Increasing incidence of invasive group A streptococcus disease in New Zealand, 2002–2012: A national population-based study

Williamson, Deborah A.; Morgan, Julie; Hope, Virginia; Fraser, John D.; Moreland, Nicole J.; Proft, Thomas; Mackereth, Graham; Lennon, Diana; Baker, Michael G; Carter, Philip E.

doi:10.1016/j.jinf.2014.09.001

Cited by 33 publications

(27 citation statements)

References 28 publications

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“…The estimated national incidence is similar to the incidence of invasive GAS in Canada (4.3/100 000) and many European countries (2–4/100 000) (CFR, 14%–19%) [17–21]. However, substantially higher rates of disease have been documented in other geographic areas, including Fiji (9.9/100 000), North Queensland, rural Kenya, and New Zealand (7.9/100 000) [22–25], as well as in European countries experiencing outbreaks, including Iceland (1.1–4.0/100 000), Sweden (6.1/100 000), and Ireland (0.8–2.7/100 000) [26–28]. …”

Section: Discussionmentioning

confidence: 81%

Epidemiology of Invasive Group A Streptococcal Infections in the United States, 2005–2012

et al. 2016

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Background Invasive group A Streptococcus (GAS) infections are associated with significant morbidity and mortality rates. We report the epidemiology and trends of invasive GAS over 8 years of surveillance. Methods From January 2005 through December 2012, we collected data from the Centers for Disease Control and Prevention’s Active Bacterial Core surveillance, a population-based network of 10 geographically diverse US sites (2012 population, 32.8 million). We defined invasive GAS as isolation of GAS from a normally sterile site or from a wound in a patient with necrotizing fasciitis (NF) or streptococcal toxic shock syndrome (STSS). Available isolates were emm typed. We calculated rates and made age- and race-adjusted national projections using census data. Results We identified 9557 cases (3.8 cases per 100 000 persons per year) with 1116 deaths (case-fatality rate, 11.7%). The case-fatality rates for septic shock, STSS, and NF were 45%, 38%, and 29%, respectively. The annual incidence was highest among persons aged ≥65 years (9.4/100 000) or <1 year (5.3) and among blacks (4.7/100 000). National rates remained steady over 8 years of surveillance. Factors independently associated with death included increasing age, residence in a nursing home, recent surgery, septic shock, NF, meningitis, isolated bacteremia, pneumonia, emm type 1 or 3, and underlying chronic illness or immunosuppression. An estimated 10 649–13 434 cases of invasive GAS infections occur in the United States annually, resulting in 1136–1607 deaths. In a 30-valent M-protein vaccine, emm types accounted for 91% of isolates. Conclusions The burden of invasive GAS infection in the United States remains substantial. Vaccines under development could have a considerable public health impact.

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Section: Discussionmentioning

confidence: 81%

Epidemiology of Invasive Group A Streptococcal Infections in the United States, 2005–2012

et al. 2016

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“…The increase of emm 89 GAS strains in prevalence and incidence has been reported in many countries [4, 6, 7, 9, 12–17, 19, 31, 32]. The first 2 emm 89 bacteremic GAS strains in Finland were reported in 1996 [20], and since then this emm type has progressively increased in number [11].…”

Section: Discussionmentioning

confidence: 99%

Genomic Characteristics Behind the Spread of Bacteremic Group AStreptococcusTypeemm89 in Finland, 2004–2014

et al. 2016

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Background. Many countries worldwide have reported increasing numbers of emm89 group A Streptococcus (GAS) infections during last decade. Pathogen genetic factors linked to this increase need assessment.Methods. We investigated epidemiological characteristics of emm89 GAS bacteremic infections, including 7-day and 30-day case-fatality rates, in Finland during 2004–2014 and linked them to whole-genome sequencing data obtained from corresponding strains. The Fisher exact test and exact logistic regression were used to compare differences between bacteremic infections due to emm89 GAS belonging to different genetic clades and subclades.Results. Out of 1928 cases of GAS bacteremic infection, 278 were caused by emm89 GAS. We identified 2 genetically distinct clades, arbitrarily designated clade 2 and clade 3. Both clades were present during 2004–2008, but clade 3 increased rapidly from 2009 onward. Six subclades (designated subclades A–F) were identified within clade 3, based on phylogenetic core genome analysis. The case-fatality rate differed significantly between subclades (P < .05), with subclade D having the highest 30-day estimated case-fatality rate (19% vs 3%–14%).Conclusions. A new emm89 clone, clade 3, emerged in 2009 and spread rapidly in Finland. Patients infected with certain subclades of clade 3 were significantly more likely to die. A specific polymerase chain reaction assay was developed to follow the spread of subclade D in 2015.

