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Increase in Invasive Group A Streptococcus Infections and Outbreaks in Denver Metropolitan Area Long-Term Care Facilities

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Increase in Invasive Group A Streptococcus Infections and Outbreaks in Denver Metropolitan Area Long-Term Care Facilities

From 2015-2018, CDPHE has received increased reports of invasive Group A Streptococcus (GAS) infections in Denver metropolitan area long-term care facilities. The number of GAS outbreaks in these facilities also increased during this time (2, 1, 7, and 4 to date, respectively). CDPHE defines a GAS outbreak in a long-term care facility as 2 or more cases (invasive or non-invasive) within a 6-month period.

Additionally, recent Whole Genome Sequencing (WGS) analysis performed on GAS isolates sent to CDC as part of routine population-based surveillance identified a cluster of 33 highly related isolates collected between 2015 and 2017. All isolates are from patients who had recent exposures to the long-term care or assisted living setting prior to their positive cultures. CDPHE is currently investigating this cluster, including other epidemiological links, as well as the overall increase in invasive GAS cases and outbreaks in this setting.

Pharyngitis (strep throat) is the most common clinical syndrome resulting from infection with GAS. Skin infections (impetigo or pyoderma) are also common. GAS may become invasive and cause more severe illness, manifesting as bacteremia, pneumonia, necrotizing fasciitis and streptococcal toxic shock. Invasive GAS can result from penetration of GAS through breaks in the skin or intact mucous membranes.

Long-term care facility residents are at an increased risk of invasive GAS because of underlying medical conditions and advanced age. Even a single case of GAS (invasive or non-invasive) should be investigated because of the possibility of unrecognized GAS transmission among staff members and residents. 

For more information and recommendations, please see CDPHE's Group A Streptococcal Infections in Long-Term Care Facilities, Frequently Asked Questions (FAQs) document available here: https://www.colorado.gov/pacific/cdphe/infectious-disease-guidelines-health-care-settings 

Suspected GAS outbreaks are immediately reportable to CDPHE or local health departments. Hospitals that admit patients from long-term care facilities and diagnose GAS infections are encouraged to contact CDPHE. To report a GAS outbreak or to receive more information on GAS, please contact Geoff Brousseau at 303-692-2766 or geoffrey.brousseau@state.co.us.


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