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Group A streptococcus-associated upper respiratory tract infections in a day-care center
T D Smith1, V Wilkinson, E L Kaplan
1Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN 55455.
Insights
Group A Streptococcus upper respiratory infections are common in day-care centers, affecting 36% of children and 8% of staff during a survey. Rapid antigen tests showed lower sensitivity for detecting these infections.
Area of Science:
- Pediatric Infectious Diseases
- Epidemiology
- Microbiology
Background:
- Group A Streptococcus (GAS) is a common cause of upper respiratory tract infections.
- Day-care centers are environments where infectious diseases can spread rapidly among young children and staff.
- Limited epidemiological data exists on GAS upper respiratory tract infections specifically within child day-care settings.
Purpose of the Study:
- To investigate the prevalence and epidemiology of group A streptococcal upper respiratory tract infections in a child day-care center.
- To assess the performance of rapid antigen detection tests compared to throat cultures for GAS in this setting.
- To identify common GAS serotypes circulating in the day-care population.
Main Methods:
- A cross-sectional survey was conducted in a child day-care center.
- Throat cultures were used to identify group A Streptococcus.
- Rapid antigen detection tests were performed concurrently with throat cultures in a subset of participants.
- GAS isolates were serotyped.
Main Results:
- During an initial 3-month period, 26% of children and staff experienced symptomatic GAS upper respiratory tract infections.
- A subsequent survey found 36% of children and 8% of adult staff had positive throat cultures for GAS.
- The most common serotypes identified were M2,T2/28 (35%), M3,T3/13 (30%), and M-NT, T25 (20%).
- Rapid antigen detection tests demonstrated a sensitivity of 35% compared to throat cultures.
Conclusions:
- Group A Streptococcus is highly prevalent in child day-care centers, indicating it is a significant upper respiratory pathogen in this environment.
- The prevalence rate of GAS infections in day-care settings is higher than previously reported.
- Rapid antigen detection tests may have limitations in accurately diagnosing GAS infections in day-care populations due to variable sensitivity.
Abstract:
Little information is available about the epidemiology of group A streptococcal upper respiratory tract infections in child day-care centers. During an initial 3-month period, symptomatic upper respiratory tract infections associated with throat cultures or rapid antigen detection tests positive for group A streptococci developed in 55 of 214 (26%) children and adult staff in one day-care center. When the entire day-care center population (except for those receiving antibiotics at the time) was then surveyed, 52 of 146 (36%) children and two of 24 (8%) adult staff had throat cultures positive for group A streptococci. Of the 54 group A streptococcal isolates found during the survey, the three most frequently encountered serotypes were M2,T2/28 (35%), M3,T3/13 (30%), and M-NT, T25 (20%). Rapid antigen detection was performed at the same time as the throat culture in the first 98 individuals examined during the culture survey but was positive in only 11 (35%) of 31 individuals with positive throat cultures. Sensitivity of the rapid antigen test was related to degree of positivity of the throat culture but not to age. The overall group A streptococcal positivity rate was 49% for 187 children and 33% for 27 adult staff; 18 of 66 (27%) children younger than 31/2 years of age were found to have group A streptococci in their upper respiratory tracts. This is the first report of high prevalence rates of group A streptococci associated with upper respiratory tract infections in a day-care center. The group A Streptococcus may represent a significant upper respiratory tract pathogen in the day-care setting.