invasive Disease

Community outbreak of invasive group A streptococcus infection in Ontario, Canada

Éclosion communautaire d'une infection invasive à streptocoque du groupe A en Ontario, Canada

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