Materiały źródłowe

• #1 Strep Throat – lji.org

  https://www.lji.org/diseases/strep-throat/

  Strep throat is one of a several conditions, among them pneumonia, scarlet fever, impetigo, and flesh-eating necrotizing fasciitis, caused by the bacterium Streptococcus pyogenes, better known as group A Streptococcus (GAS). Each year, some 600 million people worldwide contract strep throat, many of them children. Strep throat is easily treated with antibiotics; however undiagnosed or untreated strep throat can have serious complications, such as acute rheumatic fever, a major cause of acquired heart disease among young adults. […] Recurrent strep throat in children is also a problem worldwide. Even after antibiotic treatment, some children who experience recurrent strep will need to have their tonsils removed. […] Thus, LJI scientists continue to grapple with the mystery of why some children are more susceptible than others to contracting the disease.

• #2 Pathogenesis, epidemiology and control of Group A Streptococcus infection | Nature Reviews Microbiology

  https://www.nature.com/articles/s41579-023-00865-7

  Streptococcus pyogenes (Group A Streptococcus; GAS) is exquisitely adapted to the human host, resulting in asymptomatic infection, pharyngitis, pyoderma, scarlet fever or invasive diseases, with potential for triggering post-infection immune sequelae. […] Fluctuating global GAS epidemiology is characterized by the emergence of new GAS clones, often associated with the acquisition of new virulence or antimicrobial determinants that are better adapted to the infection niche or averting host immunity. […] The recent identification of clinical GAS isolates with reduced penicillin sensitivity and increasing macrolide resistance threatens both frontline and penicillin-adjunctive antibiotic treatment. […] The World Health Organization (WHO) has developed a GAS research and technology road map and has outlined preferred vaccine characteristics, stimulating renewed interest in the development of safe and effective GAS vaccines. […] This paper is a comprehensive epidemiological analysis of the global health burden of GAS diseases.

• #3 Group A Strep Disease Surveillance and Trends | Group A Strep | CDC

  https://www.cdc.gov/group-a-strep/php/surveillance/index.html

  Experts estimate that several million cases of non-invasive group A strep infections occur in the United States each year. […] For example, strep throat causes an estimated 5.2 million outpatient visits each year among people younger than 65 years old. […] Globally, the burden from non-invasive group A strep infections is even greater. […] Group A strep infections can occur any time during the year. […] However, some infections are more common in the United States in certain seasons: Strep throat and scarlet fever: Winter and spring. […] Acute rheumatic fever incidence is significantly less common in the United States and developed countries compared to less developed countries. […] Worldwide, rheumatic heart disease remains a significant cause of cardiovascular disease and death.

• #4 Evaluation of acute pharyngitis in adults – UpToDate

  https://www.uptodate.com/contents/evaluation-of-acute-pharyngitis-in-adults

  Acute pharyngitis accounts for approximately 12 million ambulatory care visits, or 1 to 2 percent of all ambulatory care visits, in the United States annually. The incidence peaks in childhood and adolescence with approximately 50 percent of all cases occurring before age 18. Among adults, most cases of acute pharyngitis occur by age 40 and incidence declines thereafter. […] The epidemiology, clinical features, and evaluation of acute pharyngitis in adults are reviewed here.

• #5 Bacterial Pharyngitis: Background, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/225243-overview

  Acute pharyngitis accounts for approximately 12 million annual ambulatory care visits in the United States. It ranks within the top 20 most-common primary diagnosis groups. […] In temperate climates, GAS pharyngitis occurs most commonly in the winter and early spring. Group A Streptococcus is responsible for 20-30% of sore throats in children and 5-15% of sore throats in adults. […] An estimated 616 million cases of GABHS pharyngitis occur annually worldwide. Rheumatic heart disease, which may be a consequence of GABHS pharyngitis, is estimated to cause about 6 million years of life lost annually. The burden of rheumatic heart disease disproportionately affects populations from developing countries. In terms of estimated global mortality, GABHS is one of the top 10 pathogens, behind HIV infection and malaria and ahead of tetanus and pertussis. […] GABHS pharyngitis is most common in individuals aged 5-15 years, although adults may also acquire the disease. Streptococcal pharyngitis is very uncommon in children younger than 3 years with the exception of children with risk factors such as an older close or household contact with GAS infection.

• #6 Streptococcal pharyngitis – Wikipedia

  https://en.wikipedia.org/wiki/Streptococcal_pharyngitis

  Pharyngitis, the broader category into which Streptococcal pharyngitis falls, is diagnosed in 11 million people annually in the United States. […] It is the cause of 15-40% of sore throats among children and 5-15% in adults. […] Cases usually occur in late winter and early spring.

