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Epidemiology, outcome and emm types of invasive group A streptococcal infections in Finland

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Abstract

In 2006, Finnish nationwide surveillance showed an increase of invasive group A streptococcal (iGAS) disease and clinicians were alarmed by severe disease manifestations, prompting the investigation of recent trends and outcome for iGAS. A case of iGAS was defined as Streptococcus pyogenes isolated from blood or cerebrospinal fluid. Cases during 1998–2007 and isolates during 2004–2007 were included. Case-patients’ 7-day outcome was available for 2004–2007. Isolates were emm typed. A total of 1,318 cases of iGAS were identified. The average annual incidence was 2.5/100,000 population. The rate was higher in males than females in persons aged 45–64 years, but lower in persons aged 25–34 years. The annual incidence was highest in 2007 (3.9/100,000). Occasional peaks occurred during midwinter and midsummer. The most common emm types were 28 (21%), 1 (16%), 84 (10%), 75 (7%) and 89 (6%). During 2004–2007, emm1 replaced emm28 as the most predominant type. The overall case fatality was 8%. Cases with emm1 were associated with high case fatality (14% vs. 8% in other types; p < 0.02); that of emm28 infections was 2% (p < 0.01). Changes in emm type prevalence influenced incidence and case fatality. Differences in age- and sex-specific incidence and seasonal patterns suggest variations in predisposing factors and underlying conditions.

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Acknowledgements

Laboratory technicians Aila Soininen, Saija Perovuo, Suvi Kavenius, Tuula Randell and Minna Lamppu are greatly acknowledged for their excellent technical assistance. Data Manager Joonas Iivonen is acknowledged for the technical expertise in retrieving and combining data from several database sources. Clinical microbiology laboratories are acknowledged for submitting notifications and isolates.

Previous presentations

These results have partly been presented at the European Scientific Conference on Applied Infectious Disease Epidemiology (ESCAIDE), October 2007, Stockholm, Sweden (poster number B.A.1.28), at the XVII Lancefield International Symposium on Streptococci and Streptococcal Diseases (LISSSD), June 2008, Porto Heli, Greece (abstract number O 4.4), and at the European Scientific Conference on Applied Infectious Disease Epidemiology (ESCAIDE), October 2009, Stockholm, Sweden (abstract number 20090261).

Funding sources

Funding was received from the Ministry of Social Affairs and Health, the Paulo Foundation, the Sigrid Jusélius Foundation, the University of Helsinki, the Finnish Cultural Foundation and the Alfred Kordelin Foundation.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Bacteriology Unit, Department of Infectious Disease Surveillance and Control, National Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland

    T. Siljander, S. Vähäkuopus & J. Vuopio

  2. Epidemiologic Surveillance and Response Unit, Department of Infectious Disease Surveillance and Control, National Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland

    O. Lyytikäinen & M. Snellman

  3. Antimicrobial Resistance Unit, Department of Infectious Disease Surveillance and Control, National Institute for Health and Welfare, Kiinamyllynkatu 13, 20521, Turku, Finland

    J. Jalava

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  1. T. Siljander
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  2. O. Lyytikäinen
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  3. S. Vähäkuopus
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  4. M. Snellman
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  5. J. Jalava
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  6. J. Vuopio
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Correspondence to T. Siljander.

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Siljander, T., Lyytikäinen, O., Vähäkuopus, S. et al. Epidemiology, outcome and emm types of invasive group A streptococcal infections in Finland. Eur J Clin Microbiol Infect Dis 29, 1229–1235 (2010). https://doi.org/10.1007/s10096-010-0989-9

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  • DOI: https://doi.org/10.1007/s10096-010-0989-9

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