Invasive Group A Streptococcal Infection | CDC EID

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Volume 17, Number 6–June 2011
Research
Invasive Group A Streptococcal Infection and Vaccine Implications, Auckland, New Zealand
Atheer Safar, Diana Lennon, Joanna Stewart, Adrian Trenholme, Dragana Drinkovic, Briar Peat, Susan Taylor, Kerry Read, Sally Roberts, and Lesley Voss
Author affiliations: Auckland City Hospital, Auckland, New Zealand (A. Safar, S. Roberts); The University of Auckland, Auckland (D. Lennon, J. Stewart); Kidz First Children's Hospital/Middlemore Hospital, Auckland (A. Trenholme); North Shore Hospital, Auckland (D. Drinkovic, K. Read); The University of Auckland/Middlemore Hospital, Auckland (B. Peat); Middlemore Hospital, Auckland (S. Taylor); and Starship Children's Hospital, Auckland (L. Voss)


Suggested citation for this article

Abstract
We aimed to assess the effect of invasive group A streptococcal (GAS) infection and the potential effects of a multivalent GAS vaccine in New Zealand. During January 2005–December 2006, we conducted prospective population-based laboratory surveillance of Auckland residents admitted to all public hospitals with isolation of GAS from normally sterile sites. Using emm typing, we identified 225 persons with confirmed invasive GAS infection (median 53 years of age; range 0–97 years). Overall incidence was 8.1 cases per 100,00 persons per year (20.4/100,000/year for Maori and Pacific Islanders; 24.4/100,000/year for persons > 65 years of age; 33/100,000/year for infants < 1 year of age). Nearly half (49%) of all cases occurred in Auckland's lowest socioeconomic quintile. Twenty-two persons died, for an overall case-fatality rate of 10% (63% for toxic shock syndrome). Seventy-four percent of patients who died had an underlying condition. To the population in our study, the proposed 26-valent vaccine would provide limited benefit.


During the 2 decades since recognition of streptococcal toxic shock syndrome (STSS), there have been many publications on invasive group A streptococcal (GAS) infections, some population-based (1–4). The spectrum of infection caused by Streptococcus pyogenes varies widely from invasive disease, such as bacteremia, sepsis, necrotizing fasciitis (NF), and STSS, to noninvasive infection, most commonly pharyngitis with suppurative complications, such as otitis media, and nonsuppurative complications, such as acute rheumatic fever (ARF) and acute glomerulonephritis (APSGN).

GAS infection causes a substantial number of illnesses and deaths, especially in the developing world, with ≈500,000 deaths worldwide annually, attributable mostly to ARF and its sequelae, rheumatic heart disease, and invasive infection (5). GAS disease and its sequelae, including GAS pharyngitis, have been well documented in New Zealand (6–12; http://dnmeds.otago.ac.nz/departments/womens/paediatrics/research/nzpsu/pdf/2008_report.pdf).

With renewed interest in GAS vaccines (13), understanding the complete spectrum of disease, including invasive GAS disease, in diverse populations is essential. The vaccine most completely studied is a 26-valent vaccine based on emm types and M subtypes collected across GAS diseases from the United States (14). We previously published a population-based approach of laboratory surveillance for invasive bacterial diseases in Auckland's public hospitals where all persons with acute disease would be admitted (8,15–18). Using this approach, we demonstrate the effects of invasive GAS on the Auckland population to complement our knowledge of other GAS-associated diseases by using prospectively collected incidence data, clinical characteristics, associated underlying conditions, and the associated emm types. This study also provided an opportunity to establish the direction of further investigations and to focus interventions in New Zealand.

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Invasive Group A Streptococcal Infection | CDC EID


Suggested Citation for this Article
Safar A, Lennon D, Stewart J, Trenholme A, Drinkovic D, Peat B, et al. Invasive group A streptococcal infection and vaccine implications, Auckland, New Zealand, 2005–2006. Emerg Infect Dis [serial on the Internet]. 2011 Jun [date cited]. http://www.cdc.gov/EID/content/17/6/983.htm

DOI: 10.3201/eid1706.100804


Comments to the Authors
Please use the form below to submit correspondence to the authors or contact them at the following address:

Diana Lennon, Community Paediatrics, The University of Auckland, Private Bag 92019, Auckland, New Zealand; email: d.lennon@auckland.ac.nz