• #7 Streptococcal Pharyngitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK525997/

  Streptococcal pharyngitis (GAS pharyngitis) is the most common bacterial cause of pharyngitis in children and adolescents, with a peak incidence in winter and early spring, and is also more common in those with a direct relation to school-aged children. The incidence of streptococcal pharyngitis declines dramatically from its peak among school-age children to middle-aged and older adults, with 93.2 cases per 1000 person-years at risk (PYAR) among children aged 3 to 9 years, 40.9 cases per 1000 PYAR in children aged 10 to 19, 8 cases per 1000 PYAR among adults aged 20 to 39, and only 1.1 cases per 1000 PYAR for adults 40 to 65 years of age. […] Accurate diagnosis requires a combination of clinical decision rules and rapid antigen detection testing (RADT), as history and physical exams alone are insufficient. […] Preventive measures are critical to reducing transmission, especially in close-contact environments.

• #8 Common Questions About Streptococcal Pharyngitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0701/p24.html

  Group A beta-hemolytic streptococcal (GABHS) infection causes 15% to 30% of sore throats in children and 5% to 15% in adults, and is more common in the late winter and early spring. […] Pharyngitis is diagnosed in 11 million persons in the outpatient setting each year in the United States. Although most episodes are caused by viruses, group A beta-hemolytic streptococcal (GABHS) infection accounts for approximately 15% to 30% of sore throats in children and 5% to 15% in adults. […] The prevalence of acute pharyngitis secondary to GABHS infection in adults ranges from 5% to 15%. GABHS pharyngitis is more common in late winter and early spring. […] The 2012 guidelines from the IDSA recommend backup throat cultures in children with negative RADT results to avoid the development of complications such as peritonsillar abscess, rheumatic fever, and poststreptococcal glomerulonephritis. […] A retrospective study analyzed data from 2006 to 2008 in 206,870 patients with sore throat who presented to a pharmacy-based clinic. […] Community-based surveillance in the United States of macrolide-resistant pediatric pharyngeal group A streptococci during 3 respiratory disease seasons.

• #9 Pathogen Safety Data Sheets: Infectious Substances – Streptococcus pyogenes – Canada.ca

  https://www.canada.ca/en/public-health/services/laboratory-biosafety-biosecurity/pathogen-safety-data-sheets-risk-assessment/streptococcus-pyogenes.html

  While S. pyogenes can colonize and infect various body sites, the most common infection caused by S. pyogenes is streptococcal pharyngitis, also known as strep throat. […] The carriage rate in children can be up to 20%, but is much lower in adults. […] More than 600 million cases of S. pyogenes-associated pharyngitis occur globally each year. […] S. pyogenes-associated pharyngitis most commonly affects children aged 5 to 15 years. […] Localized outbreaks of S. pyogenes disease in crowded or close-contact settings (e.g., hospitals, military camps, prisons, and daycares) have been reported. […] The estimated total global burden of severe S. pyogenes-associated disease is 517,000 deaths annually. […] The gold standard for S. pyogenes identification in throat specimens is isolation using culture-based methods. […] Rapid antigen detection tests that target the group A carbohydrate antigen can also be used to diagnose S. pyogenes pharyngitis.

• #10 Tonsillitis and Peritonsillar Abscess: Practice Essentials, Background, Pathophysiology and Etiology

  https://emedicine.medscape.com/article/871977-overview

  Tonsillitis most often occurs in children; however, the condition rarely occurs in children younger than 2 years. Tonsillitis caused by Streptococcus species typically occurs in children aged 5-15 years, while viral tonsillitis is more common in younger children. Peritonsillar abscess (PTA) usually occurs in teens or young adults but may present earlier. […] Between 2.5% and 10.9% of children may be defined as carriers. In one study, the mean prevalence of carrier status of schoolchildren for group A Streptococcus, a cause of tonsillitis, was 15.9%. […] According to Herzon et al, children account for approximately one third of peritonsillar abscess episodes in the United States. […] Recurrent tonsillitis was reported in 11.7% of Norwegian children in one study and estimated in another study to affect 12.1% of Turkish children.

• #11 Group A Streptococcal diseases: For health professionals – Canada.ca

  https://www.canada.ca/en/public-health/services/diseases/group-a-streptococcal-diseases/health-professionals.html

  Group A streptococcus (GAS) bacteria, Streptococcus pyogenes, are Gram-positive beta-hemolytic bacteria of which over 240 emm types (genotypes) have been identified. […] Infections typically peak during the winter and early spring and decrease over the summer. […] The Public Health Agency of Canada (PHAC) conducts annual national routine iGAS surveillance. This is done through the Canadian Notifiable Disease Surveillance System. iGAS has been nationally notifiable since January 2000. […] Non-invasive GAS (i.e., strep throat, scarlet fever) is not reported nationally. […] The National Microbiology Laboratory (NML) conducts laboratory-based surveillance of the bacteria that causes invasive GAS. Data are collected by the NML when provinces and territories send iGAS isolates for laboratory testing and emm sequencing. Laboratory data is an important source to monitor current trends in iGAS.

