CDC's Annual Epidemic Intelligence Service Conference
CDC's Annual Epidemic Intelligence Service Conference
Perspective from Anisa Ibrahim, MD, FAAP
May 06, 2019
2 min read

Antimicrobial prophylaxis halts GAS outbreak in children’s shelter

Perspective from Anisa Ibrahim, MD, FAAP
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Photo of Carla Bezold
Carla P. Bezold

ATLANTA — Research presented at the CDC’s Epidemic Intelligence Service Conference showed that an outbreak of group A Streptococcus, or GAS, in a shelter for unaccompanied migrant children that lasted more than 6 months and was stopped by the mass administration of antimicrobial prophylaxis to both children and staff members.

“This outbreak was unique because of the setting and the persistence of the infection,” Carla P. Bezold, ScD, MPH, an Epidemic Intelligence Service officer working with the Arizona Department of Health Services and the Maricopa County Department of Public Health, told Infectious Diseases in Children. “Successfully stopping this outbreak required a shelter-wide approach that involved multiple government agencies and the shelter staff.”

In January 2018, the local health department and the Office of Refugee Resettlement were notified about a GAS pharyngitis outbreak in the shelter. According to the researchers, transmission continued through July despite the fact that they implemented screening, targeted treatments and infection control interventions.

Bezold and colleagues assessed ORR surveillance to identify confirmed cases, which were identified as pharyngitis or lymphadenopathy with GAS isolation or a positive rapid test in children residing in the shelter. Infections occurring more than 5 days after arrival were considered to be acquired in the shelter.

Additionally, to identify cases among approximately 500 staff, the researchers conducted an anonymous survey about GAS symptoms in the past 6 months.

All children and staff were asked to begin antimicrobial therapy with either cephalexin or azithromycin.

During the outbreak, 195 cases of GAS were confirmed among children in the shelter. Nearly all (93%) children acquired the infection in the shelter. Most of the infected children (73%) were from Guatemala, with a median age of 16 years.

According to the researchers, 403 staff members completed the survey. Suspected GAS pharyngitis was identified in 36% of the staff. More than half (69%) of these staff members worked while ill.

The Maricopa County Department of Public Health administered 961 antibiotic courses for children (n = 423) and staff (n = 538). The outbreak ended on Aug. 7.

“Engaging staff as essential partners in the response was key to stopping this outbreak and should be done as early as possible,” Bezold said. “Regular education and engagement with staff about handwashing, identifying symptoms of GAS and staying home when ill can help prevent future outbreaks.” – by Katherine Bortz


Bezold CP, et al. Use of mass antimicrobial prophylaxis to stop a group A Streptococcus outbreak among unaccompanied children in a shelter, Maricopa County, Arizona, January-August 2018. Presented at: Epidemic Intelligence Service Conference; April 29-May 2, 2019; Atlanta.

Disclosure: Bezold reports no relevant financial disclosures.