Chris Van Beneden

Centers for Disease Control and Prevention, Atlanta, Michigan, United States

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Publications (50)226.76 Total impact

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    ABSTRACT: Meningitis and pneumonia are leading causes of morbidity and mortality in children globally infected with Streptococcus pneumoniae (pneumococcus), Neisseria meningitidis, and Haemophilus influenzae causing a large proportion of disease. Vaccines are available to prevent many of the common types of these infections. S. pneumoniae was estimated to have caused 11% of deaths in children aged <5 years globally in the pre-pneumococcal conjugate vaccine (PCV) era. Since 2007, the World Health Organization (WHO) has recommended inclusion of PCV in childhood immunization programs worldwide, especially in countries with high child mortality. As of November 26, 2014, a total of 112 (58%) of all 194 WHO member states and 44 (58%) of the 76 member states ever eligible for support from Gavi, the Vaccine Alliance (Gavi), have introduced PCV. Invasive pneumococcal disease (IPD) surveillance that includes data on serotypes, along with meningitis and pneumonia syndromic surveillance, provides important data to guide decisions to introduce PCV and monitor its impact.
    MMWR. Morbidity and mortality weekly report. 12/2014; 63(49):1159-62.
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    ABSTRACT: Background: Macrolide resistance among group A Streptococcus (GAS) is common in many countries. We analyzed prevalence of resistance to erythromycin (EryR) and other antibiotics among GAS isolates obtained from CDC’s Active Bacterial Core surveillance (ABCs) over a 14-year period. Methods: ABCs is active, laboratory- and population-based surveillance for select bacterial infections in 10 geographically diverse U.S. sites. Isolates from invasive GAS infections were collected in participating ABCs sites from 1999-2012. Susceptibility was assessed using broth microdilution and D-zone testing for inducible clindamycin resistance (CliR); emm typing was performed using DNA sequencing. Results: We tested 9175 (85%) isolates from 10,794 invasive GAS cases; 10.5% were EryR. Both EryR and CliR increased over the 14 years (test for trend: P<0.001). Marked yearly shifts in EryR prevalence occurred among several ABCs sites: CA (2001: 8.5%; 2006: 23.6%; 2010: 4.0%), MD (1999: 3.4%; 2008: 34.2%; 2012: 8.0%) and OR (2007: 4.4%; 2012: 28.3%). No penicillin or cephalosporin resistance was found. Among >85 emm types, 10 (emm 12, 49, 58, 73, 75, 76, 83, 92, 94, 114) accounted for 21% of all isolates but 65% of EryR isolates. Site-specific variability in EryR prevalence was primarily due to fluctuations of these emm types. Among 105 EryR isolates from 2012, 62 (59%) were inducibly CliR and 35 (41%) constitutively CliR; 72 of CliR (74.2%) were also tetracycline-resistant. Data from 2001-2010 indicated that a genetic element that contains both ermTR and tetM accounted for most CliR. The patient case fatality ratio did not differ by EryR (10.7% EryR vs 12.2% erythromycin susceptible; P=0.18). EryR infections were more common (P<0.05) among men than women (11.7% vs. 9.3%) and among persons age 18-34 (13.2%) and 50-64 years (13.1%) than other age groups. EryR was lowest among children age <5 years (7.5%). Conclusion: Macrolide resistance among invasive GAS infections in the U.S. gradually increased over 14 years. However, local frequency of macrolide-resistant GAS infections fluctuated markedly, depending on circulating strains. Community-specific susceptibility testing is important for clinical management. Penicillin remains a good choice for therapy of invasive GAS infections.
