Modes of transmission and attack rates of group A Streptococcal infection: a protocol for a systematic review and meta-analysis

Abstract

Background Group A Streptococcus (Strep A) is an important cause of mortality and morbidity globally. This bacterium is responsible for a range of different infections and post-infectious sequelae. Summarising the current knowledge of Strep A transmission to humans will address gaps in the evidence and inform prevention and control strategies. The objective of this study is to evaluate the modes of transmission and attack rates of group A streptococcal infection in human populations. Methods This systematic review protocol was prepared according to the Preferred Reporting Items for Systematic reviews and Meta-analysis Protocols (PRISMA-P) 2015 Statement. Using a comprehensive search strategy to identify any transmission studies that have been published in English since 1980, full-text articles will be identified and considered for inclusion against predefined criteria. We will include all studies reporting on Strep A transmission, who have identified a mode of transmission, and who reported attack rates. Risk of bias will be appraised using an appropriate tool. Our results will be described narratively and where feasible and appropriate, a meta-analysis utilizing the random-effects model will be used to aggregate the incidence proportions (attack rates) for each mode of transmission. In addition, we will also evaluate the emm genotype variants of the M protein causing Strep A infection and the association with transmission routes and attack rates, if any, by setting, socioeconomic background and geographical regions. Discussion We anticipate that this review will contribute to elucidating Strep A modes of transmission which in turn, will serve to inform evidence-based strategies including environmental health activities to reduce the transmission of Strep A in populations at risk of severe disease. Trial registration Systematic review registration: PROSPERO (CRD42019138472).

Group A streptococcal (GAS) infections amongst children in Europe: Taming the rising tide

“…The bacteria has been traditionally thought to spread by large respiratory droplets (when coughing, sneezing, or talking) from infected individuals, including asymptomatic carriers [ 6 ]. However, with advances in the methodological approaches, additional modes of transmission have been uncovered.…”

“…However, with advances in the methodological approaches, additional modes of transmission have been uncovered. Nasal secretions, sputum or spit, dust particles, skin-to-skin direct contact, indirect contact with surfaces or beddings/fabrics, food, and biological vectors like insects have now been proven to promote the transmission of bacteria [ 6 ].…”

Health-seeking behaviour and beliefs around sore throat in The Gambia: A qualitative study

“…Infection with Group A Streptococcus (Strep A, S. pyogenes) bacteria causes a broad spectrum of diseases, with the most common manifestations being sore throat and impetigo (skin lesions with pus or crusts) [1][2][3]. Its transmission has been traditionally attributed to large respiratory droplets, but is yet not fully understood [4]. Strep A infection also results in more severe complications such as acute rheumatic fever (ARF) and rheumatic heart disease (RHD), the latter being the leading cause of cardiac-related disease among people under age 25 worldwide [5][6][7].…”

Health-seeking behaviour and beliefs around sore throat in The Gambia: a qualitative study

“…1,2 ,3 Its transmission has been traditionally attributed to large respiratory droplets, but is yet not fully understood. 4 StrepA infection also results in more severe complications such as acute rheumatic fever (ARF) and rheumatic heart disease (RHD), the latter being the leading cause of cardiac-related disease among people under age 25 worldwide. 5,6,7 ARF occurs because of cross-reactivity between similar antigens found in the pathogen and the human host, primarily found in the heart and the brain.…”