Prevalence of group A β-hemolytic streptococcal throat carriage and prospective pilot surveillance of streptococcal sore throat in Ugandan school children

Abstract

Objectives: Group A β-hemolytic Streptococcus (GAS), also known as Streptococcus pyogenes, is responsible for an annual 600 million cases of acute pharyngitis globally, with 92% of those infections occurring in low-resource settings. Further knowledge of the acute streptococcal pharyngitis burden in low-resource settings is essential if serious post-streptococcal complicationsrheumatic fever (RF) and its long-term sequel rheumatic heart disease (RHD)are to be prevented. Methods: Two studies were conducted in school-aged children (5-16 years): a cross-sectional study of streptococcal pharyngeal carriage followed by a prospective cohort study of streptococcal sore throat over 4 weeks from March to April 2017. Results: The cross-sectional study revealed an overall prevalence of GAS carriage of 15.9% (79/496, 95% confidence interval 12.8-19.5%). Among 532 children enrolled in the prospective cohort study, 358 (67%) reported 528 sore throats, with 221 (41.1%) experiencing at least one GAS-positive sore throat. The overall GAS-positive rate for sore throat was 41.8% (221/528). Conclusions: The GAS pharyngeal carriage rates seen in Uganda (15.9%, 95% confidence interval 12.8-19.5%) are higher than the most recent pooled results globally, at 12% (range 6-28%). Additionally, pilot data suggest a substantially higher percentage of sore throat that was GAS-positive (41.8%) compared to pooled global rates when active recruitment is employed.

Throat Colonization and Antibiotic Susceptibility of Group a β-Hemolytic Streptococci Among Rheumatic Heart Disease Patients Attending a Cardiac Referral Hospital in Tanzania, a Descriptive Cross-Sectional Study

“…The 12.9% prevalence of throat GAS colonization found in this study is much higher than that found among 233 children with chronic RHD attending care at a cardiac clinic in Addis Ababa, Ethiopia ( 7 ), but within the reported prevalence among school-going children in sub-Saharan Africa ( 8 – 10 ). Of note, the prevalence of GAS positivity in the study by Zegeye et al ( 7 ) was 6.9%, and the difference between the two studies can mainly be attributed to the fact that all patients in the Ethiopian study were on ARF prophylaxis as compared to the present study where prophylaxis was taken regularly by 29.9% of the total studied population.…”

“…This is more serious for those who are particularly at a greater risk due to a number of factors including their genetic susceptibility, which renders them more sensitive to infection with a rheumatogenic strain of GAS ( 25 ). Only few studies from sub-Saharan Africa have reported the prevalence of GAS colonization in the general population ( 8 – 10 , 22 , 26 ), in patients with pharyngotonsillitis ( 27 , 28 ), and among RHD patients ( 7 ). The present study therefore adds to the current knowledge on RHD in the region by demonstrating that among RHD patients attending care at a tertiary health facility in Tanzania, throat GAS colonization is present in 12.9% and is independently associated with stopping ARF prophylaxis among these patients.…”

“…This causes low compliance and adherence, resulting in inadequate prophylaxis and failure to eradicate GAS from the throat ( 6 , 7 ). Furthermore, GAS throat colonization and carriage rate among asymptomatic children has been reported to be high, ranging from 9.7 to 16% in recent studies from sub-Saharan African countries ( 8 – 10 ), indicating a high burden in the communities.…”

“…With effective secondary prophylaxis, recurrence and the progression of rheumatic fever to RHD have been shown to be significantly reduced ( 12 , 13 ). So far, GAS susceptibility to penicillin has been excellent, with studies from both sub-Saharan Africa ( 7 , 8 , 10 , 14 ), as well as outside the region ( 15 ), reporting GAS to be almost 100% susceptible to penicillin.…”

Phylogenetic analysis of streptococci in samples taken from the throat cultures of children in Turkey and the presence of mef(A), mef(E), erm(B) and erm(TR) genes in patients withStreptococcus pyogenes

“…In addition to domestic transmission, other environments with a high risk of transmission include public areas, such as schools, barracks, and kindergartens. [15] Especially in acute forms, the disease usually spontaneously regresses in a week without the addition of antibiotics to treatment. However, in the presence of severe complications, including acute rheumatic fever and glomerulonephritis, it is recommended to start penicillin treatment without waiting for the culture result, and Hanage et al stated that resistant strains were developing in patients that did not respond to treatment.…”