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Volume 32, Number 1—January 2026

CME ACTIVITY - Research

Group A Streptococcus Meningitis, United States, 1997–2022

Paulina A. Hawkins, Sopio Chochua, Namrata Prasad, Jennifer O. Okaro, Yuan Li, Tasha Martin, Ann Thomas, Bridget J. Anderson, Kari E. Burzlaff, Lee Harrison, Shannon Seopaul, Nisha Alden, Rachel Herlihy, William Schaffner, H. Keipp Talbot, Ruth Lynfield, Kathy Como-Sabetti, Maria Rosales, Shua Chai, Sam Sefton, Jessica R. Howard-Anderson, Sarah Khanlian, Jessica Houston, Susan Petit, Adam L. Cohen, and Christopher J. GregoryComments to Author 
Author affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (P.A. Hawkins, S. Chochua, N. Prasad, J.O. Okaro, Y. Li, S. Chai, A.L. Cohen, C.J. Gregory); Oregon Health Authority, Portland, Oregon, USA (T. Martin, A. Thomas); New York State Department of Health, Albany, New York, USA (B.J. Anderson, K.E. Burzlaff); Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA (L. Harrison, S. Seopaul); Colorado Department of Public Health and the Environment, Denver, Colorado, USA (N. Alden, R. Herlihy); Vanderbilt University School of Medicine, Nashville, Tennessee, USA (W. Schaffner, H.K. Talbot); Minnesota Department of Health, St. Paul, Minnesota, USA (R. Lynfield, K. Como-Sabetti); California Emerging Infections Program, Oakland, California, USA (M. Rosales, S. Chai); Emory University School of Medicine, Atlanta (S. Sefton, J.R. Howard-Anderson); New Mexico Department of Health, Santa Fe, New Mexico, USA (S. Khanlian, J. Houston); Connecticut Department of Public Health, Hartford, Connecticut, USA (S. Petit)

Main Article

Table 1

Demographic and clinical characteristics of pediatric patients with group A Streptococcus meningitis versus other nonmeningitis invasive group A Streptococcus infections, United States, 1997–2022*

Characteristics Meningitis, n = 320 Nonmeningitis, n = 37,942 p value
Pediatric patients 112 (35.0) 3,342 (8.8) <0.001
Age range
0–11 mo 24 (21.4) 471 (14.1) 0.04
1–4 y 25 (22.3) 1,134 (33.9) 0.01
5–17 y 63 (56.3) 1,736 (52.0) 0.37
Sex
M 56 (50) 1,943 (58.1) 0.09
F 56 (50) 1,399 (41.9)
Race and ethnicity
White non-Hispanic 43 (38.4) 1,109 (33.2) 0.25
Black non-Hispanic 18 (16.1) 540 (16.2) >0.99
American Indian/Alaska Native non-Hispanic 2 (1.8) 73 (2.2) 0.85
Asian/Pacific Islander non-Hispanic 5 (4.5) 188 (5.6) 0.64
Other non-Hispanic 0 (0.0) 7 (0.2) 0.24
Hispanic 24 (21.4) 664 (19.9) 0.67
Unknown 20 (17.9) 761 (22.7) 0.22
Underlying conditions
Chronic medical conditions† 4 (3.6) 381 (11.4) 0.004
Immunocompromising conditions‡ 1 (0.9) 90 (2.7) 0.25
Obesity 2 (1.8) 103 (3.1) 0.47
None 99 (88.4) 2,673 (80.0) 0.004
No data available 6 (5.4) 157 (4.5)
Co-occurring syndromes
Otitis media 6 (5.4) NA NA
Pneumonia 11 (9.8) NA NA
Abscess 7 (6.8) NA NA
Septic shock 9 (8.0) NA NA
Cellulitis 9 (8.0) NA NA
Streptococcal toxic shock syndrome 4 (3.6) NA NA
None of the above 78 (69.6) NA NA
Outcomes
Died (CFR) 19 (17.0) 106 (3.2) <0.001
Vaccine target coverage
emm type data available 94 (83.9) 2,616 (78.3)
emm type in 30-valent vaccine§ 86 (91.5) 2,440 (93.3) 0.49
Antimicrobial susceptibility
Susceptibility data available 91 (81.3) 2,079 (62.2)
Nonsusceptible
Erythromycin 4 (4.4) 163 (7.9) 0.23
Clindamycin 4 (4.4) 103 (4.9) 0.86
Levofloxacin 1 (1.1) 16 (0.8) 0.68

*Bold font indicates statistical significance. CFR, case-fatality rate; NA, not applicable †Chronic medical conditions included asthma, chronic obstructive pulmonary disease, diabetes, cirrhosis, alcohol abuse, atherosclerotic cardiovascular disease, congestive heart failure, burns, cerebrospinal fluid leak, and cerebrovascular accident. ‡Immunocompromising conditions included multiple myeloma, sickle cell disease, asplenia, organ transplantation, immunoglobulin deficiency, immunosuppressive therapy, human immunodeficiency virus or the acquired immunodeficiency syndrome (HIV–AIDS), leukemia, Hodgkin’s disease, lupus, nephrotic syndrome, and chronic kidney disease. §30-valent vaccine emm types include 1, 2, 3, 4, 5, 6, 11, 12, 14, 18, 19, 22, 24, 28, 29, 44, 49, 58, 73, 75, 77, 78, 81, 82, 83, 87, 89, 92, 114, and 118.

Main Article

Page created: October 01, 2025
Page updated: January 26, 2026
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