• #12

  https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON429

  As of 8 December 2022, at least five Member States in the European Region reported to WHO an increase in cases of invasive group A streptococcus (iGAS) disease and in some cases also scarlet fever. […] The incidence of GAS pharyngitis usually peaks during winter months and early spring. Outbreaks in kindergartens and schools are common. […] Enhanced surveillance activities have been implemented in the countries reporting an increase in iGAS cases, together with public health messages addressing the general population and clinicians, in order to enhance early recognition, reporting and prompt treatment initiation of GAS cases. […] WHO currently assesses the risk for the general population posed by the reported increase in iGAS infections in some European countries as low, considering the moderate rise in iGAS cases, GAS endemicity, no newly emerging emm gene sequence types identified, and no observed increases in antibiotic resistance. […] Clusters of cases of iGAS should be reported to local, regional or national health authorities to prompt further investigation.

• #13 Group A Strep Disease Surveillance and Trends | Group A Strep | CDC

  https://www.cdc.gov/group-a-strep/php/surveillance/index.html

  CDC tracks invasive group A Streptococcus (group A strep) disease using 2 surveillance systems. […] Rates of serious group A strep disease have been increasing since 2014. […] Preliminary 2023 data indicate the number of serious infections caused by group A strep reached a 20-year high. […] Overall, the number of serious group A strep infections has been increasing in the United States over the past decade. […] The U.S. rates of invasive group A strep disease began increasing in 2014. […] The increase was largest among adults aged 18 through 64 years old, but the rate also increased among older adults. […] Through ABCs, CDC tracks data on group A strep isolate resistance to certain antibiotics. […] Group A strep bacteria are not resistant to the first-line antibiotics for strep throat: penicillin and amoxicillin.

• #14 CDC study finds substantial US increase in invasive group A strep infections | CIDRAP

  https://www.cidrap.umn.edu/antimicrobial-stewardship/cdc-study-finds-substantial-us-increase-invasive-group-strep-infections

  A surveillance study of 10 US states shows the incidence of invasive group A Streptococcus (GAS) infection more than doubled from 2013 through 2022, researchers reported yesterday in JAMA. […] The authors of the study say that while that trend has continued, the substantial increase they found over the following decade reflects elevated incidence and outbreaks among groups that have been socially and economically marginalized. […] From 2013 through 2022, surveillance in the 10 states identified 21,312 cases of invasive GAS, with 20,247 hospitalizations and 1,981 deaths. […] Incidence of invasive GAS rose from 3.6 per 100,000 in 2013 to 8.2 per 100,000 in 2022. […] The increase in invasive GAS incidence came despite significant decreases during the COVID-19 pandemic, when incidence fell by 73% among children younger than 18 and by 33% among adults 65 and older.

• #15 Group A Streptococcus Infections in Children: Epidemiological Insights Before and After the COVID-19 Pandemic

  https://www.mdpi.com/2076-0817/13/11/1007

  Group A streptococcus (GAS) is the cause of both mild and invasive infections in humans with a high morbidity and mortality rate. The transmission of disease usually occurs via droplets, so the implementation of infection mitigation strategies (IMS) during the COVID-19 pandemic altered the incidence of GAS infection. […] A surge in the incidence of invasive GAS infection was noted in December 2022 after the reversal of IMS. A global uprise in GAS infection (invasive and non-invasive) was noted, especially concerning the pediatric population. […] Epidemiological data reflecting the influence of the COVID-19 pandemic on GAS infection are reported in many countries around the world. […] The COVID-19 pandemic led to a decrease in GAS-related bloodstream infections, as reported by Amarsy et al. in Paris, France, in 2020.

• #16 Incidence and treatment of group A streptococcal infections during covid-19 pandemic and 2022 outbreak: retrospective cohort study in England using OpenSAFELY-TPP | BMJ Medicine

  https://bmjmedicine.bmj.com/content/3/1/e000791

  Recording of codes for an indication of group A streptococcal infection in primary care peaked in December 2022 at 146260 (5.7 per 1000). This value represented a 1.5-fold increase from the last comparably high season in 2017-18 (93 340 or 3.9 per 1000). […] During the period of covid-19 restrictions, a marked decrease in infections was seen, with the maximum counts and rates lower than any minimum rates before the covid-19 pandemic. Patients with group A streptococcal infections increased in 2021-22 but with no distinct seasonal pattern, until peaking in December 2022. Primary care data can supplement existing infectious disease surveillance reports by linking with patient level prescribing data. […] A peak in group A streptococcal infections in England starting in December 2022 was associated with 426 deaths, including 48 children, as of 7 May 2023.

