Resurgence of scarlet fever in China: a 13-year population-based surveillance study

Liu, Yonghong; Chan, Ta‐Chien; Yap, Li-Wei; Luo, Yinping; Xu, Wei; Qin, Shuwen; Zhao, Na; Zhao, Yu; Geng, Xin; Liu, She-Lan

doi:10.1016/s1473-3099(18)30231-7

Cited by 76 publications

(93 citation statements)

References 27 publications

(65 reference statements)

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“…Over the past decade, an exceptional upturn in the morbidity of scarlet fever has occurred in some Asian and European countries and areas, containing mainland China [20] , Vietnam [21] , Hong Kong [22] , South Korea [23] , Germany [24] and England [25] and the reasons remain unknown [26][27][28][29] .This is a worsening trend , especially in China where the ongoing resurgence in disease morbidity has exerted a marked influence on Chinese population since 2011 [20,30] .To tackle this, understanding the epidemic characteristics of this disease may play a significant role in the allocation of limited health resource and the formulation of prevention and control strategies [31] .…”

Section: Discussionmentioning

confidence: 99%

Epidemiological study of scarlet fever in Shenyang , China

Chen

Sun

et al. 2019

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Background: Since 2011, there has been an increase in the incidence of scarlet fever across China. The main objective of this study was to depict the spatiotemporal epidemiological characteristics of the incidence of scarlet fever in Shenyang, China, in 2018 so as to provide the scientific basis for effective strategies of scarlet control and prevention. Methods: Excel 2010 was used to demonstrate the temporal distribution at the month level and ArcGIS10.3 was used to demonstrate the spatial distribution at the district/county level. Moran’s autocorrelation coefficient was used to examine the spatial autocorrelation and the Getis-Ord statistic was used to determine the hot-spot areas of scarlet fever. Results: A total of 2,314 scarlet fever cases were reported in Shenyang in 2018 with an annual incidence of 31.24 per 100,000. The incidence among males was higher than that among females（p＜0.001). A vast majority of the cases (96.89%) were among children aged 3 to 11 years. The highest incidence was 625.34/100,000 in children aged 5-9 years. In 2018 there were two seasonal peaks of scarlet fever in June (summer-peak) and December (winter-peak).The incidence of scarlet fever in urban areas was significantly higher than that in rural areas(p＜0.001).The incidence of scarlet fever was randomly distributed in Shenyang. There are hotspot areas located in seven districts. Conclusions: Urban areas are the hot spots of scarlet fever and joint prevention and control measures between districts should be applied. Children aged 3-11 are the main source of scarlet fever and therefore the introduction of prevention and control into kindergarten and primary schools may be key to the control of scarlet fever epidemics.

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Section: Discussionmentioning

confidence: 99%

Epidemiological study of scarlet fever in Shenyang , China

Chen

Sun

et al. 2019

Preprint

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“…A re-emergence of scarlet fever has been noted in Hong Kong, mainland China, South Korea, and England, UK, and other countries around the world. since 2008 to 2014 [21][22][23]. Penicillin has always been the preferred treatment for the GAS infection.…”

Section: Discussionmentioning

confidence: 99%

Molecular epidemiology and antimicrobial resistance of group A streptococcus recovered from patients in Beijing, China

Zhang

Zhao

et al. 2020

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Background: Group A streptococcus (GAS) is an important human pathogen responsible for a broad range of infections. Epidemiological surveillance has been crucial to detect changes in the geographical and temporal variation of the disease pattern. The objective of this study was to investigate the molecular epidemiological characteristics and antimicrobial resistance of GAS isolates from patients in Children's Hospital in Beijing. Methods: From 2016 to 2017, pharyngeal swab samples were collected from the outpatients in Children's Hospital, Capital Institute of Pediatrics, who were diagnosed with scarlet fever. Antimicrobial susceptibility test was performed according to the distribution of conventional antibiotics and Clinical and Laboratory Standards Institute (CLSI) recommendations. The distribution of the macrolide-resistance genes ( ermB, ermA, mefA ), emm (M protein-coding gene) typing, and superantigens (SAg) gene profiling were examined by polymerase chain reaction (PCR). Results: A total of 297 GAS strains were collected. The susceptibility of the strains to penicillin, ceftriaxone, and levofloxacin was 100%. The rate of antimicrobial resistance to erythromycin and clindamycin was 98.3% and 96.6%, respectively. The dominant emm types were Streptococcus pyogenes (Lancefield group A streptococcus; GAS) is a major pathogen causing infectious diseases in children. It causes suppurative and non-suppurative diseases, such as erysipelas, suppurative tonsillitis, scarlet fever, rheumatic fever, and glomerulonephritis [1]. Globally, there are about 616 million cases of GAS pharyngitis every year, among which, 17,800 cases are new infections, and about 517,000 patients with severe GAS are deceased every year [2]. Recently, the positive rate of GAS was estimated at 21.2% in the pharyngeal culture of patients diagnosed as "streptococcal infection/tonsillitis/angina" [3]. Moreover, the incidence of streptococcal pharyngitis is common in children aged 0-14 years. From 2012 to 2014, the average number of positive cases of streptococcal culture was 2685.1/100,000 children in Beijing, including 1652.7 outpatient visits [4]. In 2011, scarlet fever broke out in mainland China and Hong Kong, with a sharp increase in incidence [5,6]. Penicillin is the preferred clinical treatment of GAS infection, while erythromycin is the first alternative antibiotic for patients allergic to penicillin, followed by clindamycin. The drug resistance rate to macrolides, used as alternative antibiotics, is gradually increasing, which might be related to the overuse of such antibiotics [7,8]. In our previous study, 95 isolates were recovered from suppurative tonsillitis, acute glomerulonephritis, scarlet fever and streptococcal dermatitis. The resistance rates of the isolates to erythromycin, clindamycin and tetracycline were 98.9%, 100%, 94.7% respectively [9] .The M protein encoded by the emm gene is the main pathogenic factor of GAS, and different types vary in pathogenicity. Therefore, emm typing is employed to track outbreak and routinely mo...

