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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 2

Demographic and clinical characteristics of adult 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
Adult patients 208 (65.0) 34,600 (91.2) <0.001
Age range, y
18–64 153 (73.6) 23,106 (66.7)
>65 55 (26.4) 11,494 (33.2) 0.04
Sex
M 93 (44.7) 19,193 (55.5) 0.002
F 115 (55.3) 15,407 (44.5)
Race and ethnicity
White non-Hispanic 102 (49.0) 15,432 (44.6) 0.20
Black non-Hispanic 24 (11.5) 3,943 (11.4) 0.93
American Indian/Alaska Native non-Hispanic 2 (0.9) 1,142 (0.3) 0.06
Asian/Pacific Islander non-Hispanic 3 (1.4) 702 (2.0) 0.59
Other non-Hispanic 0 12 (0.03) 0.07
Hispanic 18 (8.7) 3,495 (10.1) 0.50
Unknown 59 (28.4) 9,391 (27.2) 0.69
Underlying conditions
Chronic medical conditions† 102 (49.0) 21,740 (62.8) <0.001
Immunocompromising conditions‡ 24 (11.5) 4,887 (14.1) 0.29
Obesity 50 (24.0) 9,565 (27.7) 0.25
Smoking 22 (12.9) 4,432 (16.5) 0.34
Experiencing homelessness 12 (9.8) 2,778 (12.0) 0.23
Living in longterm care facility 4 (3.3) 1,538 (6.7) 0.06
Intravenous drug use 12 (5.8) 4,225 (12.2) 0.002
None of the above 61 (29.3) 7,335 (21.2) 0.06
Unknown 5 (2.4) 589 (1.7)
Co-occurring syndromes
Otitis media 38 (18.3) NA NA
Pneumonia 27 (12.9) NA NA
Abscess 15 (8.0) NA NA
Septic shock 27 (13.0) NA NA
Cellulitis 18 (8.7) NA NA
Streptococcal toxic shock syndrome 6 (2.9) NA NA
None of the above 113 (52.9) NA NA
Outcome
Died (CFR) 43 (20.7) 3,936 (11.4) <0.001
Vaccine target coverage
emm type data available 169 (81.3) 28,568 (82.6)
emm type in 30-valent vaccine§ 152 (89.9) 24,235 (84.8) 0.06
Antimicrobial susceptibility
Susceptibility data available 167 (80.3) 25210 (72.9)
Nonsusceptible
Erythromycin 20 (11.9) 5,217 (20.7) 0.004
Clindamycin 17 (10.2) 4,571 (18.1) 0.005
Levofloxacin 1 (0.6) 267 (1.1) 0.64

*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

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