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
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    ABSTRACT: Background: With limited prevention strategies, identifying prognostic factors for invasive group A Streptococcus (iGAS) infections is important. Obesity and diabetes have been linked to increased risk of skin and soft tissue infections (SSTIs)--common manifestations of iGAS. We analyzed iGAS incidence and outcomes in obese versus normal weight persons and diabetics versus non-diabetics. Methods: We identified 2010-2012 community-onset cases of iGAS among non-pregnant adults from select counties at 10 US Active Bacterial Core surveillance sites. Cases are defined by isolation of GAS from a normally sterile site or from a wound in a patient with necrotizing fasciitis or streptococcal toxic shock syndrome in a resident of the surveillance area. Patient demographics, height, weight and clinical data were obtained from medical records. We used height and weight to calculate body mass index (BMI) or imputed BMI for missing values, categorizing patients into normal weight (BMI 18.5-<25.0), overweight (25.0-<30.0), obese grades 1-2 (30.0-<40.0) and obese grade 3 (≥40.0). Through Poisson regression, we estimated iGAS incidence by BMI category and diabetes status after controlling for sex, age, race and other underlying conditions using ABCs catchment area population estimates from the 2011 Behavioral Risk Factor Surveillance System survey for denominators. Multivariable logistic regression was used to compare risk of death by BMI category and diabetes status. Results: There were 2135 iGAS cases. Diabetes [relative risk (RR)= 3.0, 95% confidence interval (CI)= (2.3-3.9)] and grade 3 obesity among non-diabetics (RR= 2.8, 95%CI= 2.3-3.4) were associated with an increased risk of iGAS. Neither obesity nor diabetes was associated with increased risk of death. SSTIs, with the lowest case fatality ratio (1.9%) among all infection types, were more common in obese and diabetic persons compared to normal weight (p<0.001) and non-diabetic (p=0.001) persons, respectively. Conclusion: Diabetes and extreme obesity in non-diabetics were independent risk factors for iGAS. SSTIs, which tend to be less severe than other infection types, seem to be driving the increased risk. Efforts to prevent and treat obesity and diabetes may help reduce the occurrence of iGAS.
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
  • JAMA Pediatrics 09/2014; · 4.28 Impact Factor
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    ABSTRACT: Large, hospital-based clinical laboratories must be prepared to rapidly investigate potential infectious disease outbreaks. To challenge the ability of our molecular diagnostics laboratory to use whole genome sequencing in a potential outbreak scenario and identify impediments, we studied 84 invasive serotype emm59 group A Streptococcus (GAS) strains collected in the United States. We performed a rapid-response exercise to the mock outbreak scenario using whole genome sequencing, genome-wide transcript analysis and mouse virulence studies. Protocol changes installed in response to lessons learned were tested in a second iteration. The initial investigation was completed in 9 days. Whole genome sequencing showed that the invasive infections were caused by multiple subclones of epidemic emm59 GAS likely spread to the United States from Canada. The phylogenetic tree showed a strong temporal-spatial structure with diversity in mobile genetic element content, features useful for identifying closely related
    Journal of Clinical Microbiology. 09/2014;
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    ABSTRACT: IMPORTANCE Liposuction is one of the most common cosmetic surgery procedures in the United States. Tumescent liposuction, in which crystalloid fluids, lidocaine, and epinephrine are infused subcutaneously before cannula-assisted aspiration of fat, can be performed without intravenous or general anesthesia, often at outpatient facilities. However, some of these facilities are not subject to state or federal regulation and may not adhere to appropriate infection control practices. OBJECTIVE To describe an outbreak of severe group A Streptococcus (GAS) infections among persons undergoing tumescent liposuction at 2 outpatient cosmetic surgery facilities not subject to state or federal regulation. DESIGN Outbreak investigation (including cohort analysis of at-risk patients), interviews using a standardized questionnaire, medical record review, facility assessment, and laboratory analysis of GAS isolates. SETTING AND PARTICIPANTS Patients undergoing liposuction at 2 outpatient facilities, one in Maryland and the other in Pennsylvania, between July 1 and September 14, 2012. MAIN OUTCOMES AND MEASURES Confirmed invasive GAS infections (isolation of GAS from a normally sterile site or wound of a patient with necrotizing fasciitis or streptococcal toxic shock syndrome), suspected GAS infections (inflamed surgical site and either purulent discharge or fever and chills in a patient with no alternative diagnosis), postsurgical symptoms and patient-reported experiences related to his or her procedure, and emm types, T-antigen types, and antimicrobial susceptibility of GAS isolates. RESULTS We identified 4 confirmed cases and 9 suspected cases, including 1 death (overall attack rate, 20% [13 of 66]). One instance of likely secondary GAS transmission to a household member occurred. All confirmed case patients had necrotizing fasciitis and had undergone surgical debridement. Procedures linked to illness were performed by a single surgical team that traveled between the 2 locations; 2 team members (1 of whom reported recent cellulitis) were colonized with a GAS strain that was indistinguishable by laboratory analysis of the isolates from the case patients. Facility assessments and patient reports indicated substandard infection control, including errors in equipment sterilization and infection prevention training. CONCLUSIONS AND RELEVANCE This outbreak of severe GAS infections was likely caused by transmission from colonized health care workers to patients during liposuction procedures. Additional oversight of outpatient cosmetic surgery facilities is needed to assure that they maintain appropriate infection control practices and other patient protections.