• #17

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9474939/

  Pharyngitis, more commonly known as sore throat, is caused by viral and/or bacterial infections. Group A Streptococcus (Strep A) is the most common bacterial cause of pharyngitis. […] We present a standardized surveillance protocol, including case definitions for pharyngitis and Strep A pharyngitis, as well as case classifications that can be used to differentiate between suspected, probable, and confirmed cases. […] An effective surveillance system for Strep A pharyngitis serves to (1) monitor trends in age- and sex-specific incidence (preferred) or period prevalence of symptomatic Strep A pharyngitis, accounting for season; (2) monitor trends in demographic and clinical characteristics of people with confirmed symptomatic Strep A pharyngitis; and (3) provide estimates of disease burden of Strep A pharyngitis estimates of disease burden.

• #18 Group A Strep | Surveillance | GAS | CDC

  http://med.iiab.me/modules/en-cdc/www.cdc.gov/groupastrep/surveillance.html

  CDC does not track non-invasive group A strep infections. […] CDC tracks invasive group A strep infections through Active Bacterial Core surveillance (ABCs), a population-based, active- and laboratory-based surveillance system. This means local and state health departments routinely contact laboratories to identify all cases, then report those cases to CDC. […] Only streptococcal toxic shock syndrome is currently a nationally reported disease. Healthcare providers and laboratories should report cases to the appropriate health department. States then report these cases to CDC through the National Notifiable Diseases Surveillance System (NNDSS).

• #19 Group A Strep | Surveillance | GAS | CDC

  http://medbox.iiab.me/modules/en-cdc/www.cdc.gov/groupastrep/surveillance.html

  CDC does not track non-invasive group A strep infections. […] CDC tracks invasive group A strep infections through Active Bacterial Core surveillance (ABCs), a population-based, active- and laboratory-based surveillance system. […] Only streptococcal toxic shock syndrome is currently a nationally reported disease. Healthcare providers and laboratories should report cases to the appropriate health department. States then report these cases to CDC through the National Notifiable Diseases Surveillance System (NNDSS).

• #20

  https://www.gov.uk/government/collections/group-a-streptococcal-infections-guidance-and-data

  Working with UKHSA, Public Health Scotland, Public Health Agency (Northern Ireland), and the National Child Mortality database, Public Health Wales (PHW) published on 4 March 2024 a rapid review into iGAS deaths in children outside of hospital that occurred at the end of 2022 and in early 2023. […] Previous activity reports on group A streptococcal infections were published by Public Health England. The following are UKHSA reports. […] Group A streptococcal infections: seasonal activity in England, 2024 to 2025 […] Group A streptococcal infections: seasonal activity in England, 2023 to 2024 […] Group A streptococcal infections: activity during the 2022 to 2023 season […] Streptococcal bacteraemia: annual data from voluntary surveillance […] Group A streptococcal infections: activity during the 2021 to 2022 season […] Invasive group A streptococcal outbreaks: home healthcare.

• #21 Group A streptococcal disease – invasive (iGAS) | Australian Government Department of Health and Aged Care

  https://www.health.gov.au/diseases/group-a-streptococcal-disease-invasive-igas

  Group A streptococcus (GAS), is a type of bacteria often found in the throat and on the skin. Group A streptococcal infections commonly cause sore throats, also known as strep throat. […] iGAS is a nationally notifiable disease. […] We monitor cases through the National Notifiable Diseases Surveillance System.

• #22 Increase in Invasive Group A streptococcal infections among children in Europe, including fatalities 

  https://www.ecdc.europa.eu/en/news-events/increase-invasive-group-streptococcal-infections-among-children-europe-including

  A number of European countries (including Ireland, France, the Netherlands, Sweden and the United Kingdom) indicate an increase seen during 2022, particularly since September 2022, in the number of cases of invasive Group A Streptococcus (iGAS) disease among children less than ten years of age. […] The observed increases reported to the European Centre for Disease Prevention and Control (ECDC) and WHO Regional Office for Europe and have followed a period of reduced incidence of Group A Streptococcus infections observed during the COVID-19 pandemic. […] GAS and iGAS infections are notifiable diseases in only a limited number of European countries, therefore it is difficult to assess the overall level of circulation in the European region at this point. […] Given that the current increase in cases of iGAS is overall relatively low, the reported cases are not caused by a new strain, and that the disease is easily treatable with antibiotics, ECDC and the WHO Regional Office for Europe currently assess that the risk for the general population posed by iGAS as low.

