Active Bacterial Core surveillance (ABCs)

http://ceip.us/projects/abcs/(opens in a new tab)

Group A Streptococcus (
https://www.cdc.gov/streplab/groupa-strep/index.html).

Overview

CEIP conducts active, laboratory, population-based surveillance and special studies for invasive bacterial diseases due to pathogens of public health importance in the three-county catchment area of Alameda, Contra Costa, and San Francisco counties. For each case of invasive disease in the study population, CEIP generates a case report with basic demographic information and sends bacterial isolates from normally sterile sites to CDC for laboratory testing.

Objectives

  • Determine the incidence and epidemiologic characteristics of invasive disease due to group A Streptococcus, group B Streptococcus, Haemophilus influenzae, Neisseria meningitidis, and Streptococcus pneumoniae, in several large populations.
  • Determine molecular epidemiologic patterns and microbiologic characteristics of public health relevance for isolates causing invasive infections for select pathogens.
  • Provide an infrastructure for further research, such as special studies aimed at identifying risk factors for disease, post-licensure evaluation of vaccine effectiveness, and monitoring effectiveness of prevention policies.

Main Components

Surveillance

Case Definition

  • A case of invasive bacterial disease is defined as isolation of H.influenzae, N. meningitidis, group A Streptococcus, group B Streptococcus, or S. pneumoniae from a normally sterile site.
    • Bacterial isolation is done by culture and culture independent diagnostic tests (CIDT) such as PCR.
    • A normally sterile site is defined as a portion of the human body in which no microorganisms are found in a healthy state and include (but are not limited to) the following: blood, cerebrospinal fluid (CSF), pleural fluid, peritoneal fluid, pericardial fluid, surgical aspirate, bone, joint fluid, or internal body site (e.g., lymph node, brain).
      • An exception to the sterile site rule applies for group A Streptococcus only: If group A Streptococcus is isolated from a wound, abscess or other tissue culture and accompanied by necrotizing fasciitis or streptococcal toxic shock syndrome (STSS), it is considered a case.
    • A resident of Alameda, Contra Costa, or San Francisco counties

Yearly surveillance reports from all ten EIP sites for pathogens under surveillance are available in PDF format at CDC’s ABCs Surveillance Reports site.

Current Projects

  1. Active surveillance for invasive disease caused by groups A and B Streptococcus, H. influenzae, N. meningitidis, and S. pneumoniae.
  2. Isolate collection and testing of all isolates of Group A Streptococcus, Group B Streptococcus, H. influenzae, N. meningitidis, and S. pneumoniae.
  3. Enhanced Surveillance for Invasive Early-Onset and Late-Onset Group B Streptococcal (EOGBS) and (LOGBS) Disease—Missed Opportunities for Prevention
    – The goal of this study is to assess implementation of interventions to prevent perinatal transmission and risk factors for neonatal sepsis cases of invasive EOGBS (cases <7 days of age) and LOGBS (cases 7- 89 days old) prenatal screening.
  4. Active Surveillance for Pathogens Causing Neonatal Sepsis – Expanded surveillance for all culture-confirmed cases of bacterial sepsis and/or meningitis (excluding coagulase-negative Staphylococcus and contaminants) in infants aged 0-2 days of age. Data collected includes labor and delivery, maternal risk factor information, and newborn clinical information abstracted from infant and maternal delivery charts.
  5. Enhanced Surveillance for Invasive Pneumococcal Disease – Demographic information and vaccination history are collected from the California Immunization Registry (CAIR) and/or medical charts for all invasive pneumococcal infections in children ≥2 months to <5 years of age and adults ≥65 years of age. Results from this expanded surveillance will enable the detection of pneumococcal conjugate vaccine failures or failures to vaccinate in these vulnerable populations.
  6. Enhanced Surveillance for Severe Invasive Group A Streptococcus (GAS) Infections – A standardized supplemental form is completed for all GAS positive cases to enhance detection and further refine the case definitions of necrotizing fasciitis (NF) and streptococcal toxic shock syndrome (STSS).
  7. Disseminated Gonococcal Infections (DGI) – In 2017, CEIP started surveillance for Neisseria gonorrhoeae from sterile sites to identify disseminated Gonococcal infections (DGI). Retrospective case ascertainment was performed for 2015-2016. Cases are identified through the current ABCs surveillance methods and a standardized case report form is completed. Isolates, if available, are sent to CDC for testing.

Related link
Surveillance for Disseminated Gonococcal Infections, Active Bacterial Core surveillance (ABCs) – United States, 2015–2019

Current Special Studies

Group B Strep Case-Control Study

The California Emerging Infections Program (CEIP), in partnership with the Centers for Disease Control and Prevention (CDC), the Bill & Melinda Gates Foundation, and the Kaiser Permanente Division of Research is conducting a multi-site research study to understand how a pregnant woman’s immune system helps protect her baby from group B Streptococcus (GBS) infection.

Cases of GBS infection in young infants are identified through routine ABCs surveillance. Controls are women colonized with GBS during pregnancy whose infants do not develop GBS infection.

