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Journal of Clinical Microbiology, July 2008, p. 2359-2367, Vol. 46, No. 7
0095-1137/08/$08.00+0     doi:10.1128/JCM.00422-08
Copyright © 2008, American Society for Microbiology. All Rights Reserved.

Epidemiology of Severe Streptococcus pyogenes Disease in Europe

Theresa L. Lamagni,^1,¶ Jessica Darenberg,^2,¶ Bogdan Luca-Harari,^3,¶ Tuula Siljander,⁴ Androulla Efstratiou,¹ Birgitta Henriques-Normark,² Jaana Vuopio-Varkila,⁴ Anne Bouvet,⁵ Roberta Creti,⁶ Kim Ekelund,^7, Maria Koliou,⁸ Ralf René Reinert,^9, Angeliki Stathi,¹⁰ Lenka Strakova,¹¹ Vasilica Ungureanu,¹² Claes Schalén,³ the Strep-EURO Study Group Aftab Jasir,^3*

Health Protection Agency Centre for Infections, London, United Kingdom,¹ Swedish Institute for Infectious Disease Control and MTC Karolinska Institutet, Solna, Sweden,² Department of Laboratory Medicine, Division of Medical Microbiology, Lund University, Lund, Sweden,³ National Public Health Institute, Helsinki, Finland,⁴ Department of Microbiology, National Reference Center for Streptococci, Hôtel Dieu AP-HP, Paris Descartes University, Paris, France,⁵ Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanita, Rome, Italy,⁶ Department of Bacteriology, Mycology and Parasitology, Statens Serum Institut, Copenhagen, Denmark,⁷ Infectious Diseases Research Laboratory, Paediatric Department, Archbishop Makarios Hospital, Nicosia, Cyprus,⁸ German National Reference Center for Streptococci, Department of Medical Microbiology, University Hospital RWTH Aachen, Aachen, Germany,⁹ Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece,¹⁰ National Institute of Public Health, Prague, Czech Republic,¹¹ National Reference Center for Streptococci, Cantacuzino Institute, Bucharest, Romania,¹²

Received 3 March 2008/ Returned for modification 18 April 2008/ Accepted 30 April 2008

The past 2 decades have brought worrying increases in severe Streptococcus pyogenes diseases globally. To investigate and compare the epidemiological patterns of these diseases within Europe, data were collected through a European Union FP-5-funded program (Strep-EURO). Prospective population-based surveillance of severe S. pyogenes infection diagnosed during 2003 and 2004 was undertaken in 11 countries across Europe (Cyprus, the Czech Republic, Denmark, Finland, France, Germany, Greece, Italy, Romania, Sweden, and the United Kingdom) using a standardized case definition. A total of 5,522 cases were identified across the 11 countries during this period. Rates of reported infection varied, reaching 3/100,000 population in the northern European countries. Seasonal patterns of infection showed remarkable congruence between countries. The risk of infection was highest among the elderly, and rates were higher in males than in females in most countries. Skin lesions/wounds were the most common predisposing factor, reported in 25% of cases; 21% had no predisposing factors reported. Skin and soft tissue were the most common foci of infection, with 32% of patients having cellulitis and 8% necrotizing fasciitis. The overall 7-day case fatality rate was 19%; it was 44% among patients who developed streptococcal toxic shock syndrome. The findings from Strep-EURO confirm a high incidence of severe S. pyogenes disease in Europe. Furthermore, these results have identified targets for public health intervention, as well as raising awareness of severe S. pyogenes disease across Europe.

Published ahead of print on 7 May 2008.

^¶ T.L.L., J.D., and B.L.-H. contributed equally to this study.

Present address: Department of Anaesthesiology, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.

Present address: Wyeth Vaccines Research, Paris La Défense, France.

The members of the Strep-EURO study group are Y. Ioannou (Cyprus), P. Kriz and J. Motlova (Czech Republic), Anette Hammerum and Margit S. Kaltoft (Denmark), Joonas Iivonen (Finland), Julien Loubinoux and Liliana Mihaila (France), Mark van der Linden and Rudolf Lütticken (Germany), Joseph Papaparaskevas and Levantia Zachariadou (Greece), Lucilla Baldassarri and Graziella Orefici (Italy), Monica Straut (Romania), Anna Norrby-Teglund (Sweden), and Catherine Keshishian and Shona Neal (United Kingdom).