    JAMA Internal Medicine 05/2014; · 13.25 Impact Factor
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    ABSTRACT: We sequenced the genomes of 3,615 strains of serotype Emm protein 1 (M1) group A Streptococcus to unravel the nature and timing of molecular events contributing to the emergence, dissemination, and genetic diversification of an unusually virulent clone that now causes epidemic human infections worldwide. We discovered that the contemporary epidemic clone emerged in stepwise fashion from a precursor cell that first contained the phage encoding an extracellular DNase virulence factor (streptococcal DNase D2, SdaD2) and subsequently acquired the phage encoding the SpeA1 variant of the streptococcal pyrogenic exotoxin A superantigen. The SpeA2 toxin variant evolved from SpeA1 by a single-nucleotide change in the M1 progenitor strain before acquisition by horizontal gene transfer of a large chromosomal region encoding secreted toxins NAD(+)-glycohydrolase and streptolysin O. Acquisition of this 36-kb region in the early 1980s into just one cell containing the phage-encoded sdaD2 and speA2 genes was the final major molecular event preceding the emergence and rapid intercontinental spread of the contemporary epidemic clone. Thus, we resolve a decades-old controversy about the type and sequence of genomic alterations that produced this explosive epidemic. Analysis of comprehensive, population-based contemporary invasive strains from seven countries identified strong patterns of temporal population structure. Compared with a preepidemic reference strain, the contemporary clone is significantly more virulent in nonhuman primate models of pharyngitis and necrotizing fasciitis. A key finding is that the molecular evolutionary events transpiring in just one bacterial cell ultimately have produced millions of human infections worldwide.
    Proceedings of the National Academy of Sciences 04/2014; · 9.81 Impact Factor
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    ABSTRACT: Background. Group A Streptococcus (GAS) is an important bacterial cause of life-threatening illness among the elderly. Public health officials investigated a protracted GAS outbreak in skilled nursing facility in Georgia housing patients requiring 24-hour nursing or rehabilitation, to prevent additional cases. Methods. We defined a case as illness in a SNFA resident with onset after January 2009 with GAS isolated from a usually sterile (invasive) or non-sterile site (noninvasive). Cases were "recurrent" if >1 month elapsed between episodes. We evaluated infection control practices, performed a GAS carriage study, emm-typed available GAS isolates, and conducted a case-control study of risk factors for infection. Results. Three investigations, spanning 36 months, identified 19 residents with a total of 24 GAS infections; 15 invasive (3 recurrent) and 9 noninvasive (2 recurrent) episodes. All invasive cases required hospitalization; 4 died. Seven residents were GAS carriers. All invasive cases and resident carrier isolates were type emm 11.0. We observed hand hygiene lapses, inadequate infection documentation and more frequent wound care staff turnover on Wing A versus B. Risk factors associated with infection in multivariable analysis included living on Wing A (OR 3.4, 95% CI 0.9-16.4) and having an indwelling line (OR 5.6, 95% CI 1.2- 36.4). Cases ceased following facility-wide chemoprophylaxis in July 2012. Conclusion. Staff turnover, compromised skin integrity in residents, a sub-optimal infection control program, and lack of awareness of infections likely contributed to continued GAS transmission. In large, prolonged GAS outbreaks in SNFs, facility-wide chemoprophylaxis may be necessary to prevent sustained person-to-person transmission.
