School-based Streptococcal A Sore-throat Treatment Programs and Acute Rheumatic Fever Amongst Indigenous Māori: A Retrospective Cohort Study

Walsh, L.; Innes-Smith, Sandra; Wright, Janine; Michniewicz, Thanjon; Tozer, Megan; Humby, Jonathan; Ngata, Richard; Lennon, Diana; Scott-Jones, Joseph; Malcolm, J. L.

doi:10.1097/inf.0000000000002770

Cited by 9 publications

(39 citation statements)

References 29 publications

(45 reference statements)

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“…Interventions also targeted rapid and accessible diagnosis of GAS infections and RF, such as access to sore throat clinics in the community, 32,33 improving GAS diagnosis tools, 34,35 and a range of school-based throat swabbing programmes. 17,[36][37][38][39][40][41][42][43][44][45] Mana Kidz is a school-based programme in Counties Manukau run by a Māori-led primary health organisation who practice a Kaupapa Māori approach. Over 34 000 children consented (approximately 50% Pacific and 39% Māori) from 88 primary and intermediate schools.…”

Section: Primary Preventionmentioning

confidence: 99%

Addressing rheumatic fever inequities in Aotearoa New Zealand: a scoping review of prevention interventions

Tu’akoi

Ofanoa²,

Ofanoa³

et al. 2022

J. Prim. Health Care

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Introduction. Rheumatic fever is a preventable illness caused by untreated Group A Streptococcus (GAS) infection. Despite reductions in most high-income countries, rheumatic fever rates remain a concern in Aotearoa New Zealand. Pacific and Māori people are inequitably affected, with risk of initial hospitalisation due to rheumatic fever 12-and 24-fold more likely, respectively, compared to non-Māori and non-Pacific people. Aim. This scoping review aims to explore the range of interventions and initiatives in New Zealand seeking to prevent GAS and rheumatic fever, with a particular focus on Pacific and Māori. Methods. Databases Scopus, Medline, EMBASE and CINAHL, along with grey literature sources, were searched to broadly identify interventions in New Zealand. Data were screened for eligibility and the final articles were charted into a stocktake table. Results. Fifty-eight studies were included, reporting 57 interventions. These targeted school-based throat swabbing, awareness and education, housing, secondary prophylaxis, improving primary care guidelines and diagnosis of sore throats and skin infections. Some interventions reported short-term outcomes of improvements in awareness, a reduction in rheumatic fever risk and fewer hospitalisations. Evaluation outcomes were, however, lacking for many initiatives. Pacific and Māori people primarily served only in an advisory or delivery capacity, rather than as partners in co-design or leadership from the beginning. Discussion. Although positive outcomes were reported for some interventions identified in this review, rheumatic fever rates have not shown any long-term reduction over time. Co-designing interventions with affected communities could ensure that strategies are better targeted and do not contribute to further stigma.

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Section: Primary Preventionmentioning

confidence: 99%

Addressing rheumatic fever inequities in Aotearoa New Zealand: a scoping review of prevention interventions

Tu’akoi

Ofanoa²,

Ofanoa³

et al. 2022

J. Prim. Health Care

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“…An estimate of costs, Numbers needed to treat NNT, and cost-bene t for 30 days S. salivarius, was integrated with previously reported BOP district school-based RFPP costs. (5,35) Statistical Analysis…”

Section: School Terms Study Periodsmentioning

confidence: 99%

“…(36) Counties-Manukau DHB RFPP documented a 49% GAS prevalence decline. (5,8) Both school programmes had 96% consent and participation. The co-authors presented these ndings with D. Lennon and J Stewart to ASID 2015 (36) , also submitting both BOPDHB and CMDHB ndings to HRC the funder (11) and then published these ndings (5,8) , which were incorporated and discussed in RFPP's review.…”

Section: Powermentioning

confidence: 99%

“…(5,8) Both school programmes had 96% consent and participation. The co-authors presented these ndings with D. Lennon and J Stewart to ASID 2015 (36) , also submitting both BOPDHB and CMDHB ndings to HRC the funder (11) and then published these ndings (5,8) , which were incorporated and discussed in RFPP's review. (12) The secondary outcome GAS pharyngitis was informed by data from the six month follow up component of Di Pierro's S.…”

Section: Powermentioning

confidence: 99%

“…New Zealand Europeans (NZE) are 74% of the population but present with 4.6% of the ARF cases. (5) Furthermore, ARF's common sequela, Rheumatic Heart Disease (RHD), shortens life expectancy for Māori and Paci c people with RHD on average by 14-17 years. (2)…”

mentioning

confidence: 99%

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Cluster-allocated S. salivarius is more effective than antibiotics-alone reducing pharyngeal Group A Streptococcus prevalence for schoolchildren at risk of Rheumatic fever: a stepped-wedge non-randomized trial