The study’s primary objectives are to estimate antibody concentration and function associated with an 80% reduction in odds of GBS disease among infants for the two most common serotypes of GBS. The results from this study may inform the development of a vaccine for mothers to protect newborns from GBS infection.

Completed Projects

  1. Assessing underlying complement deficiencies among Neisseria meningitidis cases reported through ABCs – CEIP collected supplemental surveillance information on complement deficiency testing and results among meningococcal disease cases with culture dates in 2019-2023. The objectives of this project were to inform meningococcal vaccine recommendations for individuals with complement deficiencies, to inform complement deficiency testing guidance for meningococcal disease patients and to improve understanding of US meningococcal disease epidemiology.
    McNamara LA, Potts CC, Blain A, et al. Invasive Meningococcal Disease due to Nongroupable Neisseria meningitidis-Active Bacterial Core Surveillance Sites, 2011-2016. Open Forum Infect Dis. 2019;6(5):ofz190. Published 2019 Apr 15.
  2. H. influenzae Neonatal Sepsis Expanded Surveillance (HINSES) – An extended case report form was completed for all cases of invasive H. influenzae among infants 0-30 days of age, pregnant women, and women who delivered ≤30 days prior to specimen collection (including stillbirth or abortion). HINSES surveillance was conducted from January 1, 2016, through December 31, 2020. The objectives of this project were to monitor the incidence of and further characterize H. influenzae neonatal sepsis and H. influenzae disease in pregnant and post-partum women; monitor maternal risk factors associated with neonatal H. influenzae disease; and monitor the association between maternal H. influenzae infection and neonatal H. influenzae disease.
  3. Surveillance for Non-Bacteremic Pneumococcal Pneumonia (SNIPP) – CEIP conducted population-based surveillance for non-invasive pneumococcal pneumonia (SNIPP) cases among adults. The purpose of the project was to determine the incidence of SNIPP when PCV13 was not routinely recommended for adults and to measure disease burden in the years following the 2014 ACIP recommendation of routine use of PCV13 in series with PPSV23 for all adults aged ≥65 years. Surveillance for this project ended on December 31, 2020.
  4. Enhanced Collection of Vaccination History for All Invasive Haemophilus influenzae Type b (Hib) or of Unknown Type in Children Less Than 15 years of Age – For cases occurring between January 1, 1998 and December 31, 2006, CEIP collected additional information on cases of H. influenzae infection in persons less than 15 years of age in which the serotype is either type b (Hib) or unknown. Information collected included household risk factors, underlying humoral immune deficiencies, and vaccination history.
  5. Active Surveillance for Non A, Non B beta-hemolytic Streptococcal Invasive Disease – Active surveillance was conducted for all cases occurring in 2003, 2004, and 2005. Cases under surveillance were defined as: sterile site isolates of groups C, F, L, E, P, U, or V ß-hemolytic Streptococci, including the following (only if ß-hemolytic): S. dysgalactiae, S. equi, S. iniae, S. constellatus, S. phocae, S. canis, S. anginosus (or S. milleri group), S. porcinus, S. intermedius, S. didelphis. Isolates were collected whenever possible and forwarded to the CDC Streptococcus Laboratory for testing.
  6. Early Onset GBS Traceback Study – Beginning in May 2010, CEIP staff reviewed labor, delivery, and prenatal records of mothers of infants with early-onset GBS disease (aged < 7 days with GBS isolated from a normally sterile site) retrospectively identified from 2008-2009 cases. The medical record review gathered relevant prenatal and intrapartum information. Prenatal care providers were interviewed to determine if the mothers underwent screening prenatal for GBS. Relevant prenatal specimen laboratory records and standard operating procedure information for GBS specimens were obtained from the laboratory where the screening test was processed. The study results were published in the Obstetrics & Gynecology journal in 2014.
    Verani JR, Spina NL, Lynfield R, Schaffner W, Harrison L, Holst A, Thomas S, Garcia JM, Scherzinger K, Aragon D, Petit S, Thompson J, Pasutti L, Carey R, McGee L, Weston E, Schrag S. Early-onset Group B Streptococcal Disease in the United States: Potential for Further Reduction. Obstet Gynecol 2014; 123 4:828-837.
  7. Assessing the Effectiveness of Tetravalent Meningococcal Conjugate Vaccine (MCV4) among Persons Aged 11-27 Years – The purpose of this study was to conduct a case-control, retrospective study to evaluate the effectiveness of the tetravalent (A, C, Y, W-135) meningococcal conjugate vaccine against invasive meningococcal disease in persons aged ≥ 11 years old and born on or after January 1, 1986. MCV4 was licensed based on safety and immunogenicity data, without data on clinical efficacy. In February 2005, MCV4 was recommended by the Advisory Committee on Immunization Practices of the CDC for routine use among young adolescents aged 11-12 years, for those adolescents who have not previously received MCV4 before high school entry, college freshmen living in dormitories, and other populations at increased risk. Study enrollment began January 1, 2006 and ended on August 31, 2013. Data analysis has been completed at CDC and a manuscript has been accepted for publication. Publication details are pending.
  8. Evaluating the Effectiveness of a 13-Valent Pneumococcal Conjugate Vaccine (PCV13) among Children – S. pneumoniae (pneumococcus) is a significant cause of meningitis, pneumonia, and bacteremia in children. Since 2000, the use of the 7-valent pneumococcal conjugate vaccine (PCV7), has significantly reduced the incidence of invasive pneumococcal disease (IPD) in children less than five years-old. There is less IPD overall since the introduction of the vaccine, but the proportion of disease caused by pneumococcal strains other than the seven represented in the PCV7 vaccine has increased. In 2010, the FDA licensed a new vaccine, the 13-valent pneumococcal conjugate vaccine, that protects against an additional six serotypes, including 19-A, which is the serotype that now causes the greatest proportion of disease. The PCV13 Vaccine Effectiveness Study was a case-control study to evaluate the effectiveness of one or more doses of PCV13 vaccine against IPD caused by PCV13 serotypes (as a group) among children between 2 and 59 months old. Study enrollment began in August 2010 and ended in 2015. Primary data analysis was completed at CDC, and the study results were published in Lancet Respiratory Medicine in May 2016. Secondary analysis on the utility of using zip code to estimate socioeconomic status (SES) confounders was completed and published in SSM Population Health in December 2016.

