Prospective Surveillance of Invasive Group A Streptococcal Disease, Fiji, 2005–2007

Steer, Andrew C.; Jenney, Adam; Kado, Joseph; Good, Michael F.; Batzloff, Michael R.; Waqatakirewa, Lepani; Mullholland, E. Kim; Carapetis, Jonathan R.

doi:10.3201/eid15/2.080558

Cited by 39 publications

(45 citation statements)

References 26 publications

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“…The heterogeneity in S. pyogenes emm types is in agreement with other studies from developing countries and indigenous populations, all of which report highly diverse emm types among throat, skin, and invasive isolates (16,25,27). Not only are the isolates more heterogenic, but also the emm types are strikingly different from those in the Western population (17,28).…”

Section: Discussionsupporting

confidence: 79%

“…In contrast, results from the 2003-2004 European surveillance covering 11 countries reported 13% and 8% of cases with STSS and necrotizing fasciitis, respectively (15), and similar figures have been observed in Canada (8,11) and the United States (23). Two recent prospective studies from developing countries, including one from New Caledonia, which reported 43% of cases with necrotizing fasciitis but only low frequencies of STSS (3%) (16), and one from Fiji, where 5% and 7% of cases with STSS and necrotizing fasciitis, respectively, were noted (27).…”

Section: Discussionmentioning

confidence: 77%

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Clinical and Microbiologic Characteristics of Invasive Streptococcus pyogenes Infections in North and South India

et al. 2012

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fThe lack of epidemiologic data on invasive Streptococcus pyogenes infections in many developing countries is concerning, as S. pyogenes infections are commonly endemic in these areas. Here we present the results of the first prospective surveillance study of invasive Streptococcus pyogenes infections in India. Fifty-four patients with invasive S. pyogenes infections were prospectively enrolled at two study sites, one in the north and one in the south of India. Sterile-site isolates were collected, and clinical information was documented using a standardized questionnaire. Available acute-phase sera were tested for their ability to inhibit superantigens produced by the patient's own isolate using a cell-based neutralizing assay. The most common clinical presentations were bacteremia without focus (30%), pneumonia (28%), and cellulitis (17%). Only two cases of streptococcal toxic shock syndrome and no cases of necrotizing fasciitis were identified. Characterization of the isolates revealed great heterogeneity, with 32 different emm subtypes and 29 different superantigen gene profiles being represented among the 49 sterile-site isolates. Analyses of acute-phase sera showed that only 20% of the cases in the north cohort had superantigen-neutralizing activity in their sera, whereas 50% of the cases from the south site had neutralizing activity. The results demonstrate that there are important differences in both clinical presentation and strain characteristics between invasive S. pyogenes infections in India and invasive S. pyogenes infections in Western countries. The findings underscore the importance of epidemiologic studies on streptococcal infections in India and have direct implications for current vaccine developments.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 77%

Clinical and Microbiologic Characteristics of Invasive Streptococcus pyogenes Infections in North and South India

et al. 2012

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“…The overall annual incidence of invasive GAS disease in Alaska is slightly higher (5.8/100,000 population) than reported from CDC's Active Bacterial Disease Surveillance network (3.7/100,000; 2001 to 2013; http://www.cdc.gov /abcs/reports-findings/surv-reports.html). When we compared the incidence among Alaska Native persons (13.7/100,000) to that in non-AN persons (3.9/100,000), the rate was much higher among AN persons and similar to what has been reported for developing countries such as Fiji and for indigenous populations in Australia and New Zealand (38)(39)(40). In our study, the highest burden of disease was found among children Ͻ2 years of age (14.8 cases/100,000 persons) and adults Ͼ65 years of age (15.7 cases/ 100,000 persons).…”