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“…In order to compare the collection of ARF-associated GAS strains with other GAS-related clinical syndromes, we included contemporaneous strains from invasive GAS infections and strains recovered from cases of presumptive GAS pharyngitis. The 2,681 invasive strains were collected over an 11-year period (2002 to 2012) and have been well described (12). GAS pharyngeal isolates were obtained from a prospective study conducted in Auckland, New Zealand, in 2013 (13).…”

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confidence: 99%

M-Protein Analysis of Streptococcus pyogenes Isolates Associated with Acute Rheumatic Fever in New Zealand

et al. 2015

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We applied an emm cluster typing system to group A Streptococcus strains in New Zealand, including those associated with acute rheumatic fever (ARF). We observed few so-called rheumatogenic emm types but found a high proportion of emm types previously associated with pyoderma, further suggesting a role for skin infection in ARF.T wo of the most significant consequences of group A streptococcal (GAS) infection are acute rheumatic fever (ARF) and its sequelae, rheumatic heart disease (RHD). New Zealand has among the highest incidences of ARF in the developed world, with the greatest burden of disease in indigenous New Zealand (Ma ori) and Pacific populations (1).Contemporary molecular typing of GAS is carried out by sequence analysis of the hypervariable region of the emm gene that encodes the M protein (2). Studies in the United States have suggested an association between distinct GAS emm types (so-called rheumatogenic strains, such as emm3, emm5, emm6, and emm18) and ARF (3). However, more recent epidemiological studies in areas where ARF is common today have found that ARF is not restricted to these rheumatogenic strains (4), raising questions around the concept of rheumatogenicity and emm type. It has further been postulated that certain GAS emm types (most notably emm3) may be rheumatogenic due to the presence of a specific collagen-binding motif, designated peptide associated with rheumatic fever (PARF), which elicits an immune response to type IV collagen (5, 6). To date, however, the presence of the PARF motif has not been systematically assessed in a large collection of GAS strains temporally associated with ARF.Recently, an Australian and New Zealand GAS vaccine development program (the Coalition to Accelerate New Vaccines Against Streptococcus [CANVAS]) was formed with the aim of identifying suitable vaccine GAS candidates for both the Australian and New Zealand settings, and more widely (7). At present, the most clinically advanced GAS vaccine candidates are those that target the N-terminal region of the M protein, such as an experimental 30-valent M-protein vaccine (8). While this vaccine includes the classical rheumatogenic emm types, there have been few analyses to inform the coverage of contemporary ARF strains. Recently, an emm cluster-based typing system that classifies known emm types into 48 related emm clusters has been applied to several collections of GAS isolates and has shed new insights into the epidemiology of GAS and the potential vaccine coverage of M-protein-based vaccines (9, 10). The emm cluster system also predicts an emm pattern type that in turn correlates well with tissue tropism (pattern A-C for pharyngeal, pattern D for skin, and pattern E for either) (9). Accordingly, the aims of this study were to (i) compare the molecular epidemiology and theoretical vaccine coverage of GAS isolates associated with ARF in New Zealand with those of GAS isolates recovered from other GAS-related clinical syndromes, and (ii) identify GAS isolates containing the PARF motif and associate the pre...

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Increasing incidence of invasive group A streptococcus disease in New Zealand, 2002–2012: A national population-based study

Cited by 33 publications

References 28 publications

Epidemiology of Invasive Group A Streptococcal Infections in the United States, 2005–2012

Epidemiology of Invasive Group A Streptococcal Infections in the United States, 2005–2012

Genomic Characteristics Behind the Spread of Bacteremic Group AStreptococcusTypeemm89 in Finland, 2004–2014

M-Protein Analysis of Streptococcus pyogenes Isolates Associated with Acute Rheumatic Fever in New Zealand

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