    Clinical Infectious Diseases 09/2013; · 9.37 Impact Factor
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    ABSTRACT: To describe epidemiology of bacterial meningitis in the World Health Organization Eastern Mediterranean Region countries and assist in introduction of new bacterial vaccines. A laboratory-based sentinel surveillance was established in 2004, and up to 10 countries joined the network until 2010. Personnel at participating hospitals and national public health laboratories received training in surveillance and laboratory methods and used standard clinical and laboratory-confirmed case definitions. Over 22 000 suspected cases of meningitis were reported among children ≤5 years old and >6600 among children >5 years old. In children ≤5 years old, 921 of 13 125 probable cases (7.0%) were culture-confirmed. The most commonly isolated pathogens were S pneumoniae (27% of confirmed cases), N meningitidis (22%), and H influenzae (10%). Among culture-confirmed case-patients with known outcome, case-fatality rate was 7.0% and 12.2% among children ≤5 years old and those >5 years old, respectively. Declining numbers of Haemophilus influenzae type b meningitis cases within 2 years post-Haemophilus influenzae type b conjugate vaccine introduction were observed in Pakistan. Bacterial meningitis continues to cause significant morbidity and mortality in the Eastern Mediterranean Region. Surveillance networks for bacterial meningitis ensure that all sites are using standardized methodologies. Surveillance data are useful to monitor impact of various interventions including vaccines, but maintaining data quality requires consistent reporting and regular technical support.
    The Journal of pediatrics 07/2013; 163(1 Suppl):S25-31. · 4.02 Impact Factor
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    ABSTRACT: BACKGROUND: In November 2011, the Georgia Department of Public Health (GDPH) partnered with the Centers for Disease Control and Prevention (CDC) and the local health department to investigate an outbreak of 11 cases of invasive group A Streptococcus (GAS) between June 2009 and October 2011 in a 240-bed skilled nursing facility (SNF). This included additional case finding, an infection control review, case-control study, and GAS carriage study. Residents and staff with positive cultures received antibiotic treatment. However, 4 new invasive GAS cases were detected by GDPH from March 24-May 19, 2012. METHODS: Additional case finding was performed through review of microbiology laboratory results at two referral hospitals. To detect persistent carriage among SNF residents, we cultured any non-surgical wounds and the oropharynx of residents who were recent cases or who had positive cultures during the November carriage study. Aggressive efforts were made to treat all staff and residents with either an intramuscular injection of penicillin + 4 days of oral rifampin, or a 10-day course of oral cephalexin to eradicate possible carriage. Throat cultures were performed on those who declined or had contraindications to antibiotics. Until culture results were negative, untreated residents were placed on contact precautions and untreated staff members were furloughed. Follow-up throat and wound cultures were performed on residents who: 1) had a positive wound culture prior to antibiotic treatment; 2) did not receive antibiotics during the facility-wide treatment period, or 3) were newly admitted to the facility during the treatment period. Emm sequence typing was performed on GAS isolates obtained from invasive cases and from throat and wound screening cultures. RESULTS: Case finding identified 2 non-invasive cases in addition to the 4 invasive cases. Four residents had GAS-positive wound cultures during pre-treatment testing. All GAS isolates tested were emm type 11, matching cases from the previous investigation. During treatment, 80% of employees and 75% of residents received penicillin/rifampin, 18% of employees and 23% of residents received cephalexin, and only 2% of each received throat swabs instead of antibiotics. Those who did not receive antibiotics had negative cultures. All follow-up cultures at 5 weeks were negative. No further cases of invasive GAS have occurred among facility residents since May 2012. CONCLUSIONS: Facility-wide prophylactic antibiotic treatment was an aggressive but necessary measure to stop this prolonged and persistent outbreak of invasive GAS. High treatment rates were achieved through partnership with clinical and administrative leadership of the SNF.