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“…Before the advent of antibiotics, scarlet fever was extremely serious, often causing long periods of illness, many dangerous complications, and even death. A re-emergence of scarlet fever has been noted in Hong Kong, mainland China, South Korea, and England, UK, and other countries around the world since 2008 to 2014 [21][22][23]. Penicillin has always been the preferred treatment for the GAS infection.…”

Section: Discussionmentioning

confidence: 99%

Molecular epidemiology and antimicrobial resistance of group A streptococcus recovered from patients in Beijing, China

Zhang

Zhao

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Group A streptococcus (GAS) is an important human pathogen responsible for a broad range of infections. Epidemiological surveillance has been crucial to detect changes in the geographical and temporal variation of the disease pattern. The objective of this study was to investigate the molecular epidemiological characteristics and antimicrobial resistance of GAS isolates from patients in Children's Hospital in Beijing.Methods: From 2016 to 2017, pharyngeal swab samples were collected from the outpatients in Children's Hospital, Capital Institute of Pediatrics, who were diagnosed with scarlet fever.Antimicrobial susceptibility test was performed according to the distribution of conventional antibiotics and Clinical and Laboratory Standards Institute (CLSI) recommendations. The distribution of the macrolide-resistance genes ( ermB, ermA, mefA ), emm (M protein-coding gene) typing, and superantigens (SAg) gene profiling were examined by polymerase chain reaction (PCR).Results: A total of 297 GAS isolates were collected. The susceptibility of the isolates to penicillin, ceftriaxone, and levofloxacin was 100%. The resistance rate to erythromycin and clindamycin was 98.3% and 96.6%, respectively. The dominant emm types were emm12 (65.32%), emm1 (27.61%), emm75 (2.69%), and emm89 (1.35%). Of the 297 isolates, 290 (97.64%) carried the ermB gene, and 5 (1.68%) carried the mefA gene, while none carried the ermA gene. The most common superantigen genes identified from GAS isolates were smeZ (96.97%) , speC (92.59%), speG (91.58%), ssa (85.52%), speI (54.55%), speH (52.19%), and speA (34.34%). Isolates with the genotype emm1 possessed speA , speC , speG , speJ , speM , ssa , and smeZ , while emm12 possessed speC , speG , speH , speI , speM , ssa , and smeZ superantigens.Conclusions: The prevalent strain of GAS isolates in Beijing has a high resistance rate to macrolides; however, penicillin can still be the preferred antibiotic for treatment. Erythromycin resistance was predominantly mediated by ermB. The common emm types were emm12 and emm1. There was a correlation between emm and the superantigen gene. Thus, long-term monitoring and investigation of the emm types and superantigen genes of GAS prevalence are imperative. Background 3Streptococcus pyogenes (Lancefield group A streptococcus; GAS) is a major pathogen causing infectious diseases in children. It causes suppurative and non-suppurative diseases, such as erysipelas, suppurative tonsillitis, scarlet fever, rheumatic fever, and glomerulonephritis [1]. Globally, there are about 616 million cases of GAS pharyngitis every year, among which, 17,800 cases are new infections, and about 517,000 patients with severe GAS are deceased every year [2]. Recently, the positive rate of GAS was estimated at 21.2% in the pharyngeal culture of patients diagnosed as "streptococcal infection/tonsillitis/angina" [3]. Moreover, the incidence of streptococcal pharyngitis is common in children aged 0-14 years. From 2012 to 2014, the average number of positive cases of streptococca...

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Resurgence of scarlet fever in China: a 13-year population-based surveillance study

Abstract: National Key R&D Plan of China Science and key epidemiological disciplines of Zhejiang Provincial Health of China.

Cited by 76 publications

References 27 publications

Epidemiological study of scarlet fever in Shenyang , China

Epidemiological study of scarlet fever in Shenyang , China

Molecular epidemiology and antimicrobial resistance of group A streptococcus recovered from patients in Beijing, China

Molecular epidemiology and antimicrobial resistance of group A streptococcus recovered from patients in Beijing, China

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