• #23

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9474939/

  Standardized case definitions are important for obtaining accurate surveillance data, enabling comparisons of surveillance data across jurisdictions, and monitoring the impact of interventions. […] The selection of surveillance strategies depends on specific epidemiologic and clinical characteristics of the disease outcome of interest, the overall surveillance objectives, surveillance location, services accessibility, and the resources available to conduct surveillance. […] Reliable burden estimates will inform the public health response to pharyngitis, advocate for vaccine use, and enable monitoring of the effect of interventions.

• #24 Universal protocols for Strep A surveillance set to transform research for world-first vaccine

  https://www.thekids.org.au/news–events/news-and-events-nav/2022/september/protocols-for-strep-a-surveillance/

  A global consortium of Group A Streptococcus (Strep A) researchers has launched a series of best practice surveillance protocols designed to unite international research efforts for a world-first Strep A vaccine. […] The Strep A Vaccine Global Consortium (SAVAC), based at the International Vaccine Institute, spear-headed the protocol development to provide clear case definitions for diseases caused by Strep A and guide researchers with the design and planning of clinical trials measuring vaccine efficacy and safety. […] The surveillance protocols address each of the seven disease endpoints responsible for the majority of the global health and economic burden of Strep A pharyngitis; impetigo; cellulitis; invasive Group A Strep infections; acute rheumatic fever (ARF); rheumatic heart disease (RHD) and acute poststreptococcal glomerulonephritis.

• #25 Standardisation Of Epidemiological Surveillance Of Group A Streptococcal Pharyngitis – MMGH Consulting

  https://www.mmglobalhealth.org/publications/standardisation-of-epidemiological-surveillance-of-group-a-streptococcal-pharyngitis/

  Pharyngitis, more commonly known as sore throat, is caused by viral and/or bacterial infections. Group A Streptococcus (Strep A) is the most common bacterial cause of pharyngitis. […] We present a standardised surveillance protocol, including case definitions for pharyngitis and Strep A pharyngitis, as well as case classifications that can be used to differentiate between suspected, probable, and confirmed cases. […] The type of surveillance methodology depends on the resources available and the objectives of surveillance. Active surveillance and laboratory confirmation is the preferred method for case detection. […] Participant eligibility, the surveillance population and additional considerations for surveillance of pharyngitis are addressed, including baseline sampling, community engagement, frequency of screening and season.

• #26 Universal protocols for Strep A surveillance set to transform research for world-first vaccine

  https://www.thekids.org.au/news–events/news-and-events-nav/2022/september/protocols-for-strep-a-surveillance/

  The new protocols are designed to be used for Strep A surveillance studies throughout the globe, making sure that research studies can be compared with each other, and that results from different populations and different studies can be compiled and analysed together. […] Co-Chair of the SAVAC Burden of Disease Working Group that oversaw these protocols, Dr Chris Van Beneden from the US CDC Foundation, said a key aspect of robust surveillance for Strep A involves generating updated regional disease burden estimates and developing platforms for future impact evaluation. […] Given that the disease spectrum associated with Strep A is broad and complex, accurately estimating the global burden of disease is challenging. In particular, current estimates underrepresent the extent of disease in low-and middle-income countries, Dr Van Beneden said.

• #27 Azthena logo with the word Azthena

  https://www.news-medical.net/health/What-Causes-Strep-Throat.aspx

  Such typing and subtyping endeavors have been of great significance in streptococcal epidemiology […] High-resolution genotyping can be used to determine specific relatedness among strains isolated from outbreaks of streptococcal pharyngitis, whereas rapid sequencing of the gene that encodes for M-protein is a fast and definite way of comparing M-typeable and M-non-typeable strains.

• #28 Group A Streptococcus Treatment and Management

  https://www.uspharmacist.com/article/group-a-streptococcus-treatment-and-management

  Streptococcal pharyngitis, also referred to as strep throat, is one of the most common upper respiratory infections in school-age children and young adults. In the United States, strep throat accounts for approximately 12 million visits annually in outpatient care settings. […] GAS is the most common bacterial cause of streptococcal pharyngitis in children and young adults and peaks in winter and early to mid spring. […] A recent meta-analysis showed that the prevalence of GAS pharyngitis in children aged younger than 5 years was 24%; in those aged younger than 18 years who presented to an outpatient center for treatment, it was 37%. […] Many regions of the world with low income and poor infrastructure continue to suffer a high burden of S pyogenes diseases, with millions of deaths annually.

