Skip to main content
×
Home
    • Aa
    • Aa

The dynamic nature of group A streptococcal epidemiology in tropical communities with high rates of rheumatic heart disease

  • M. I. McDONALD (a1) (a2), R. J. TOWERS (a1), R. ANDREWS (a1), N. BENGER (a1), P. FAGAN (a1), B. J. CURRIE (a1) and J. R. CARAPETIS (a1)...
Summary
SUMMARY

Prospective surveillance was conducted in three remote Aboriginal communities with high rates of rheumatic heart disease in order to investigate the epidemiology of group A β-haemolytic streptococci (GAS). At each household visit, participants were asked about sore throat. Swabs were taken from all throats and any skin sores. GAS isolates were emm sequence and pattern-typed using standard laboratory methods. There were 531 household visits; 43 different emm types and subtypes (emmST) were recovered. Four epidemiological patterns were observed. Multiple emmST were present in the population at any one time and household acquisition rates were high. Household acquisition was most commonly via 5- to 9-year-olds. Following acquisition, there was a 1 in 5 chance of secondary detection in the household. Throat detection of emmST was brief, usually <2 months. The epidemiology of GAS in these remote Aboriginal communities is a highly dynamic process characterized by emmST diversity and turnover.

Copyright
Corresponding author
*Author for correspondence: Dr M. I. McDonald, Menzies School of Health Research, PO Box 41096, Casuarina, 0811, NT, Australia. (Email: malcolm.mcdonald@menzies.edu.au)
References
Hide All
1. McDonald M, et al. Low rates of streptococcal pharyngitis and high rates of pyoderma in communities where rheumatic fever is hyperendemic. Clinical Infectious Diseases 2006; 43: 683689.
2. Wannamaker L. The epidemiology of streptococcal infections. In: McCarty M ed. Streptococcal Infections. New York: Columbia University Press, 1954, pp. 157175.
3. Quinn R, Lowry P, van der Zwaag R. Significance of hemolytic streptococci for Nashville school children: clinical and serologic observations. Southern Medical Journal 1978; 71: 242246.
4. Martin JM, et al. Group A streptococci among school-aged children: clinical characteristics and the carrier state. Pediatrics 2004; 114: 12121219.
5. Potter E, et al. Tropical acute rheumatic fever and associated streptococcal infections compared with concurrent acute glomerulonephritis. Journal of Pediatrics 1978; 92: 325333.
6. Majeed H, et al. Group A streptococcal strains in Kuwait: a nine-year prospective study of prevalence and associations. Pediatric Infectious Diseases Journal 1992; 11: 295300.
7. Anthony B, et al. The dynamics of streptococcal infections in a defined population of children: serotypes associated with skin and respiratory infections. American Journal of Epidemiology 1976; 104: 652666.
8. Kaplan EL, Wotton JT, Johnson DR. Dynamic epidemiology of group A streptococcal serotypes associated with pharyngitis. Lancet 2001; 358: 13341337.
9. Hartas J, et al. Characterisation of group A streptococcal isolates from tropical Australia with high prevalence of rheumatic fever: probing for signature sequences to identify members of the family of serotype 5. Microbial Pathogenesis 1995; 18: 345354.
10. Beall B, Facklam R, Thompson T. Sequencing emm-specific PCR products for routine and accurate typing of group A streptococci. Journal of Clinical Microbiology 1996; 34: 953958.
11. Centers for Diseases Control and Prevention (CDC). Streptococcus laboratory. Atlanta, Georgia, USA (http://www.cdc.gov/ncidod/biotech/strep/strepindex.htm). Accessed 2 January 2007.
12. Bessen D, et al. Genetic correlates of throat and skin isolates of group A streptococci. Journal of Infectious Diseases 1996; 173: 896900.
13. McGregor KF, et al. Group A streptococci from a remote community have novel multilocus genotypes but share emm-types and housekeeping alleles with isolates from worldwide sources. Journal of Infectious Diseases 2004; 189: 717723.
14. Carapetis JR. Ending the heartache: the epidemiology and control of acute rheumatic fever and rheumatic heart disease in the Top End of the Northern Territory [Ph.D. Thesis]. Sydney: University of Sydney, 1998.
15. McDonald M, et al. Recovering streptococci from the throat in remote tropical communities: a practical alternative to direct plating. Journal of Clinical Microbiology 2006; 44: 547551.
16. Bessen DE, et al. Contrasting molecular epidemiology of group A streptococci causing tropical and nontropical infections of the skin and throat. Journal of Infectious Diseases 2000; 182: 11091116.
