Increasing Incidence of Invasive Group A Streptococcus Disease in First Nations Population, Alberta, Canada, 2003–2017

Abstract

G AS disease is caused by the gram-positive coccus bacterium Streptococcus pyogenes; invasive GAS (iGAS) disease is typically defined as identification of GAS from any sterile site, including blood, cerebrospinal fluid, brain, and deep tissues. GAS affects persons worldwide and causes a wide array of diseases including pharyngitis, skin infections (e.g., impetigo and cellulitis), bacteremia, pneumonia, septic arthritis, rheumatic fever, rheumatic heart disease, and the severe invasive diseases necrotizing fasciitis and streptococcal toxic shock syndrome (1,2). The epidemiology of many of these diseases varies by region; pharyngitis is more common in high-income countries, and diseases such as impetigo are more common in tropical climates and low-income countries (3,4). In 2005, the mortality rate associated with GAS disease (noninvasive and invasive) was ≈500,000 deaths/year (2). GAS bacteria can be typed by identifying variability in the DNA sequence at the tip of a coiled-coil protein on the bacteria's surface (the M protein), which is encoded by the emm gene. Worldwide, there are >240 emm types (5,6). Prevalence of emm types varies according to population and geography (7). In addition, the diversity of emm types is greater in developing countries and less in more developed countries (8-10). Previous studies have shown that rates of iGAS disease are higher for indigenous populations than for other populations (11-15). Examples include Native Americans in Arizona and Alaska and indigenous communities in parts of Australia and northwestern Ontario, Canada. For parts of the country such as western Canada, detailed descriptive data on iGAS in the indigenous population are lacking. We previously reported increased age-standardized rates of iGAS in Alberta's general population and increasing incidence from a low of 4.2 cases/100,000 persons in 2003 to a high of 10.2 cases/100,000 persons in 2017 (16). On the basis of that finding, we explored whether iGAS rates also increased for the First Nations population of Alberta during the same period. Methods Case and Population Data All iGAS cases were identified by diagnostic microbiology laboratories in Alberta, where iGAS disease is listed as a Public Health Notifiable Disease (https:// open.alberta.ca/publications/streptococcal-disease

Pathogenesis, epidemiology and control of Group A Streptococcus infection

“…It remains critical to have access to better local and global surveillance systems for tracking GAS diseases, given that studies have shown that vulnerable close contacts of patients with mild diseases are at greater risk of invasive infections 34 . In addition, a significant increase in the incidence of invasive GAS disease has been documented in several countries, particularly in disadvantaged and vulnerable populations 4,[35][36][37] , again highlighting the importance of closely monitoring GAS epidemiology. It should be noted that improved centralized healthcare reporting systems might also have contributed to the detected increase.…”

Staphylococcus aureus Community-acquired Pneumonia in Children After 13-Valent Pneumococcal Vaccination (2008–2018): Epidemiology, Clinical Characteristics and Outcomes

“…An increment in the frequency of invasive diseases caused by S. pyogenes, including pneumonia, has been reported in several countries. 6,[15][16][17] In a study conducted in France on the epidemiology of community-acquired pleural empyema, the frequency of pneumococcal infection declined from 79.1% in 2009 to 36.4% in 2017 (P < 0.001), with S. pyogenes being the leading cause in the later years of the study period (2015-2017, 45.5%). 4 Because of the stable prevalence of S. aureus CAP, recent updates to guidelines recommend maintaining aminopenicillins as first-line treatment for most cases of CAP, since they remain highly active against S. pyogenes and S. pneumoniae.…”

Respiratory carriage of hypervirulent Klebsiella pneumoniae by indigenous populations of Malaysia

“…It is well documented that similar communities across the world are at increased risk of respiratory disease. Such examples include from the epidemiology of severe community acquired pneumonia in Australian Aboriginals [ 42 ] to increased incidence of invasive Group A Streptococci in First Nations populations in Alberta Canada [ 43 ] and Staphylococcus aureus disease in Native American individuals, where burden is many times the national average [ 44 ]. Whilst we have not determined K. pneumoniae disease burden in our Orang Ulu and Asli populations, this study is an important step in future attempts to do so.…”