The epidemiology of invasive group a streptococcal infection and potential vaccine implications: United States, 2000-2004
The epidemiology of invasive group a streptococcal infection and potential vaccine implications: United States, 2000-2004
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DOI：
10.1086/521264
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发表时间：
2007-10-01
影响因子：
11.8
通讯作者：
Van Beneden, Chris
中科院分区：
文献类型：
--
作者：
O'Loughlin, Rosalyn E.;Roberson, Angela;Van Beneden, Chris
背景。侵袭性A群链球菌（GAS）感染在美国引起显著的发病率和死亡率。我们报告了侵袭性GAS感染的当前流行病学特征，并估计了多价GAS疫苗的潜在影响。从2000年1月到2004年12月，我们从疾病控制和预防中心的活性细菌核心监测（abc）收集数据，这是一个基于人口的系统，在美国10个站点运行（2004年人口，2970万）。我们将侵袭性气体疾病定义为从正常无菌部位或从监测区域居民的坏死性筋膜炎或链球菌中毒性休克综合征患者的伤口标本中分离出气体。所有分离株均为emm型。我们使用美国人口普查数据来计算比率，并进行年龄和种族调整后的全国预测。我们发现5400例侵袭性GAS感染（每10万人中有3.5例），其中735例死亡（病死率13.7%）。链球菌中毒性休克综合征和坏死性筋膜炎的病死率分别为36%和24%。发病率在老年人（每10万人9.4例）、婴儿（每10万人5.3例）和黑人（每10万人4.7例）中最高，并且随着时间的推移保持稳定。我们估计，美国每年发生8950- 11500例侵袭性GAS感染，导致1050 - 1850例死亡。拟议的26价疫苗中的emm类型占所有病例和死亡的79%。与死亡相关的独立因素包括年龄增长；患有链球菌中毒性休克综合征、脑膜炎、坏死性筋膜炎、肺炎或菌血症；且emm类型为1、3或12。在美国，气体仍然是严重疾病的一个重要原因。采用疫苗可大大降低这些感染造成的发病率和死亡率。
Background. Invasive group A Streptococcus ( GAS) infection causes significant morbidity and mortality in the United States. We report the current epidemiologic characteristics of invasive GAS infections and estimate the potential impact of a multivalent GAS vaccine.Methods. From January 2000 through December 2004, we collected data from Centers for Disease Control and Prevention's Active Bacterial Core surveillance (ABCs), a population-based system operating at 10 US sites ( 2004 population, 29.7 million). We defined a case of invasive GAS disease as isolation of GAS from a normally sterile site or from a wound specimen obtained from a patient with necrotizing fasciitis or streptococcal toxic shock syndrome in a surveillance area resident. All available isolates were emm typed. We used US census data to calculate rates and to make age- and race-adjusted national projections.Results. We identified 5400 cases of invasive GAS infection (3.5 cases per 100,000 persons), with 735 deaths ( case-fatality rate, 13.7%). Case-fatality rates for streptococcal toxic shock syndrome and necrotizing fasciitis were 36% and 24%, respectively. Incidences were highest among elderly persons (9.4 cases per 100,000 persons), infants (5.3 cases per 100,000 persons), and black persons (4.7 cases per 100,000 persons) and were stable over time. We estimate that 8950-11,500 cases of invasive GAS infection occur in the United States annually, resulting in 1050 1850 deaths. The emm types in a proposed 26-valent vaccine accounted for 79% of all cases and deaths. Independent factors associated with death include increasing age; having streptococcal toxic shock syndrome, meningitis, necrotizing fasciitis, pneumonia, or bacteremia; and having emm types 1, 3, or 12.Conclusions. GAS remains an important cause of severe disease in the United States. The introduction of a vaccine could significantly reduce morbidity and mortality due to these infections.