High Incidence of Invasive Group A Streptococcal Infections in Remote Indigenous Communities in Northwestern Ontario, Canada

Abstract

Background.Worldwide, indigenous populations appear to be at increased risk for invasive group A streptococcal (iGAS) infections. Although there is empirical evidence that the burden of iGAS disease is significant among remote First Nations communities in Northwestern Ontario, Canada, the epidemiology of iGAS infections in the area remains poorly characterized.Methods.Individuals that met case definition for iGAS disease and whose laboratory specimens were processed by Meno Ya Win Health Centre in Sioux Lookout, Canada or who were reported to Thunder Bay District Health Unit, Canada were identified for the period 2009 to 2014. Case demographics, clinical severity, comorbidities, and risk factors were collected through chart review. Strain typing and antibiotic susceptibility were determined when possible. Basic descriptive statistics were calculated.Results.Sixty-five cases of iGAS disease were identified, for an annualized incidence of 56.2 per 100 000. Primary bacteremia was present in 26.2% of cases, and cellulitis was identified in 55.4% of cases. The most common comorbidities identified were diabetes (38.5%) and skin conditions (38.5%). Prevalent risk factors included alcohol dependence (25%). Fourteen different emm types were identified among 42 isolates, with the most common being emm114 (17.4%), emm11 (15.2%), and emm118 (13.0%). Resistance to erythromycin and clindamycin was found in 24.6% of isolates.Conclusions.Rural and remote First Nations communities in Northwestern Ontario experience iGAS infections at a rate 10 times the provincial and national average. Compared with other North American series, a lower proportion of isolates causing infection were of emm types included in candidate GAS vaccines.

Prevalent emm Types among Invasive GAS in Europe and North America since Year 2000

“…A recent epidemiological study on iGAS strains from remote indigenous communities in Northwestern Ontario, over the period 2009–2014, indicated that among 46 invasive isolates, 14 different emm types were identified, with emm -type variability observed over time. The most common emm types were emm 114 (17.4%), emm 11 (15.2%), emm 118 (13.0%), emm 68, and emm 82 (10.9% each) ( 62 ).…”

From SARS to pandemic influenza: the framing of high-risk populations

“…An important social wakeup since the 2003 SARS pandemic is the emergence of the Truth and Reconciliation process in Canada, recognizing the historical cultural genocide of Indigenous peoples caused in part by abuses in government-supported residential schools (Smylie and Firestone 2016). Indigenous peoples in Canada have faced myriad of social, environmental, and biological disasters including the ongoing suicide crisis (Webster 2016), access to safe drinking water (Bradford et al 2016) and infectious diseases including group A streptococcal (iGAS) infections, rheumatic fever (Bocking et al 2016), tuberculosis (Patel et al 2017), and the 2009 pH1N1 (Jung et al 2017). The sustained high incidence of infectious disease in Indigenous peoples coupled with decreasing incidence in the rest of the Canadian population is suggested to be caused by 'structural violence' such that social structures, institutions, culture, and other factors combine to inform these extreme health disparities (Galtung 1969).…”

Sociocultural, behavioural and political factors shaping the COVID-19 pandemic: the need for a biocultural approach to understanding pandemics and (re)emerging pathogens

“…Similarly, China itself reported similar discrimination on a national level against those from Wuhan, the epicentre of the outbreak (Ren et al, 2020). Work on indigenous communities has also linked ethnicity and associated structural violence issues to health inequalities, with research pointing to higher rates of infection for diseases such as HIV (Negin et al, 2015), tuberculosis (Romero-Sandoval et al, 2007;Tuite et al, 2017), malaria (Donnelly et al, 2016) and streptococcal Infections (Bocking et al, 2017). For communities that not only suffer stigma, but also live in poor socioeconomic conditions, or in remote communities (the protective effect of which will likely depend on long-distance social connections), access to medical aid and information in the context of COVID-19 may be problematic.…”