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Invasive group A streptococcus carriage in a child care centre after a fatal case
M M Engelgau1, C H Woernle, B Schwartz
1Epidemic Intelligence Service, Centers for Disease Control and Prevention, US Public Health Service, Department of Health and Human Services, Atlanta, Georgia.
Insights
Invasive group A streptococcal T-1 infections are a concern in childcare settings. Increased risk factors for carriage include sharing rooms and longer childcare hours, while antibiotic use may decrease risk.
Area of Science:
- Microbiology
- Epidemiology
- Public Health
Background:
- Invasive group A streptococcal (GAS) disease, particularly serotype T-1, poses a significant risk in childcare settings.
- Following a fatal case, a study was conducted to assess GAS T-1 prevalence and identify carriage risk factors.
Observation:
- Throat cultures were performed on 87% of children in a childcare center.
- Group A Streptococcus was isolated from 25% of children, with 76% of typed isolates being T-1.
- GAS T-1 was present in six out of nine rooms, indicating potential transmission.
Findings:
- The prevalence of GAS T-1 carriage was 18%.
- Risk factors for GAS T-1 carriage included sharing a room with an index case (OR=2.7) and increased weekly childcare hours (OR=1.03).
- Antibiotic use in the preceding four weeks was associated with a decreased risk of carriage (OR=0.2).
Implications:
- Childcare environments require targeted infection control strategies for invasive GAS T-1.
- Understanding transmission dynamics and risk factors is crucial for preventing outbreaks.
- Identified risk factors alone were insufficient to fully predict carriage of this invasive strain.
Abstract:
After a fatal case of invasive group A streptococcal disease, serotype T-1, in a child care centre, group A streptococcal T-1 prevalence was measured and risk factors for carriage were determined. A total of 87% (224/258) had throat culture tests. Group A streptococcus was isolated from 57 (25%), and of the 50 isolates serotyped, 38 (76%) were T-1. Group A streptococcal T-1 prevalence was 18% (38/217) and six of nine rooms had children with group A streptococcal T-1 isolates. The risk of group A streptococcal T-1 carriage was increased for children who shared the index case's room (odds ratio (OR) = 2.7; 95% confidence interval (CI) = 0.8 to 9.4) and for each additional hour per week in child care (OR = 1.03; 95% CI = 1.001 to 1.061); and decreased in children taking antibiotics in the preceding four weeks (OR = 0.2; 95% CI = 0.1 to 0.9). Carriage of the invasive group A streptococcal strain could not be determined by identified risk factors alone.