Bacteria called group A Streptococcus (group A strep; GAS) can cause many different infections. Invasive group A strep (iGAS) infections include necrotizing fasciitis and streptococcal toxic shock syndrome. The most common iGAS outbreaks investigated in the United States are those occurring in long-term care facilities (LTCFs). Healthcare-associated iGAS clusters can also involve postpartum and post-surgical infections. Outbreaks and clusters of healthcare-associated iGAS often require urgent public health action. Even a single case of iGAS warrants investigation and follow-up, to rule out a larger problem.

Featured Resources:

• CDC has a toolkit for identifying and managing LTCF Group A Strep outbreaks. This toolkit is intended for use by personnel in state, tribal, local, and territorial public health departments and LTCFs, including skilled nursing and rehabilitation facilities.
• • A decision tool outlines detailed actions that investigators should consider, depending on the number of cases identified.
  • The toolkit reviews the multiple routes of transmission that are common in LTCFs and describes how GAS outbreaks can involve multiple facilities.
  • These tools can also be used to respond to non-invasive GAS infections, such as clusters of wound infections or pharyngitis.
  • Additional resources, including state health department group A strep investigation toolkits are available here.
• A CDC led workshop resulted in recommendations for the control of iGAS among exposed household contacts, as well as recommendations for responding to postpartum and postsurgical iGAS.
• The North Carolina Department of Health and Human Services developed a resource containing steps that healthcare facilities can take to conduct surveillance for iGAS among postpartum or postsurgical patients. This same document contains a list of infection control practices which might be assessed in facilities as part of GAS prevention or response activities.
• A CDC outbreak report examined the role of working while ill, described as “presenteeism,” in introduction and transmission of GAS among a skilled nursing facility community.
• CDC is available to assist state, tribal, local, and territorial health departments for GAS outbreaks, particularly for persistent, large, or severe outbreaks. For assistance, contact gasoutbreaks@cdc.gov.