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Volume 31, Number 8—August 2025

Research

Group A Streptococcus among American Indian Persons, White Mountain Apache Tribal Lands, United States, 2016–20191

Catherine G. Sutcliffe2Comments to Author , Ryan Close2, Laura B. Brown, Dennie Parker, Jayshree Patel, Eugene Romancito, Robert Weatherholtz, James McAuley3, and Laura L. Hammitt3
Author affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (C.G. Sutcliffe, L.B. Brown, D. Parker, R. Weatherholtz, L.L. Hammitt); Indian Health Service Hospital, Whiteriver, Arizona, USA (R. Close, J. Patel, E. Romancito, J. McAuley); MaineHealth, Portland, Maine, USA (R. Close)

Main Article

Table 2

Incidence rates of severe and invasive group A Streptococcus infection among American Indian persons in the White Mountain Apache Tribal lands, Arizona, USA, 2017–2019

Characteristic Total no. Severe and invasive infections
 Invasive infections
 Severe infections
No. Incidence* (95% CI) No. Incidence* (95% CI) No. Incidence* (95% CI)
Overall 34,061 161 472.7 (405.2–551.4) 48 140.9 (106.2–187.0) 113 331.8 (276.0–398.8)
By age, y
0–4 3,391 7 206.4 (98.5–432.7) 1 29.5 (4.2–209.4) 6 176.9 (79.5–393.6)
5–17 8,791 11 125.1 (69.3–225.9) 0 0 11 125.1 (69.3–225.9)
18–49 14,514 90 620.1 (504.7–761.9) 22 151.6 (99.8–230.1) 68 468.5 (369.6–593.9)
50–64 4,845 32 660.5 (467.6–932.9) 12 247.7 (140.8–435.9) 20 412.8 (266.6–639.3)
>65
 2,520
 21
 833.3 (544.3–1,275.8)
13
 516.0 (300.0–887.3)
8
 317.5 (158.9–634.1)
Year 1† 16,948 79 466.1 (374.1–580.8) 23 135.7 (90.2–204.2) 56 330.4 (254.4–429.2)
By age, y
0–4 1,693 5 295.3 (123.1–708.8) 1 59.1 (8.3–419.3) 4 236.3 (88.8–629.0)
5–17 4,366 5 114.5 (47.7–275.0) 0 0 5 114.5 (47.7–275.0)
18–49 7,260 42 578.5 (427.9–782.1) 8 110.2 (55.1–220.3) 34 468.3 (334.9–654.9)
50–64 2,383 14 587.5 (348.5–990.5) 6 251.9 (113.3–560.0) 8 335.7 (168.1–670.5)
>65
 1,246
 13
 1043.3 (607.5–1,791.8)
8
 642.1 (321.8–1,281.0)
5
 401.3 (167.3–962.4)
Year 2† 17,113 82 479.2 (386.1–594.7) 25 146.1 (98.7–216.1) 57 333.1 (257.0–431.6)
By age, y
0–4 1,698 2 117.8 (29.5–470.8) 0 0 2 117.8 (29.5–470.8)
5–17 4,425 6 135.6 (61.0–301.7) 0 0 6 135.6 (61.0–301.7)
18–49 7,254 48 66.2 (499.1–877.2) 14 193.0 (114.4–325.7) 34 468.7 (335.2–655.5)
50–64 2,462 18 731.1 (461.4–1,158.5) 6 243.7 (109.5–541.9) 12 487.4 (277.2–857.1)
>65 1,274 8 627.9 (314.7–1,252.9) 5 392.4 (163.6–941.3) 3 235.5 (76.1–729.2)

*Cases/100,000 persons. †No significant difference was observed between years 1 (March 2017–February 2018) and 2 (March 2018–February 2019) for all group A Streptococcus (incidence rate ratio: 1.03; 95% confidence interval: 0.76–1.40), invasive group A Streptococcus (incidence rate ratio: 1.08; 95% confidence interval: 0.61–1.90) or severe group A Streptococcus (incidence rate ratio: 1.01; 95% confidence interval: 0.70–1.46).

Main Article

1Preliminary results from this study were presented at IDWeek, October 2–6, 2019, Washington, DC, USA.

2These first authors contributed equally to this article.

3These senior authors contributed equally to this article.

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