O: Public Health
Oral Abstract Submission
Osatohamwen Idubor, MD, MHS, CHES
Epidemic Intelligence Service Officer
Centers for Disease Control and Prevention
Atlanta, GA
Disclosure: Nothing to disclose
Nisha B. Alden, MPH
Respiratory and Invasive Bacterial Disease Program Manager
Colorado Department of Public Health and Environment
Denver, Colorado
Disclosure: CDC: Grant/Research Support
Srinivas Nanduri, MBBS, MPH
Medical Epidemiologist
Centers for Disease Control and Prevention
Atlanta, GA
Disclosure: Nothing to disclose
Abimbola Ogundimu, DrPH, RN, CIC
Nurse Infection Preventionist/Health Scientist
Centers for Disease Control and Prevention
Atlanta, GA
Disclosure: Nothing to disclose
Sukarma SS. Tanwar, MBBS, MMed, MScPH
EIS Officer
Centers for Disease Control and Prevention
Atlanta, GA
Disclosure: Nothing to disclose
Heather Reese, PhD, MPH
Epidemic Intelligence Service Officer
Centers for Disease Control and Prevention
Atlanta, GA
Disclosure: Nothing to disclose
Wycliffe Odongo, MSc
Public Health Informatics Fellow
Centers for Disease Control and Prevention
Atlanta, GA
Disclosure: Nothing to disclose
Rachel Herlihy, MD. MPH
State Epidemiologist
Colorado Department of Public Health and Environment
Denver, Colorado
Disclosure: Nothing to disclose
Helen Johnston, MPH
Emerging Infections Unit Manager
Colorado Department of Public Health and Environment
Denver, Colorado
Disclosure: Centers for Disease Control and Prevention: Grant/Research Support
Alexis Burakoff, MD, MPH
Epidemiologist
Colorado Department of Public Health and Environment
Denver, CO
Disclosure: Nothing to disclose
April Burdorf, BSN, MPH
Nurse Infection Preventionist
Colorado Department of Public Health and Environment
Denver, CO
Disclosure: Nothing to disclose
Ariella P. Dale, PhD, MPH
HAI Surveillance Data Coordinator
Denver, CO
Disclosure: Nothing to disclose
Janell Nichols, MA
Infection Preventionist
Colorado Department of Public Health and Environment
Lakewood, CO
Disclosure: Nothing to disclose
Wendy M. Bamberg, MD
Medical Epidemiologist
Colorado Department of Public Health and Environment
Denver, CO
Disclosure: Nothing to disclose
Alana Cilwick, MPH
Epidemiologist
Colorado Department of Public Health and Environment
Denver, CO
Disclosure: Nothing to disclose
Devra Barter, MS
Emerging Infections Epidemiologist
Colorado Department of Public Health and Environment
Denver, Colorado
Disclosure: Nothing to disclose
Geoff Brousseau, MPH
C. difficile Surveillance Coordinator
Colorado Department of Public Health and Environment
Denver, CO
Disclosure: Nothing to disclose
Sopio Chochua, M.D., Ph.D.
Microbiologist
Centers for Disease Control and Prevention
Atlanta, Georgia
Disclosure: Nothing to disclose
Nimalie D. Stone, MD, MS
Long Term Care Team Lead
CDC Division of Healthcare Quality and Promotion
Atlanta, Georgia
Disclosure: Nothing to disclose
Chris Van Beneden, MD, MPH
Medical Epidemiologist
Centers for Disease Control and Prevention
Atlanta, GA
Disclosure: Nothing to disclose
Background : Older adults residing in nursing homes (NH) are at increased risk for invasive group A Streptococcus (GAS) infections due to advanced age, presence of wounds, and comorbidities; approximately one third of infected patients die. Beginning in 2015, increasing numbers of GAS infections in NH residents and several NH clusters were reported from the Denver metropolitan area. Colorado Department of Public Health & Environment (CDPHE) and CDC investigated to characterize cases and assess if outbreaks resulted from interfacility transmission.
Methods : We reviewed data from Active Bacterial Core surveillance (ABCs) in the 5-county Denver area from January 2017–June 2018. We defined a case as isolation of GAS from a normally sterile site in a NH resident. GAS isolates underwent whole-genome sequencing (WGS) at CDC’s Streptococcus Laboratory to determine emm types for genotyping. Among isolates with the same emm type, pairwise single nucleotide polymorphism (SNP) distances were calculated using Nucmer software. In October 2018, a CDPHE-CDC team assessed infection control at NHs with cases of the most common emm type.
Results : Over 18 months, among > 100 NHs in the Denver area, ≥ 1 GAS case was identified in 29 NHs, with 6 having ≥ 3 cases. During this period, 68 cases in NH residents were identified. WGS identified 17 emm types among isolates from these cases; most common was emm11.10 (34%, n=22), a rare subtype in ABCs. All emm11.10 isolates had nearly identical genomes (average pairwise SNP distance: 3.2), and were isolated from 10 NHs, with 2 NHs having ≥ 4 cases. Multiple infection control lapses were noted during site visits to 8 NHs.
Conclusion :
Multiple outbreaks due to GAS were noted in 5-county Denver area NHs in 2017–2018. WGS of surveillance isolates identified a rarely seen emm subtype 11.10 from multiple facilities with temporal and genomic clustering suggesting interfacility GAS transmission.