    2013 Council of State and Territorial Epidemiologists Annual Conference; 06/2013
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    ABSTRACT: Background. Chlamydia pneumoniae illness is poorly characterized, particularly as a sole causative pathogen. We investigated a C. pneumoniae outbreak at a federal correctional facility. Methods. We identified inmates with acute respiratory illness (ARI) from November 1, 2009 - February 24, 2010 through clinic self-referral and active case-finding. We tested oropharyngeal and/or nasopharyngeal swabs for C. pneumoniae by quantitative polymerase chain reaction (qPCR) and sera by microimmunofluorescence. Cases were inmates with ARI and radiologically-confirmed pneumonia, positive qPCR, or serological evidence of recent infection. Swabs from 7 acutely ill inmates were tested for 18 respiratory pathogens using qPCR TaqMan array cards (TAC). Follow-up swabs from case-patients were collected for up to 8 weeks. Results. Among 33 self-referred and 226 randomly selected inmates, 52 (20.1%) met case definition; 4 were confirmed by radiologically-confirmed pneumonia only, 9 by qPCR only, 17 by serology only, and 22 by both qPCR and serology. The prison attack rate was 10.4% (95% CI: 7.0, 13.8%). White inmates and residents of housing unit Y were at highest risk. TAC testing detected C. pneumoniae in 4 (57%) inmates; no other causative pathogens were identified. Among 40 inmates followed prospectively, C. pneumoniae was detected for up to 8 weeks. Thirteen (52%) of 25 inmates treated with azithromycin continued to be qPCR positive >2 weeks after treatment. Conclusions. C. pneumoniae was the causative pathogen of this outbreak. Higher risk among certain groups suggests social interaction contributed to transmission. Persistence of C. pneumoniae in the oropharynx creates challenges for outbreak control measures.
    Clinical Infectious Diseases 05/2013; · 9.37 Impact Factor
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    ABSTRACT: The guideline is intended for use by healthcare providers who care for adult and pediatric patients with group A streptococcal pharyngitis. The guideline updates the 2002 Infectious Diseases Society of America guideline and discusses diagnosis and management, and recommendations are provided regarding antibiotic choices and dosing. Penicillin or amoxicillin remain the treatments of choice, and recommendations are made for the penicillin-allergic patient, which now include clindamycin.
    Clinical Infectious Diseases 11/2012; 55(10):1279-82. · 9.37 Impact Factor
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    ABSTRACT: The guideline is intended for use by healthcare providers who care for adult and pediatric patients with group A streptococcal pharyngitis. The guideline updates the 2002 Infectious Diseases Society of America guideline and discusses diagnosis and management, and recommendations are provided regarding antibiotic choices and dosing. Penicillin or amoxicillin remain the treatments of choice, and recommendations are made for the penicillin-allergic patient, which now include clindamycin.
    Clinical Infectious Diseases 09/2012; 55(10):e86-e102. · 9.37 Impact Factor
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    ABSTRACT: Surveillance is essential to estimating the global burden of pneumonia, yet differences in surveillance methodology and health care-seeking behaviors limit inter-country comparisons. Results were compared from community surveys measuring health care-seeking for pneumonia defined as: (1) cough and difficulty breathing for ⩾2days; or, (2) provider-diagnosed pneumonia. Surveys were conducted in six sites in Guatemala, Kenya and Thailand; these sites also conduct, active, hospital- and population-based disease surveillance for pneumonia. Frequency of self-reported pneumonia during the preceding year ranged from 1.1% (Thailand) to 6.3% (Guatemala) and was highest in children aged <5years and in urban sites. The proportion of persons with pneumonia who sought hospital-based medical services ranged from 12% (Guatemala, Kenya) to 80% (Thailand) and was highest in children <5years of age. Hospitals and private provider offices were the most common places where persons with pneumonia sought health care. The most commonly cited reasons for not seeking health care were: (a) mild illness; (b) already recovering; and (3) cost of treatment. Health care-seeking patterns varied widely across countries. Using results from standardized health care utilization surveys to adjust facility-based surveillance estimates of pneumonia allows for more accurate and comparable estimates.
    Journal of epidemiology and global health. 06/2012; 2(2):73-81.
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    ABSTRACT: Genomic analysis of type emm59 group A Streptococcus invasive strains isolated in the United States discovered higher than anticipated genetic heterogeneity among strains and identified a heretofore unrecognized monoclonal cluster of invasive infections in the San Francisco Bay area. Heightened monitoring for a potential shift in the epidemic behavior of emm59 group A Streptococcus is warranted.
