Nick Daneman, MD; Karen A. Green, RN, MSc; Donald E. Low, MD; Andrew E. Simor, MD; Barbara Willey, ART; Benjamin Schwartz, MD; Baldwin Toye, MD; Peter Jessamine, MD; Gregory J. Tyrrell, PhD; Sigmund Krajden, MD; Lee Ramage, BScN, RN; David Rose, MD; Ruth Schertzberg, ART; Delena Bragg, RN; Allison McGeer, MD; and the Ontario Group A Streptococcal Study Group*
Acknowledgments: The authors thank the many patients, physicians, microbiology technologists, infection control practitioners, and public health staff who have collaborated in the surveillance and outbreak investigations across Ontario. They also thank MDS Laboratories for assistance with specimen transport.
Grant Support: By Centers for Disease Control and Prevention contracts 200-91-0929 and 200-94-0877.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Allison McGeer, MD, Mount Sinai Hospital, Room 210, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada; e-mail, email@example.com.
Current Author Addresses: Dr. Daneman: Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, G-Wing Room 106, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.
Ms. Green: Mount Sinai Hospital, Room 210, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada.
Dr. Low: Mount Sinai Hospital, Room 1487, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada.
Dr. Simor: Sunnybrook Health Sciences Centre, Room B121, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.
Ms. Willey: Mount Sinai Hospital, Room 1460, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada.
Dr. Schwartz: Centers for Disease Control and Prevention, Room 5309, 12 Corporate Boulevard, Atlanta, GA 30329.
Drs. Toye and Jessamine: The Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada.
Dr. Tyrrell: National Centre for Streptococcus, 2B3.13 WMC, 8440-112 Street, Edmonton, Alberta T6G 2J2, Canada.
Dr. Krajden: St. Joseph's Health Center, 30 The Queensway, Toronto, Ontario M6R 1B5, Canada.
Ms. Ramage: Hamilton Health Sciences Office, 50 Wing, Room 219, 711 Concession Street, Hamilton, Ontario L8V 1C3, Canada.
Dr. Rose: The Scarborough Hospital–Grace Site, 3030 Birchmount Road, Scarborough, Ontario M1W 3W3, Canada.
Ms. Schertzberg: Grand River Hospital, 835 King Street West, Kitchener, Ontario N2G 1G3, Canada.
Ms. Bragg: Humber River Regional Hospital, 2111 Finch Avenue, Toronto, Ontario M5N 1N1, Canada.
Dr. McGeer: Mount Sinai Hospital, Room 210, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada.
Author Contributions: Conception and design: K.A. Green, A. McGeer.
Analysis and interpretation of the data: N. Daneman, K.A. Green, G.J. Tyrrell, A. McGeer.
Drafting of the article: N. Daneman.
Critical revision of the article for important intellectual content: N. Daneman, K.A. Green, G.J. Tyrrell, A. McGeer.
Final approval of the article: N. Daneman, K.A. Green, P. Jessamine, D. Rose, A. McGeer.
Provision of study materials or patients: K.A. Green, B. Toye, P. Jessamine, S. Krajden, D. Rose.
Obtaining of funding: K.A. Green, A. McGeer.
Administrative, technical, or logistic support: B. Willey, B. Toye, A. McGeer.
Collection and assembly of data: K.A. Green, D. Bragg, A. McGeer.
Daneman N., Green K., Low D., Simor A., Willey B., Schwartz B., Toye B., Jessamine P., Tyrrell G., Krajden S., Ramage L., Rose D., Schertzberg R., Bragg D., McGeer A., ; Surveillance for Hospital Outbreaks of Invasive Group A Streptococcal Infections in Ontario, Canada, 1992 to 2000. Ann Intern Med. 2007;147:234-241. doi: 10.7326/0003-4819-147-4-200708210-00004
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Published: Ann Intern Med. 2007;147(4):234-241.
Streptococcus pyogenes has the capacity to produce myriad invasive diseases, the most dramatic being necrotizing fasciitis and streptococcal toxic shock syndrome (1). The rate of invasive disease has increased in recent decades to more than 3 per 100 000 persons per year, and the case-fatality rate remains approximately 15% (2, 3). Equally as dramatic as the illness that group A streptococcus produces in individual patients are the outbreaks it has caused in hospitals (4–63). Such outbreaks have involved as many as 56 patients and health care workers and have continued for as long as 3 years (32, 39). Preventing hospital transmission of group A streptococcal infection would allow for the prevention of many secondary cases of disease (64).
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Hospital Medicine, Infectious Disease, Streptococcal Infections.
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