Journal Article

Epidemic of Group A <i>Streptococcus</i> M/<i>emm</i>59 Causing Invasive Disease in Canada

Gregory J. Tyrrell, Marguerite Lovgren, Theresa St. Jean, Linda Hoang, David M. Patrick, Greg Horsman, Paul Van Caeseele, Lee E. Sieswerda, Allison McGeer, Robert A. Laurence, Anne-Marie Bourgault and Donald E. Low

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 51, issue 11, pages 1290-1297
Published in print December 2010 | ISSN: 1058-4838
Published online December 2010 | e-ISSN: 1537-6591 | DOI:
Epidemic of Group A Streptococcus M/emm59 Causing Invasive Disease in Canada

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Background. The incidence of invasive group A Streptococcus (GAS) disease can vary over time and geographic region, possibly reflecting the population's susceptibility to particular strains but also variation in the predominant M/emm types. Canadian surveillance documented an epidemic of an uncommon M/emm59 type from 2006 to 2009.

Methods. Invasive GAS isolates are submitted by Public Health Laboratories in Canada to the National Centre for Streptococcus for M/emm typing. Patient age, sex, geographic location, and the anatomical source of isolate are provided with the isolate. When it was recognized that M/emm59 strains were increasing in prevalence, clinical information was collected on M/emm59 cases captured in Alberta and compared with cases of other M/emm types occurring in this province.

Results. From January 2006 through December 2009, 539 (13.0%) of 4150 invasive GAS cases were identified as M/emm59: 164 from British Columbia, 146 from Alberta, 62 from Saskatchewan, 82 from Manitoba, 68 from Ontario, 14 from Quebec, 1 from New Brunswick, 1 from Newfoundland, 1 from Yukon, and 1 from Nunavut. The predominant clinical presentation was bacteremia (45.0%) followed by cellulitis (41.4%). Compared with concurrent cases of invasive GAS disease caused by all other M/emm types, identified risk factors for M/emm59 disease were alcohol abuse (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.4–3.8), homelessness (OR, 2.0; 95% CI, 1.2–3.4), hepatitis C virus infection (OR, 2.0; 95% CI, 1.1–3.5), and illicit drug use (OR, 1.7; 95% CI, 1.0–3.0).

Conclusions. Western Canada has witnessed the rapid emergence of a rare GAS strain causing invasive disease predominately in a select population of disadvantaged persons.

Journal Article.  3796 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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