Adverse events following mass antibiotic prophylaxis during a Group A Streptococcus outbreak in the Canadian Forces Leadership and Recruit School

• Published in: Canada communicable disease report Vol. 46; no. 9; pp. 264 - 271
• Main Authors: Lu, Diane, Strauss, Barbara, Simkus, Kristen, Tepper, Martin, Gagnon, François, Johnson, Noémie, Girard, Eric, Barnes, Kirsten
• Format: Journal Article
• Language: English
• Published: Ottawa Public Health Agency of Canada 03.09.2020
• Subjects: Allergies; Antibiotics; Armed forces; Azithromycin; Disease prevention; Epidemics; Gastrointestinal symptoms; Gram-positive bacteria; Injection; Language policy; Leadership; Military; Military personnel; Military training; Nausea; Outbreaks; Pain; Penicillin; Personnel; Polls & surveys; Prophylaxis; Streptococcus; Streptococcus infections; Surveillance; Teachers; Teaching methods; Training; Vomiting; United States > US
• DOI: 10.14745/ccdr.v46i09a03
• ISSN: 1481-8531; 1188-4169

Background: Between December 2016 and March 2018, two outbreaks of Group A Streptococcus (GAS) infection occurred at the Canadian Forces Leadership and Recruit School. A voluntary mass antibiotic prophylaxis (MAP) program was implemented in March 2018, to interrupt an ongoing GAS outbreak, and to prevent future outbreaks. Methods: Instructors and recruits were offered a one-time intramuscular injection of 1.2 million units penicillin G benzathine (PGB). Individuals with a penicillin allergy were offered azithromycin; 500 mg orally once weekly for four consecutive weeks. Instructors and recruits were also asked to complete a voluntary and anonymous survey one week after receipt of MAP, to detect MAP-related adverse events. Results: MAP was offered to 2,749 individuals; 2,707 of whom agreed to receive it (98.5% uptake). The majority of personnel experienced adverse events in the days following MAP; 92.3% of personnel who received PGB reported localized pain at the injection site, and 70.2% of personnel who received azithromycin reported gastrointestinal symptoms. However, only five cases of serious adverse events were reported, and less than 1% of recruits could not complete their basic military training course because of MAP-related adverse events. Conclusion: The MAP program implemented in March 2018 was the first of its kind in the Canadian Armed Forces, and the largest single use of PGB in a defined group in Canada. It resulted in very few serious adverse events and with minimal impact on military recruits’ successful completion of recruit training.