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Surveillance for Hospital Outbreaks of Invasive Group A Streptococcal Infections in Ontario, Canada, 1992 to 2000

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*
[+] Article and Author Information

From the University of Toronto, Mount Sinai Hospital, Sunnybrook Health Sciences Centre, St. Joseph's Health Centre, The Scarborough Hospital, and Humber River Regional Hospital, Toronto, Ontario, Canada; Centers for Disease Control and Prevention, Atlanta, Georgia; The Ottawa Hospital, Ottawa, Ontario, Canada; National Centre for Streptococcus, Edmonton, Alberta, Canada; Hamilton Health Sciences, Hamilton, Ontario, Canada; and Grand River Hospital, Waterloo, Ontario, Canada.


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, amcgeer@mtsinai.on.ca.

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.


Ann Intern Med. 2007;147(4):234-241. doi:10.7326/0003-4819-147-4-200708210-00004
Text Size: A A A

In prospective surveillance from 1 January 1992 to 31 December 2000, 2351 cases of invasive group A streptococcal disease were detected in Ontario (3) (Table 1). Of the 291 nosocomial invasive group A streptococcal infections, 29 (10%) were associated with 20 outbreaks. These 20 nosocomial outbreaks also involved 26 laboratory-confirmed noninvasive group A streptococcal illnesses, for a total of 53 outbreak-associated patient cases (there were 6 cases in health care workers, all pharyngitis). The average rate of outbreaks over the 9-year period was 1.0 per 100 hospitals per year, with an average rate of outbreak-associated disease of 0.5 per 100 000 hospital admissions per year.

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Summary for Patients

Invasive Streptococcal Infections in Hospitals in Ontario, Canada, 1992 to 2000

The summary below is from the full report titled “Surveillance for Hospital Outbreaks of Invasive Group A Streptococcal Infections in Ontario, Canada, 1992 to 2000.” It is in the 21 August 2007 issue of Annals of Internal Medicine (volume 147, pages 234-241). The authors are N. Daneman, K.A. Green, D.E. Low, A.E. Simor, B. Willey, B. Schwartz, B. Toye, P. Jessamine, G.J. Tyrrell, S. Krajden, L. Ramage, D. Rose, R. Schertzberg, D. Bragg, A. McGeer, and the Ontario Group A Streptococcal Study Group.

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