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APHA Scientific Session and Event Listing

Yael Bar-Ze'ev, MD¹, Oshri Wasserzug, MD¹, Lea Valinsky, PhD², Zina Korenman, MSc², Nadav Davidovitch, MD, MPH, PhD³, Eyal Klement, DVM, MSc⁴, Raid Kayouf, MSc¹, and Salman Zarka, MD, MPH⁵. (1) Army Health Branch, Medical Corps, IDF, 02149, Tel Hashomer, Israel, 972-3-9772625, zahbar@zahav.net.il, (2) Central Laboratories, Israeli Ministry of Health, 9 Yaakov Eliav, Jerusalem, Israel, (3) Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 West 168th Street, 9th floor, New York, NY 10032, (4) Army Health Branch, Medical Corps, IDF, 02149, Tel Hashomer, Israel, (5) Army Health Branch and Haifa University School of Public Health, Medical Corps, IDF and Haifa University, 02149, Tel Hashomer, Israel

Background: Ecthyma, an ulcerated form of impetigo, is usually caused by Group A Streptococcus (GAS). Objective: To describe three ecthyma outbreaks that occurred in different special forces units in the Israeli Defense Force (IDF) from October 2004 through February 2005. The need for prophylactic antibiotic treatment will also be discussed. Methodology: The soldiers were examined and samples from ecthyma sores, pharynx and anterior nares were cultured. Serological T typing and genetic emm - typing was performed on all isolates. Results: The first outbreak was exceptional clinically and epidemiologically. Ecthyma was diagnosed in 49 out of a 55 soldiers company (attack rate 89%) and pharyngeal GAS carriage rate was 60%. The sequel was severe: One case of streptococcal toxic shock, 4 cases of post streptococcal glomerulonephritis, 3 cases of pneumonia and one case of septic olecranon bursitis. Molecular typing analysis identified an uncommon emm type 81, T type 8, GAS as the cause of this outbreak. Shortly after, two ecthyma outbreaks were identified in other units. Isolates from the outbreaks were subjected to Pulsed Field Gel Electrophoresis, which showed that all outbreaks were caused by a single clone of GAS. A comprehensive epidemiological investigation revealed poor hygiene conditions coupled with training that allowed for frequent abrasions. We speculate that the 3 outbreaks were actually part of the same one, although no apparent common source was identified. Conclusions: This outbreak demonstrates the severe consequences that can be caused by a combination of a highly virulent GAS strain and favorable person-to-person transmission conditions.

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