ABSTRACT
BACKGROUND: Most cases of invasive group A streptococcal (GAS) disease arise sporadically in the community, but outbreaks of severe invasive GAS infections have been reported in closed environments, such as military populations, family communities and hospitals. An outbreak of invasive GAS disease involving 3 cases of streptococcal toxic shock syndrome (TSS), one with a fatal course, occurred among children attending a day-care center located in Cantabria, Northern Spain. OBJECTIVE: To determine the characteristics of GAS isolates obtained from the outbreak environment. METHODS: GAS isolates obtained from children attending the same day-care facility, staff members, and family contacts were assayed for emm typing, pulse-field gel electrophoresis (PFGE), and toxin-gene content. One isolate obtained from the fatal case was also characterized by multilocus sequence typing. Antimicrobial susceptibility testing was done. Strains from patients unrelated to the outbreak were included for comparison. RESULTS: All GAS isolates from children attending the day-care center, including those from streptococcal TSS cases, shared the same emm type 4, genomic pattern by PFGE (A) and toxin-gene profile. Neither the emm type nor the PFGE pattern or toxin gene profile of the outbreak-associated strains were encountered among GAS isolated from household or staff contacts. CONCLUSIONS: A clone of GAS belonging to emm type 4 and characterized by a specific PFGE pattern and toxin-gene profile was responsible for a community outbreak of streptococcal TSS disease in a child day-care center in Spain. This is the first day-care outbreak reported in our country.
Subject(s)
Disease Outbreaks , Streptococcal Infections/epidemiology , Streptococcal Infections/microbiology , Streptococcus pyogenes/isolation & purification , Anti-Bacterial Agents/pharmacology , Antigens, Bacterial/genetics , Bacterial Outer Membrane Proteins/genetics , Bacterial Toxins/genetics , Bacterial Typing Techniques , Carrier Proteins/genetics , Child Day Care Centers , Child, Preschool , Community-Acquired Infections/epidemiology , Community-Acquired Infections/microbiology , DNA Fingerprinting , DNA, Bacterial/genetics , Electrophoresis, Gel, Pulsed-Field , Genotype , Humans , Infant , Microbial Sensitivity Tests , Sequence Analysis, DNA , Shock, Septic/microbiology , Spain/epidemiology , Streptococcal Infections/complications , Streptococcus pyogenes/classification , Streptococcus pyogenes/geneticsABSTRACT
OBJECTIVE: To determine the serosubtypes of meningococcus B causing invasive disease in Cantabria and the percentage of agreement with the Cuban vaccine strain, VA-MENGOC-BC. METHODS: We performed a retrospective review of all cases of invasive disease due to meningococcus B declared through the Diseases of Mandatory Reporting System between 1st January 1998 and 28th February 2003. The bacteriological isolates of the "Marqués de Valdecilla" University Hospital, and the serosubtyping performed in the Majadahonda reference laboratory (Madrid, Spain) were also analyzed. RESULTS: Of the 117 declared cases, serosubtype was identified in 79 (67.5%). The agreement with the Cuban vaccine strain was 67%, 71% and 76% in the age groups of newborn to 19 years, 18 months to 19 years, and 4 to 19 years, respectively. When strains with cross-protection were included, these percentages increased to 83%, 83% and 84%, respectively, in the same age groups. CONCLUSIONS: The percentage of agreement between the Cuban vaccine strain and heterologous strains with cross-protection was high. Therefore, this vaccine could be useful in Cantabria.
Subject(s)
Meningococcal Infections/microbiology , Meningococcal Vaccines , Neisseria meningitidis, Serogroup B/classification , Bacterial Capsules , Cuba , Female , Humans , Male , Meningococcal Infections/epidemiology , Neisseria meningitidis, Serogroup B/immunology , Neisseria meningitidis, Serogroup B/isolation & purification , Polysaccharides, Bacterial/immunology , Serotyping , Spain/epidemiologyABSTRACT
Objetivo: Conocer los serosubtipos de meningococo B causantes de enfermedad invasiva en Cantabria y el porcentaje de concordancia con la cepa de la vacuna cubana VA-MengocBC. Métodos: Revisión retrospectiva de todos los casos de enfermedad invasiva por meningococo B declarados a través del sistema de Enfermedades de Declaración Obligatoria (EDO) entre el 1 de enero de 1998 y el 28 de febrero de 2003, los aislamientos bacteriológicos del Hospital Universitario Marqués de Valdecilla y la serosubtipificación hecha en el laboratorio de referencia de Majadahonda. Resultados: De los 117 casos declarados, se identificó el serosubtipo de 79 (67,5 por ciento). La coincidencia con la cepa vacunal cubana fue del 67, el 71 y el 76 por ciento en los grupos de edad de 0 a 19 años, 18 meses a 19 años, y de 4 a 19 años, respectivamente. Incluyendo las cepas con protección cruzada, estos porcentajes se elevan al 83, el 83 y el 84 por ciento, respectivamente, en los mismos grupos de edad. Conclusiones: El porcentaje de coincidencia con la cepa vacunal cubana y con las cepas heterólogas con protección cruzada es alto, por lo que esta vacuna podría ser de utilidad para la situación epidemiológica de Cantabria (AU)