    Emerging Infectious Diseases 04/2012; 18(4):650-2. · 6.79 Impact Factor
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    ABSTRACT: To investigate an outbreak of bacterial meningitis at an outpatient radiology clinic (clinic A) and to determine the source and implement measures to prevent additional infections. A case was defined as bacterial meningitis in a patient undergoing myelography at clinic A from October 11 to 25, 2010. Patients who underwent myelography and other procedures at clinic A during that period were interviewed, medical records were reviewed, and infection prevention practices were assessed. Case-patient cerebrospinal fluid (CSF) specimens, oral specimens from health care personnel (HCP), and opened iohexol vials were tested for bacteria. Bacterial isolates were compared using pulsed-field gel electrophoresis. A culture-negative CSF specimen was tested using a real-time polymerase chain reaction assay. Three cases were identified among 35 clinic A patients who underwent procedures from October 11 to 25, 2010. All case-patients required hospitalization, 2 in an intensive care unit. Case-patients had myelography performed by the same radiology physician assistant and technician on October 25; all patients who underwent myelography on October 25 were affected. HCP did not wear facemasks and reused single-dose iohexol vials for multiple patients. Streptococcus salivarius (a bacteria commonly found in oral flora) was detected in the CSF of 2 case-patients (1 by culture, 1 using real-time polymerase chain reaction) and in HCP oral specimens; 1 opened iohexol vial contained Staphylococcus epidermidis. Pulsed-field gel electrophoresis profiles from the case-patient S salivarius and the radiology physician assistant were indistinguishable. Bacterial meningitis likely occurred because HCP performing myelography did not wear facemasks; lapses in injection practices may have contributed to transmission. Targeted education regarding mask use and safe injection practices is needed among radiology HCP.
    Journal of the American College of Radiology: JACR 03/2012; 9(3):185-90.
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    ABSTRACT: Whole-genome sequencing of serotype M3 group A streptococci (GAS) from oropharyngeal and invasive infections in Ontario recently showed that the gene encoding regulator of protease B (RopB) is highly polymorphic in this population. To test the hypothesis that ropB is under diversifying selective pressure among all serotype M3 GAS strains, we sequenced this gene in 1178 strains collected from different infection types, geographic regions, and time periods. The results confirmed our hypothesis and discovered a significant association between mutant ropB alleles, decreased activity of its major regulatory target SpeB, and pharyngitis. Additionally, isoallelic strains with ropB polymorphisms were significantly less virulent in a mouse model of necrotizing fasciitis. These studies provide a model strategy for applying whole-genome sequencing followed by deep single-gene sequencing to generate new insight to the rapid evolution and virulence regulation of human pathogens.
    The Journal of Infectious Diseases 01/2012; 205(11):1719-29. · 5.85 Impact Factor
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    ABSTRACT: The epidemiology of streptococcal infection in pregnant and postpartum women is poorly described in recent literature. We used data from multistate surveillance for invasive Streptococcus pneumoniae, group A Streptococcus (GAS), and group B Streptococcus (GBS) infections to estimate disease incidence and severity in these populations. Cases were reported through the Centers for Disease Control and Prevention Active Bacterial Core surveillance, an active population- and laboratory-based system. A case was defined as illness in a woman aged 15-44 years with streptococcus isolated from a normally sterile body site during 2007-2009. Pregnant or postpartum status was recorded at the time of culture. Incidence was calculated as cases per 1000 woman-years with use of national Census data; 95% confidence intervals were calculated on the basis of λ distribution. We used multivariable logistic regression to explore associations between pregnant or postpartum status and hospital length of stay, a marker of disease severity. We identified 1848 cases in women; 6.0% of women were pregnant, and 7.5% were postpartum. Pregnant women had a higher mean incidence of GBS disease, compared with nonpregnant women (0.04 cases per 1000 woman-years [range, 0.03-0.05 cases per 1000 woman-years] vs 0.02 cases per 1000 woman-years [range, 0.02-0.02 cases per 1000 woman-years]). Postpartum women had elevated mean incidence of all 3 pathogens, compared with nonpregnant women (S. pneumoniae: 0.15 cases per 1000 woman-years [range, 0.09-0.25 cases per 1000 woman-years] vs 0.052 cases per 1000 woman-years [range, 0.049-0.056 cases per 1000 woman-years]; GAS: 0.56 cases per 1000 woman-years [range, 0.42-0.70 cases per 1000 woman-years] vs 0.019 cases per 1000 woman-years [range, 0.017-0.021 cases per 1000 woman-years]; GBS: 0.49 cases per 1000 woman-years [range, 0.36-0.64 cases per 1000 woman-years] vs 0.018 [range, 0.016-0.020 cases per 1000 woman-years]). Neither pregnancy nor postpartum status was associated with longer length of stay among women infected with any of the 3 pathogens. Although invasive streptococcal infections do not appear to be more severe in pregnant or postpartum women, postpartum women have a 20-fold increased incidence of GAS and GBS, compared with nonpregnant women.