Section: Discussionmentioning

confidence: 72%

Epidemiology of Invasive Group A Streptococcal Disease in Alaska, 2001 to 2013

et al. 2016

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The Arctic Investigations Program (AIP) began surveillance for invasive group A streptococcal (GAS) infections in Alaska in 2000 as part of the invasive bacterial diseases population-based laboratory surveillance program. Between 2001 and 2013, there were 516 cases of GAS infection reported, for an overall annual incidence of 5.8 cases per 100,000 persons with 56 deaths (case fatality rate, 10.7%). Of the 516 confirmed cases of invasive GAS infection, 422 (82%) had isolates available for laboratory analysis. All isolates were susceptible to penicillin, cefotaxime, and levofloxacin. Resistance to tetracycline, erythromycin, and clindamycin was seen in 11% (n ‫؍‬ 8), 5.8% (n ‫؍‬ 20), and 1.2% (n ‫؍‬ 4) of the isolates, respectively. A total of 51 emm types were identified, of which emm1 (11.1%) was the most prevalent, followed by emm82 (8.8%), emm49 (7.8%), emm12 and emm3 (6.6% each), emm89 (6.2%), emm108 (5.5%), emm28 (4.7%), emm92 (4%), and emm41 (3.8%). The five most common emm types accounted for 41% of isolates. The emm types in the proposed 26-valent and 30-valent vaccines accounted for 56% and 78% of all cases, respectively. GAS remains an important cause of invasive bacterial disease in Alaska. Continued surveillance of GAS infections will help improve understanding of the epidemiology of invasive disease, with an impact on disease control, notification of outbreaks, and vaccine development.

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“…Since the late 1980s, there has been an increase in the number of reports of invasive infections caused by S. pyogenes in Europe and the United States, with a significant preponderance of the emm1 and emm3 types (1,14,18,20). A few studies have recently reported a different GAS type distribution in developing countries and in indigenous populations (3,17,22). Knowledge of the emm type distribution in a region may shed more light on the pathogenesis of GAS infections and is crucial for selecting appropriate vaccine candidates which would include multiple M protective epitopes.…”

mentioning

confidence: 99%

Clinical and Microbial Characteristics of Invasive Streptococcus pyogenes Disease in New Caledonia, a Region in Oceania with a High Incidence of Acute Rheumatic Fever

et al. 2010

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New Caledonia is an archipelago in the South Pacific with a high prevalence of acute rheumatic fever and rheumatic heart disease. Conducted in 2006, this study aimed at characterizing clinical manifestations and microbial features of isolates obtained from invasive Streptococcus pyogenes disease. Clinical and demographic data were collected prospectively. Isolates were biotyped, T typed, emm sequenced, and tested for antibiotic susceptibility. Detection of the speA, speB, speC, and ssa genes was also carried out. The estimated annual incidence of invasive S. pyogenes disease in 2006 was high at 38 cases/100,000 inhabitants in New Caledonia. Invasive isolates were obtained from 90 patients with necrotizing fasciitis (41 cases), bacteremia with no identified focus (12 cases), myositis (10 cases), septic arthritis (9 cases), erysipelas (8 cases), postpartum infection (4 cases), myelitis and osteomyelitis (3 cases), severe pneumonia (2 cases), and endocarditis (1 case). The most frequent associated comorbidities were skin lesions (71%) and obesity (29%). Thirty-one different emm types were identified, and the following six accounted for 54% of the isolates: emm15 (15.5%), emm92 (12.2%), emm106 (8.9%), emm74 (6.7%), emm89 (5.6%), and emm109 (5.6%). The speA, speC, and ssa genes were expressed at different frequencies in the various emm types. The first epidemiological study of invasive S. pyogenes disease in New Caledonia highlights that emm type distribution is particular and should be taken into account in the development of an appropriate vaccine. These findings support the prevention of pyoderma and other cutaneous lesions in order to limit the development of both invasive disease and poststreptococcal sequelae in the South Pacific.

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Prospective Surveillance of Invasive Group A Streptococcal Disease, Fiji, 2005–2007

Cited by 39 publications

References 26 publications

Clinical and Microbiologic Characteristics of Invasive Streptococcus pyogenes Infections in North and South India

Clinical and Microbiologic Characteristics of Invasive Streptococcus pyogenes Infections in North and South India

Epidemiology of Invasive Group A Streptococcal Disease in Alaska, 2001 to 2013

Clinical and Microbial Characteristics of Invasive Streptococcus pyogenes Disease in New Caledonia, a Region in Oceania with a High Incidence of Acute Rheumatic Fever

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