Changes to the approach to public health surveillance for healthcare-associated invasive Group A Streptococcus infections

 

Key points Starting May/June 2024, the Colorado Department of Public Health and Environment’s (CDPHE) Healthcare-Associated Infections and Antimicrobial Resistance (HAI/AR) Program will only routinely review medical records of reported cases of invasive Group A Streptococcus (iGAS) infection in patients 55 years and older to identify healthcare exposures. CDPHE will no longer review medical records for patients younger than 55 years old for this purpose. This approach will allow CDPHE to identify and respond to 95% of long-term facility cases of iGAS, as well as allow for more efficient use of public health resources to respond to healthcare-associated iGAS infection in people at greatest risk of severe disease. The Vaccine Preventable and Invasive Disease Program will continue laboratory-based surveillance for iGAS in the five-county Denver metro area without changes. Background Healthcare-associated iGAS can cause severe disease and death. A single case of iGAS in a healthcare setting can be an indicator of an outbreak. Most healthcare-associated iGAS outbreaks occur in long-term care facilities, frequently skilled nursing facilities. Approximately 30% of cases of iGAS in residents of long-term care facilities reported to CDPHE from 2020-2023 were associated with an outbreak. Long-term care facility staff may not be aware of an iGAS outbreak because iGAS infection may be diagnosed in a hospital and cases may occur weeks or months apart. In contrast to long-term care facility outbreaks of iGAS, postpartum and postsurgical infections are less common and more readily identified by hospital providers.  CDPHE’s HAI/AR Program conducts active surveillance for iGAS in healthcare settings. GAS identified from a normally sterile site or from a non-sterile site in the presence of streptococcal toxic shock syndrome or necrotizing fasciitis is a four-day laboratory-reportable condition for patients residing in Arapahoe, Adams, Denver, Douglas, and Jefferson counties as part of CDC’s Emerging Infections Program - Active Bacterial Core Surveillance project. Currently, the HAI/AR Program reviews the medical records associated with all reported cases in order to identify healthcare exposures, including recent surgery, delivery, and long-term care facility residency. The HAI/AR Program investigates single cases and clusters of cases with healthcare exposures, in order to identify and respond to outbreaks and prevent additional cases of iGAS in healthcare settings. Between 2020 and 2023, reports of iGAS in the catchment area increased from fewer than 500 to greater than 1,000 per year. The proportion of iGAS reports with long-term care facility exposure was 1% among patients aged 0-54 years and 15% among patients aged 55 years and older. Medical record review for reports in patients 55 years and older will capture 95% of long-term facility cases of iGAS while reducing the volume of medical record review by 50%. Passive surveillance through provider reports will capture the remaining 5% of long-term care facility-associated cases, cases of iGAS in younger postpartum and post-surgical patients, and healthcare-associated cases outside the Denver metro area.  Health care providers statewide should contact the HAI/AR Program for technical assistance with the evaluation and management of single cases of iGAS in healthcare settings. Outbreaks of any kind, including suspected outbreaks of iGAS in healthcare settings, are immediately reportable. Contact the HAI/AR Program at 303-692-2700 or (cdphe_hai_ar@state.co.us). .