    Moore MR, Link-Gelles R, Schaffner W, Lynfield R, Holtzman C, Harrison LH, Zansky SM, Rosen JB, Reingold A, Scherzinger K, Thomas A, Guevara RE, Motala T, Eason J, Barnes M, Petit S, Farley MM, McGee L, Jorgensen JH, Whitney CG. Effectiveness of 13-valent pneumococcal conjugate vaccine for prevention of invasive pneumococcal disease in children in the USA: a matched case-control study. Lancet Respir Med. 2016 May;4(5):399-406. doi: 10.1016/S2213-2600(16)00052-7. Epub 2016 Mar 14. Link-Gelles R, Westreich D, Aiello AE, Shang N, Weber DJ, Holtzman C, Scherzinger K, Reingold A, Schaffner W, Harrison LH, Rosen JB, Petit S, Farley M, Thomas A, Eason J, Wigen C, Barnes M, Thomas O, Zansky S, Beall B, Whitney CG, Moore MR. Bias with respect to socioeconomic status: A closer look at zip code matching in a pneumococcal vaccine effectiveness study. SSM Popul Health. 2016 Dec;2:587-594.

  9. Legionellosis Surveillance – From January 1, 2011, through December 31, 2015, CEIP conducted active surveillance for legionellosis. Legionellosis is a term used to describe any disease caused by Legionella bacteria, which usually manifests as one of two distinct diseases: 1) Legionnaires’ disease (LD), a serious, sometimes lethal, form of pneumonia, and 2) Pontiac fever (PF), a flu-like, self-limited illness. CEIP staff collected risk factor information for all suspect and confirmed cases of legionellosis to better describe the incidence and epidemiologic characteristics of the disease.
    Cooley LA, Pondo T, Francois Watkins LK, Shah P, Schrag S; Active Bacterial Core Surveillance Program of the Emerging Infections Program Network. Population-Based Assessment of Clinical Risk Factors for Legionnaires’ Disease. Clin Infect Dis. 2020;70(11):2428-2431

Publications

Andrejko K, Gierke R, Rowlands J, et al. 1718. Effectiveness of 13-valent pneumococcal conjugate vaccine for prevention of invasive pneumococcal disease among children in the United States between 2010 and 2019: an indirect cohort study, Vaccine 2024; ISSN 0264-410X,

Oliver SE, Rubis AB, Soeters HM, et al. Secondary Cases of Invasive Disease Caused by Encapsulated and Nontypeable Haemophilus influenaze – 10 U.S. Jurisdictions, 2011-2018. MMWR Morb Mortal Wkly Rep 2023;72;386-390.

Oliver SE, Rubis AB, Soeters HM, Reingold A, Barnes M, Petit S, Farley M, Harrison LH, Khanlian S, Wester R, Thomas A, Schaffner W, Marjuki H, Wang X, Hariri S. Epidemiology of Invasive Nontypeable Haemophilus influenzae Disease- United States, 2008-2019. Clin Infect Dis. 2023; ciad054

Prasad N, Rhodes J, Deng L, et al. Changes in the Incidence of Invasive Bacterial Disease During the COVID-19 Pandemic in the United States, 2014-2020. J Infect Dis. 2023;227(7):907-916.

Contact

For questions about ABCs surveillance and projects, please contact:
Maria Rosales
Project Coordinator, ABCs
abcs@ceip.us

ABCs Links

Archived Projects
https://ceip.us/projects/abcs/archived-projects/

CDC ABCs webpage: https://www.cdc.gov/abcs/index.html

Bact Facts Interactive allows you to analyze and visualize ABCs data:
https://www.cdc.gov/abcs/bact-facts-interactive.html