Malcolm

Innes-Smith

Bennett

et al. 2022

Preprint

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Background Acute rheumatic fever triggered by pharyngeal and skin Group A Streptococcal infections (GAS) disproportionately affects indigenous Māori schoolchildren. This stepped-wedged study in Whakatāne, New Zealand compared whole-school-cluster allocated Streptococcus salivarius probiotic effectiveness on GAS pharyngeal prevalence (carriage and pharyngitis) following antibiotics, compared to antibiotics-alone for GAS positive children. Each of two clusters followed a sequence with a different Streptococcus salivarius exposure period over ten winter weeks in 2015. Method Both clusters had high Māori schoolchildren rolls (99% and 81%) at high risk of acute rheumatic fever. The parents/guardians of 60% of eligible schoolchildren consented. Schoolchildren had pharyngeal swabs and sore-throat questionnaires administered by external student-nurses, informing GAS prevalence (primary outcome) and pharyngitis (secondary outcome). GAS positive schoolchildren’s usual care was 10 days once-daily oral amoxicillin. One whole cluster then commenced S. salivarius daily for 30 days. The other initial control cluster had S. salivarius six weeks later, after both clusters were re-swabbed, and GAS positive schoolchildren treated. Student-nurses and laboratory scientists assessing outcomes were blinded to prior S. salivarius exposure. S. salivarius and control period findings were compared. Results Per-protocol efficacy, informed by study swabs, showed Odds of pharyngeal GAS prevalence reduced substantially, but not significantly 0.6 (95% CI 0.29–1.21) for added S. salivarius, (n 235) compared to antibiotics-alone (n 106). Subgroup analysis of 197 originally GAS negative schoolchildren’s swabs found significantly reduced Odds of GAS prevalence with S. salivarius 0.42 (95% CI 0.19–0.94). compared to controls (n 80). Intention to treat analysis utilizing study swabs showed S. salivarius effectively reduced GAS prevalence from 15.5–7.4%, Odds 0.52 (95% CI 0.28–0.97) (n 309) compared to antibiotics-alone (n 157). Intention to treat sub-analysis utilizing all swabs for 260 GAS negative schoolchildren, demonstrated S. salivarius effectiveness Odds 0.52 (95% CI 0.27-1.00) compared to 131 controls. GAS pharyngitis declined from 10/128 to 2/128 over three months Odds 0.19 (95%CI 0.04–0.87) following antibiotics and S. salivarius. Conclusion Whole-cluster S. salivarius probiotic, given after antibiotic treatment of schoolchildren with pharyngeal GAS, significantly reduces GAS pharyngeal prevalence, carriage, and pharyngitis, by limiting GAS negative schoolchildren acquiring Group A Streptococcus. Trial registration ACTRN12615000402549

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A Strep A vaccine global demand and return on investment forecast to inform industry research and development prioritization

Walkinshaw¹,

Wright²,

Williams³

et al. 2023

npj Vaccines

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Investment in Strep A vaccine R&D is disproportionately low relative to the large burden of Strep A diseases globally. This study presents a novel Strep A vaccine global demand and financial forecast model with estimates of potential global demand and associated revenue and profits for a hypothetical Strep A vaccine as well as a net present value (NPV) analysis of return on capital investments required to develop the vaccine. A positive NPV was calculated for a variety of developer scenarios and target populations, including the global rollout of the vaccine in private and public markets by a multinational pharmaceutical corporation and a staged rollout by a developing country vaccine manufacturer for both infant and child populations. The results suggest there is a viable commercial market for a Strep A vaccine. It is hoped that this study will help to inform industry decision-making and drive increased prioritization of, and investment in, Strep A vaccine research and development.

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School-based Streptococcal A Sore-throat Treatment Programs and Acute Rheumatic Fever Amongst Indigenous Māori: A Retrospective Cohort Study

Abstract: Supplemental Digital Content is available in the text.

Cited by 9 publications

References 29 publications

Addressing rheumatic fever inequities in Aotearoa New Zealand: a scoping review of prevention interventions

Addressing rheumatic fever inequities in Aotearoa New Zealand: a scoping review of prevention interventions

Cluster-allocated S. salivarius is more effective than antibiotics-alone reducing pharyngeal Group A Streptococcus prevalence for schoolchildren at risk of Rheumatic fever: a stepped-wedge non-randomized trial

A Strep A vaccine global demand and return on investment forecast to inform industry research and development prioritization

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