    Clinical Infectious Diseases 07/2011; 53(2):114-23. · 9.37 Impact Factor
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    ABSTRACT: In January 2008, a long-term acute care hospital (LTACH) in New Mexico reported a cluster of severe group A Streptococcus (GAS) infections. We defined a case as illness in a patient in the LTACH from 1 October 2007 through 3 February 2008 from whom GAS was isolated from a usually sterile site or with illness consistent with GAS infection and GAS isolated from a nonsterile site. To identify carriers, we swabbed the oropharynx and skin lesions of patients and staff. We observed facility procedures to assess possible transmission routes and adherence to infection control practices. We also conducted a case-control study to identify risk factors for infection with use of asymptomatic patients who were noncarriers as control subjects. We identified 11 case patients and 11 carriers (8 patients and 3 staff). No carriers became case patients. Significant risk factors for infection in univariate analysis included sharing a room with an infected or colonized patient (6 [55%] of 11 case patients vs 3 [8%] of 39 control subjects), undergoing wound debridement (64% vs 13%), and receiving negative pressure wound therapy (73% vs 33%). Having an infected or colonized roommate remained associated with case patients in multivariable analysis (odds ratio, 15.3; 95% confidence interval, 2.5-110.9). Suboptimal infection control practices were widespread. This large outbreak of GAS infection was the first reported in an LTACH, a setting that contains a highly susceptible patient population. Widespread infection control lapses likely allowed continued transmission. Similar to the situation in other care settings, appropriate infection control and case cohorting may help prevent and control outbreaks of GAS infection in LTACHs.
    Clinical Infectious Diseases 04/2011; 52(8):988-94. · 9.37 Impact Factor
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    ABSTRACT: A group A streptococcal (GAS) vaccine, while not currently available, offers the possibility of a more effective approach; however, barriers to its implementation are likely to exist. The objectives of this study were to describe the attitudes of physicians about the importance of preventing GAS-associated conditions and to identify potential barriers to vaccine implementation. Surveys were sent to randomly selected physicians from the AAP and the AAFP. The GAS conditions believed by respondents to be most important to prevent among pediatric patients were ARF (31%) followed by STSS (24%) and pharyngitis (20%). Pediatricians and family physicians identified similar factors that would encourage routine use of a GAS vaccine. Less than half of pediatricians and only a third of family physicians would recommend a GAS vaccine if it could not be given concurrently with other immunizations or if there were strong parental resistance to the vaccine. This descriptive study provides important information about the anticipated use of a GAS vaccine by primary care physicians in the United States.
    Vaccine 10/2010; 28(44):7155-60. · 3.77 Impact Factor

Publication Stats

645 Citations
226.76 Total Impact Points

Institutions

  • 2002–2014
    • Centers for Disease Control and Prevention
      • • Division of Healthcare Quality Promotion
      • • Division of Bacterial Diseases
      Atlanta, Michigan, United States
  • 2012
    • Ann & Robert H. Lurie Children's Hospital of Chicago
      Chicago, Illinois, United States
    • Houston Methodist Hospital
      Houston, Texas, United States
  • 2010
    • Cincinnati Children's Hospital Medical Center
      • Division of Infectious Diseases
      Cincinnati, OH, United States
  • 2005
    • National Institute of Allergy and Infectious Diseases
      Maryland, United States