• #29 Group A Streptococcus Treatment and Management

  https://www.uspharmacist.com/article/group-a-streptococcus-treatment-and-management

  The majority of these deaths follow the development of rheumatic heart disease (RHD), which remains a concern in both developed and developing countries. […] In many developed countries, the prevalence of RHD is much lower; however, the majority of S pyogenes associated deaths are attributed to the clinical manifestations associated with invasive disease.

• #30 Group A streptococcal (GAS) pharyngitis: A practical guide to diagnosis and treatment | Canadian Paediatric Society

  https://cps.ca/documents/position/group-a-streptococcal

  Group A Streptococcus (GAS) pharyngitis is a common clinical syndrome in primary care, yet controversy remains regarding the best approach to diagnosis and treatment, including the benefits of antibiotics. […] GAS pharyngitis occurs most often in children 5 to 11 years of age and during winter and spring months each year. […] Although the incidence and prevalence of ARF and RHD have decreased significantly in high-income countries, they remain important causes of morbidity and mortality in low- and middle-income countries and in Indigenous populations worldwide. […] This inequity of disease burden for ARF between Indigenous and non-Indigenous populations is multifactorial, with many studies suggesting that limited access to health care and poor living conditions contribute to increased risk of ARF.

• #31 Missing Piece Study protocol: prospective surveillance to determine the epidemiology of group A streptococcal pharyngitis and impetigo in remote Western Australia | BMJ Open

  https://bmjopen.bmj.com/content/12/4/e057296

  Group A -haemolytic Streptococcus (GAS), a Gram-positive bacterium, causes skin, mucosal and systemic infections. […] Aboriginal and Torres Strait Islander peoples in Australia have the highest rates of ARF and RHD in the world. Despite this, the contemporaneous prevalence and incidence of GAS pharyngitis and impetigo in remote Australia remains unknown. […] The Missing Piece Study aims to document the epidemiology of GAS pharyngitis and impetigo through collection of clinical, serological, microbiological and bacterial genomic data among remote-living Australian children. […] The Kimberley has the second highest incidence of ARF in Australia with a rate of 166/100 000 Aboriginal people under the age of 45 years. […] The Missing Piece Surveillance study is a project designed to understand the concurrent burden of laboratory-confirmed GAS pharyngitis and impetigo infections in remote Australian settings.

• #32 Group A streptococcal (GAS) pharyngitis: A practical guide to diagnosis and treatment | Canadian Paediatric Society

  https://cps.ca/documents/position/group-a-streptococcal

  In settings where the disease burden is high, interventions to improve living conditions, ensure early diagnosis and treatment of GAS pharyngitis through public and health care provider education, and improve access to medical care have been shown to reduce ARF incidence. […] For children with a high pre-test probability of having GAS pharyngitis (e.g., a CENTOR score 3), microbiological diagnosis is important to limit inappropriate antibiotic use. […] In communities at high risk for ARF (and specifically in northern or Indigenous communities), testing should be considered in any child 3 years of age presenting with sore throat.

• #33 LSHTM LSHTM Research Online

  https://researchonline.lshtm.ac.uk/5375/

  There were 61 episodes of GAS culture-positive sore throat during the study period equating to an incidence of 14.7 cases per 100 child-years (95% CI, 11.2-18.8). […] The incidence of GCS/GGS culture-positive sore throat was 28.8 cases per 100 child-years (95% CI, 23.9-34.5). […] The molecular epidemiology of pharyngeal GAS in our study differed greatly from that in industrialized nations and this has implications for GAS vaccine clinical research in Fiji and other tropical developing countries.

• #34 Local Genomic Surveillance of Invasive Streptococcus pyogenes in Eastern North Carolina (ENC) in 2022–2023

  https://www.mdpi.com/1422-0067/25/15/8179

  The recent increase in Group A Streptococcus (GAS) incidences in several countries across Europe and some areas of the United States (U.S.) has raised concerns. […] The Centers for Disease Control and Prevention (CDC) has classified erythromycin-resistant GAS as a “concerning threat”, causing 5400 infections and 450 deaths per year in the United States (U.S.) as of 2017, up from 1300 infections and 160 deaths as of 2010. […] In December 2022, the World Health Organization (WHO) reported a surge of invasive GAS (iGAS) infections in several European countries, including the United Kingdom, France, The Netherlands, Belgium, Portugal, and Denmark. […] In February 2023, the CDC also reported a higher level of iGAS infections in some U.S. areas, including Colorado and Minnesota. […] The CDC ABCs is an active laboratory- and population-based surveillance system for invasive bacterial pathogens of public health importance, including iGAS.

