Abstract
Objective
Group A Streptococcus (GAS) is a frequent cause of outbreaks in healthcare institutions, yet outbreak reports in the literature from homeless shelters are less common, despite an increased risk of severe GAS infection in homeless populations. In 2016, we conducted a case-control study to identify significant risk factors associated with GAS acquisition in a protracted, 19-month outbreak of GAS in a large, urban men’s homeless shelter in Ontario, Canada.
Methods
Cases (individuals with either clinical GAS emm74 infection or asymptomatic carriers of GAS emm74) and controls were identified from shelter residents from February to September 2016. Information on demographics, clinical presentation, pre-existing health conditions, and risk factors for GAS transmission were collected for all study participants from a variety of sources, including the public health notifiable disease information system, electronic health records, the shelter electronic information system, and interviews with client services workers.
Results
From the multivariable logistic regression model, younger individuals (OR 9.1; 95% CI 1.57–52.9), those with previous skin conditions (OR 56.2; 95% CI 2.73–1160), and those with recent wounds (with wound care: OR 51.5, 95% CI 8.86–299, and without wound care: OR 77.4, 95% CI 7.38–812) were found to be at increased risk of acquiring GAS in this outbreak.
Conclusion
The outbreak investigation clearly demonstrated the need for improved wound care and infection prevention and control practices, for early screening and detection of skin and soft tissue infections, and for a comprehensive, integrated electronic information system in homeless shelters.
Résumé
Objectif
Les streptocoques du groupe A (SGA) constituent une cause fréquente d’éclosions dans les établissements de soins, mais les éclosions dans les refuges pour sans-abri sont moins communément abordées dans la presse scientifique malgré le risque accru d’infections à SGA invasives dans les populations sans abri. Nous avons mené en 2016 une étude cas/témoins pour déterminer les facteurs de risque significatifs associés à l’acquisition du SGA lors d’une éclosion prolongée (sur 19 mois) survenue dans un grand refuge pour hommes sans-abri en milieu urbain en Ontario, au Canada.
Méthode
Les cas (les personnes ayant une infection clinique à SGA de type emm74 ou les porteurs asymptomatiques du SGA de type emm74) et les témoins ont été recensés entre février et septembre 2016 parmi les résidents du refuge. Les données démographiques, le tableau clinique, l’état de santé préexistant et les facteurs de risque de transmission du SGA ont été obtenus pour tous les participants de l’étude à partir de sources diverses : le système d’information du service de santé publique sur les maladies à signalement obligatoire; les dossiers médicaux électroniques; le système d’information électronique du refuge; et des entretiens avec les préposés du service à la clientèle.
Résultats
Selon notre modèle de régression logistique multivariée, les jeunes sujets (RC 9,1; IC de 95% 1,57–52,9), les sujets ayant une affection cutanée antérieure (RC 56,2; IC de 95% 2,73–1160) et les sujets ayant des plaies récentes (traitées : RC 51,5; IC de 95% 8,86–299 et non traitées : RC 77,4; IC de 95% 7,38–812) ont couru un risque accru d’acquérir le SGA durant cette éclosion.
Conclusion
L’enquête sur l’épidémie a clairement montré la nécessité d’améliorer le traitement des plaies et les pratiques de prévention et de contrôle des infections, ainsi que le besoin d’un dépistage et d’une détection précoces des infections de la peau et des tissus mous, et d’un système d’information électronique complet et intégré dans les refuges pour sans-abri.
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Acknowledgements
Toronto Public Health would like to acknowledge the support of Toronto's Shelter Support and Housing Administration division, staff at the shelter, the TPH investigation team, Dr. Elizabeth Rea, the Inner City Family Health Team, Inner City Health Associates, the Public Health Agency of Canada, and content experts Drs. Allison McGeer and Edward Kaplan.
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Dohoo, C., Stuart, R., Finkelstein, M. et al. Risk factors associated with group A Streptococcus acquisition in a large, urban homeless shelter outbreak. Can J Public Health 111, 117–124 (2020). https://doi.org/10.17269/s41997-019-00258-5
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DOI: https://doi.org/10.17269/s41997-019-00258-5