The epidemiology of severe Streptococcus pyogenes disease in Europe

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

^* To whom correspondence should be addressed. Email: aftab.jasir{at}mmb.lu.se.

	Abstract

The past two decades have brought worrying increases in severe Streptococcus pyogenes diseases globally. To investigate and compare the epidemiological patterns of these diseases within Europe, data on severe S. pyogenes infections were collected through an EU FP-5 funded programme (Strep-EURO). Prospective population-based surveillance of severe S. pyogenes infection diagnosed during 2003 and 2004 was undertaken in eleven countries across Europe (Cyprus, Czech Republic, Denmark, Finland, France, Germany, Greece, Italy, Romania, Sweden, UK) using a standardised case definition. A total of 5522 cases of severe S. pyogenes infection were identified across the eleven countries during this period. Rates of reported infection varied, reaching 3/100,000 population in the northern European countries. Seasonal patterns of infections showed remarkable congruence between countries. Risk of infection was highest among the elderly, with rates being higher in males than 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 was the most common focus of infection, 32% of patients having cellulitis and 8% necrotizing fasciitis. The overall 7-day case fatality rate was 19%, 44% among cases who developed streptococcal toxic shock syndrome. 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.