• #35 CDC study finds substantial US increase in invasive group A strep infections | CIDRAP

  https://www.cidrap.umn.edu/antimicrobial-stewardship/cdc-study-finds-substantial-us-increase-invasive-group-strep-infections

  The percentage of adult patients with one or more underlying condition rose increased from 86.6% in 2013 to 93% in 2022. […] „An increasing prevalence of underlying health conditions associated with invasive GAS likely contributed to rising incidence,” the study authors wrote. […] In the accompanying editorial, Osowicki and Theresa Lamagni note that increases in invasive GAS have also been reported in other high-income countries, particularly in the immediate wake of COVID-19. […] They also suggest that the increase in incidence might even be greater, since the ABC surveillance system doesn’t include 8 of the 10 poorest US states. […] „Overall, the theme of this US invasive GAS disease update looks to be a backward slide in the social determinants of invasive GAS, most evident in, but not limited to, disadvantaged and marginalized populations in the US,” Osowicki and Lamagni wrote. […] Whatever is driving the increase in invasive GAS incidence, the study authors say it requires urgent attention.

• #36 Incidence and treatment of group A streptococcal infections during covid-19 pandemic and 2022 outbreak: retrospective cohort study in England using OpenSAFELY-TPP | BMJ Medicine

  https://bmjmedicine.bmj.com/content/3/1/e000791

  This study supports the findings of routine surveillance reports, indicating a reduction in group A streptococcal infections during covid-19 restrictions, followed by a peak in December 2022. […] Existing surveillance systems, such as notifiable disease reports and general practice in-hours surveillance bulletins, describe clinical events, but do not link to relevant prescribing data.

• #37 Universal protocols for Strep A surveillance set to transform research for world-first vaccine

  https://www.thekids.org.au/news–events/news-and-events-nav/2022/september/protocols-for-strep-a-surveillance/

  With vaccine development gaining momentum, backed up by the 2018 World Health Assembly adoption of a global resolution on ARF and RHD we envisage these protocols will provide a much clearer picture of mortality and infection rates, unite global research activities and accelerate our combined efforts for a world-first Strep A vaccine.

• #38 Missing Piece Study protocol: prospective surveillance to determine the epidemiology of group A streptococcal pharyngitis and impetigo in remote Western Australia | BMJ Open

  https://bmjopen.bmj.com/content/12/4/e057296

  To date, primary prevention strategies for ARF and efforts in GAS vaccine development have been based on the concept that ARF is caused solely by GAS pharyngitis. […] In light of these observed low rates of pharyngitis and high rates of impetigo in Aboriginal and Torres Strait Islander populations, primary prevention efforts have been redirected at reducing GAS impetigo. […] Without this prospective surveillance study, we remain at an impasse in our ability to inform the prioritisation of treatment for sore throats, skin sores or both, in remote-living Aboriginal and Torres Strait Islander children.

• #39 Group A Streptococcus Infections in Children: Epidemiological Insights Before and After the COVID-19 Pandemic

  https://www.mdpi.com/2076-0817/13/11/1007

  A decrease in iGAS infection in the USA was noted by McNeil et al. in 2020, especially regarding the incidence of deep abscesses. […] Data from the USA in regards to GAS infection after the implementations of IMS strategies, mainly from Colorado and Minnesota, by Barnes et al., underlined an uprise of iGAS infection in children in the last trimester of 2022, which followed the unusual decline of cases during 2020. […] The COVID-19 pandemic and the implementation of IMS strategies led to a downregulation of GAS infection, a circumstance that was altered once they were discontinued. A global surge in GAS infection (invasive and non-invasive) was noted, especially concerning the pediatric population. […] The growing incidence of invasive GAS infections in children highlights the urgent need for ongoing surveillance of emm types and superantigens, as well as the establishment of clear diagnostic and treatment guidelines.

• #40 Invasive Group A Streptococcal Disease: a Resurging Menace?

  https://www.cepheid.com/en-US/insights/insight-hub/tech-disease-trends/2024/11/invasive-group-streptococcal-disease.html

  Enhanced surveillance and timely reporting are crucial for the early detection and control of iGAS outbreaks. Clinicians should vigilantly monitor for signs and symptoms of severe GAS infections, especially in high-risk populations: children and the elderly, immunocompromised people, and those with chronic diseases. They should also report case clusters to public health authorities promptly to facilitate outbreak investigations and implement control measures. […] Considering the epidemiological links between GAS and iGAS, it can be hypothesized that addressing GAS pharyngitis through early detection and intervention would lower the total GAS burden and, in turn, reduce the potential for invasive infections.