17. McGregor KF, et al. Multilocus sequence typing of Streptococcus pyogenes representing most known emm types and distinctions among subpopulation genetic structures. Journal of Bacteriology 2004; 186: 42854294.
18. Williams S, Markey P. Acute post streptococcal glomerulonephritis in a remote community. Northern Territory Diseases Control Bulletin 2005; 12: 1618.
19. Massell B. Rheumatic Fever and Streptococcal Infection. Boston: Countway, 1997, p. 193.
20. Bisno A. Group A streptococcal infections and acute rheumatic fever. New England Journal of Medicine 1991; 325: 783793.
21. Abdissa A, et al. High diversity of group A streptococcal emm types among healthy schoolchildren in Ethiopia. Clinical Infectious Diseases 2006; 42: 13621367.
22. Teixeira LM, et al. Genetic and phenotypic features of Streptococcus pyogenes strains isolated in Brazil that harbor new emm sequences. Journal of Clinical Microbiology 2001; 39: 32903295.
23. Pruksakorn S, et al. Epidemiological analysis of non-M-typeable group A Streptococcus isolates from a Thai population in northern Thailand. Journal of Clinical Microbiology 2000; 38: 12501254.
24. Sharma M, et al. Heterogeneity of community based paediatric GAS isolates from India: challenges to the multivalent vaccine. In: Sriprakash KS ed. Streptococci – New Insights into an Old Enemy. Amsterdam: Elsevier, 2006, pp. 4953.
25. Tanaka D, et al. emm typing of group A streptococcus clinical isolates: identification of dominant types for throat and skin isolates. Microbiology and Immunology 2002; 46: 419423.
26. Dicuonzo G, et al. Group A streptococcal genotypes from pediatric throat isolates in Rome, Italy. Journal of Clinical Microbiology 2001; 39: 16871690.
27. Danchin MH. Disease burden and management of group A streptococcal pharyngitis in primary care in Australia. Department of Paediatrics [Ph.D. Thesis]. Melbourne: University of Melbourne, 2006.
28. Miner LJ, et al. Molecular characterization of Streptococcus pyogenes isolates collected during periods of increased acute rheumatic fever activity in Utah. Pediatric Infectious Diseases Journal 2004; 23: 5661.
29. Davies MR, et al. Evidence for increased horizontal gene transfers among streptococci from group A streptococcal endemic regions. In: Sriprakash KS ed. Streptococci – New Insights into an Old Enemy. Amsterdam: Elsevier, 2006, pp. 188192.
30. Hu MC, et al. Immunogenicity of a 26-valent group A streptococcal vaccine. Infection and Immunity 2002; 70: 21712177.
31. Shulman S, et al. Temporal changes in streptococcal M protein types and near-disappearance of acute rheumatic fever in the United States. Clinical Infectious Diseases 2006; 42: 441447.
32. Dunlap M, Harvey H. The carrier state and type-specific immunity in streptococcal disease. American Journal of Diseases of Children 1967; 114: 229243.
33. Guirguis N, et al. Type-specific immunity and pharyngeal acquisition of group A streptococcus. American Journal of Epidemiology 1982; 116: 933939.
34. Kaplan E, et al. Two year persistence of group A streptococci (GAS) in the throat accompanied by falling streptococcal antibody titers: the upper respiratory carrier state confirmed and microbiologically/immunologically examined. Proceedings of the XVIth Lancefield International Symposium on Streptococci and Streptococcal Diseases. Palm Cove, Queensland, Australia, 2005.
35. Wannamaker L, et al. Studies on immunity to streptococcal infections in man. American Journal of Diseases of Children 1953; 86: 347348.
36. Lancefield R. Persistence of type-specific antibodies in man following infection with group A streptococci. Journal of Experimental Medicine 1959; 110: 271292.
37. Dillon H. Post-streptococcal glomerulonephritis following pyoderma. Reviews of Infectious Diseases 1979; 1: 935945.
38. Dingle J, Badger G, Jordan W. Streptococcal infections. In: Illness in the Home: A Study of 25,000 Illnesses in a Group of Cleveland Families. Cleveland: Press of Western Reserve University, 1964, pp. 97117.
39. Levine J, et al. Studies on the transmission within families of group A hemolytic streptococci. Journal of Laboratory and Clinical Medicine 1966; 67: 483494.
40. Jaggi P, et al. Age influences the emm type distribution of pediatric group A streptococcal pharyngeal isolates. Pediatric Infectious Diseases Journal 2005; 24: 10891092.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
  • URL: /core/journals/epidemiology-and-infection
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Full text views

Total number of HTML views: 1
Total number of PDF views: 13 *
Loading metrics...

Abstract views

Total abstract views: 151 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 23rd October 2017. This data will be updated every 24 hours.