• #41 Scarlet Fever: A Deadly History and How it Prevails

  https://asm.org/articles/2023/january/scarlet-fever-a-deadly-history-and-how-it-prevails

  Since September 2022, there has been a significant outbreak of scarlet fever in children in Europe, and more recently, there have been documented increases in cases in the U.S. […] Importantly, antimicrobial susceptibility test results from routine laboratory surveillance in England did not demonstrate any increased antibiotic resistance among S. pyogenes organisms, indicating that drug resistance is not responsible for increased virulence or spread of the organism in the current outbreak. […] Expanded surveillance and research are needed to understand these outbreaks, but the pathogenesis and epidemiology of the disease provide additional context clues. […] The Centers for Disease Control (CDC) estimates that in the last 5 years, 14,000 to 25,000 cases of invasive group A strep disease have occurred in the U.S. and that 1,500-3,000 people die yearly from these infections. It is imperative that data on the prevalence of disease are reported to public health agencies regularly and surveillance is performed at the public health level. […] WHO recommends continued surveillance and advises healthcare providers to maintain a high level of suspicion for group A strep-related diseases, as identifying and treating these infections early may prevent invasive Streptococcal disease and other serious downstream outcomes.

• #42 CDC warns of increase in invasive strain of strep throat in US | Fox News

  https://www.foxnews.com/health/invasive-strep-throat-strain-has-more-doubled-us-reports-cdc

  „Surges of invasive and noninvasive GAS disease in 2022 and 2023 have been reported in countries spanning the Northern and Southern Hemispheres, with new reports of the same phenomenon still coming to light.” […] In 2023, strep throat infections caused by GAS skyrocketed, mostly in children, according to a report from Epic Research. […] After a dip in cases during the coronavirus pandemic, the rate of infections was 30% higher than the previous peak seen in February 2017, the report found. […] Dr. Shana Johnson, a physical medicine and rehabilitation physician in Scottsdale, Arizona, previously shared with Fox News Digital that rates of GAS, including the more dangerous invasive type, were „at the highest levels seen in years.” […] Group A strep is best treated with antibiotics unless a more severe illness is contracted, according to Johnson.

• #43 Group A Streptococcus – National Collaborating Centre for Infectious Diseases

  https://nccid.ca/debrief/group-a-streptococcus/

  iGAS diseases are a global cause of morbidity and mortality, but are more prevalent in populations who are living in overcrowded conditions or in socioeconomically disadvantaged regions. Globally, iGAS diseases are responsible for more than 500,000 deaths annually. […] Following the COVID-19 pandemic, several countries have witnessed an increase in iGAS. In December 2022, the World Health Organization reported an increase in iGAS cases and deaths across Europe (including France, the Netherlands, the United Kingdom, Ireland, and Sweden). Similarly, in December 2022, the U.S. Centers for Disease Control and Prevention (CDC) issued a health advisory for a spike in pediatric iGAS cases. […] iGAS is endemic in Canada, with the average number of cases rising steadily since 2000. Preliminary data from the Public Health Agency of Canada (PHAC) reported over 4,600 samples submitted to the National Microbiology Laboratory (NML) in January 2023 a record number for the country. The previous peak occurred in 2019 at roughly 3,200 cases.

• #44 Group A Streptococcus Infections in Children: Epidemiological Insights Before and After the COVID-19 Pandemic

  https://www.mdpi.com/2076-0817/13/11/1007

  Epidemiological data from Germany, as reported by Goretzki et al., noted an outbreak of iGAS infection in the last trimester of 2022 in the pediatric population, with a median age of 4 years old, mainly presented as pneumonia, followed by STSS, with a high viral co-infection rate of 46% and a high ICU admission rate of 59% and death rate, when compared to statistics of pre-pandemic years. […] A similar observation is noted by Tomidis Chatzimanouil et al. in a retrospective cohort study also conducted in Germany. […] A total of 60% of the cases reported a viral co-infection, mainly human metapneumovirus, respiratory syncytial virus, Influenza A, varicella-zoster, and rhinovirus. […] The purpose of this review is to provide an overview of the influence of the COVID-19 pandemic on the incidence of GAS infection in children (invasive or non-invasive).

• #45 September 2023 Page 2

  https://portal.ct.gov/DPH/Epidemiology-and-Emerging-Infections/CTEPI/Volumes/43/Vol-No-6/September-2023-Page-2

  Group A Streptococcus (GAS) bacteria can cause a range of illnesses from mild infections like strep throat and impetigo to more severe or life-threatening diseases including sepsis, cellulitis, necrotizing fasciitis, and streptococcal toxic shock syndrome. […] The Connecticut Department of Public Health (CT DPH) identifies iGAS cases (people with GAS identified in a normally sterile body site) through statewide active surveillance conducted by the Active Bacterial Core Surveillance project. […] Continued iGAS surveillance is needed to assess whether changes in seasonal and age group incidence during the pandemic persist. Surveillance also allows for identification of clusters that might warrant public health intervention.

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