scholarly journals Invasive group A Streptococcus disease in Australian children: 2016 to 2018 – a descriptive cohort study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Jane Oliver ◽  
◽  
Elise Thielemans ◽  
Alissa McMinn ◽  
Ciara Baker ◽  
...  
Keyword(s):  
Disease Surveillance ◽  
Vaccine Development ◽  
Group A Streptococcus ◽  
Invasive Disease ◽  
Incidence Rates ◽  
Surveillance Systems ◽  
Invasive Group ◽  
Australian State ◽  
Life Threatening ◽  
Group A

Abstract Objectives Invasive group A Streptococcus (iGAS) disease is serious and sometimes life-threatening. The Paediatric Active Enhanced Disease Surveillance (PAEDS) Network collects voluntary notifications from seven major Australian paediatric hospitals on patients with certain conditions, including iGAS disease. Our aims were to: 1) Describe the epidemiological distribution of paediatric iGAS disease in Australia and correlate this with influenza notifications, 2) Identify GAS strains commonly associated with invasive disease in children. Methods IGAS and influenza notification data were obtained (from the PAEDS Network and the Australian Institute of Health and Welfare, respectively, for the period 1 July 2016 to 30 June 2018). Included iGAS patients had GAS isolated from a normally sterile body site. Data were described according to selected clinical and demographic characteristics, including by age group and Australian State, with proportions and minimum incidence rates estimated. Results A total of 181 patients were identified, with most (115, 63.5%) <5 years old. The mean annual minimum incidence rate was 1.6 (95% confidence interval: 1.1–2.3) per 100,000 children across the study period. An epidemiological correlation with the seasonal burden of influenza was noted. Contact prophylaxis was not consistently offered. Of 96 patients with emm-typing results available, 72.9% showed emm-1, −4 or − 12. Conclusions Robust surveillance systems and cohesive patient management guidelines are needed. Making iGAS disease nationally notifiable would help facilitate this. Influenza vaccination may contribute to reducing seasonal increases in iGAS incidence. The burden of disease emphasises the need for ongoing progress in GAS vaccine development.

scholarly journals Survey of the bp/tee genes from clinical group A streptococcus isolates in New Zealand – implications for vaccine development

2014 ◽  
Vol 63 (12) ◽  
pp. 1670-1678 ◽  
Author(s):  
John D. Steemson ◽  
Nicole J. Moreland ◽  
Deborah Williamson ◽  
Julie Morgan ◽  
Philip E. Carter ◽  
...  
Keyword(s):  
New Zealand ◽  
Vaccine Development ◽  
Group A Streptococcus ◽  
Invasive Disease ◽  
T Antigen ◽  
Clinical Group ◽  
Wide Range ◽  
Life Threatening ◽  
Group A ◽  
The Individual

Group A streptococcus (GAS) is responsible for a wide range of diseases ranging from superficial infections, such as pharyngitis and impetigo, to life-threatening diseases, such as toxic shock syndrome and acute rheumatic fever (ARF). GAS pili are hair-like extensions protruding from the cell surface and consist of highly immunogenic structural proteins: the backbone pilin (BP) and one or two accessory pilins (AP1 and AP2). The protease-resistant BP builds the pilus shaft and has been recognized as the T-antigen, which forms the basis of a major serological typing scheme that is often used as a supplement to M typing. A previous sequence analysis of the bp gene (tee gene) in 39 GAS isolates revealed 15 different bp/tee types. In this study, we sequenced the bp/tee gene from 100 GAS isolates obtained from patients with pharyngitis, ARF or invasive disease in New Zealand. We found 20 new bp/tee alleles and four new bp/tee types/subtypes. No association between bp/tee type and clinical outcome was observed. We confirmed earlier reports that the emm type and tee type are associated strongly, but we also found exceptions, where multiple tee types could be found in certain M/emm type strains, such as M/emm89. We also reported, for the first time, the existence of a chimeric bp/tee allele, which was assigned into a new subclade (bp/tee3.1). A strong sequence conservation of the bp/tee gene was observed within the individual bp/tee types/subtypes (>97 % sequence identity), as well as between historical and contemporary New Zealand and international GAS strains. This temporal and geographical sequence stability provided further evidence for the potential use of the BP/T-antigen as a vaccine target.

scholarly journals The Shock of Strep: Rapid Deaths Due to Group a Streptococcus

2018 ◽  
Vol 8 (1) ◽  
pp. 136-149 ◽  
Author(s):  
Katrina M. Thompson ◽  
Alana K. Sterkel ◽  
Joseph A. McBride ◽  
Robert F. Corliss
Keyword(s):  
Streptococcus Pyogenes ◽  
Group A Streptococcus ◽  
Invasive Disease ◽  
Significant Morbidity ◽  
Invasive Group ◽  
Life Threatening ◽  
Group A ◽  
Severe Infections ◽  
Microscopic Findings ◽  
Positive Coccus

Streptococcus pyogenes, also known as group A beta-hemolytic strep, is a Gram positive coccus responsible for several million infections every year. The types of infections vary widely from pharyngitis to myositis, but all can advance to severe life threatening invasive disease. Of those infected, approximately 1100 to 1600 people die each year due to invasive disease. Why certain individuals contract severe infections is not known, but many strains of Streptococcus pyogenes are known to produce toxins and superantigens. Invasive Streptococcus pyogenes infections have been shown to cause significant morbidity and rapid mortality. In many cases, patients expire before full antemortem testing can be performed, causing physicians and families to look to forensic pathologists for answers. Understanding the pathogenesis of invasive group A strep infections, relevant gross and microscopic findings, and proper culturing techniques is critical for forensic pathologists to diagnosis this condition and assist in the education and protection of the communities they serve.

scholarly journals Epidemiology of Invasive Group A Streptococcal Disease in Alaska, 2001 to 2013

2015 ◽  
Vol 54 (1) ◽  
pp. 134-141 ◽  
Author(s):  
Karen Rudolph ◽  
Michael G. Bruce ◽  
Dana Bruden ◽  
Tammy Zulz ◽  
Alisa Reasonover ◽  
...  
Keyword(s):  
Vaccine Development ◽  
Case Fatality ◽  
Invasive Disease ◽  
Population Based ◽  
The Arctic ◽  
Surveillance Program ◽  
Bacterial Disease ◽  
Invasive Group ◽  
Laboratory Surveillance ◽  
Group A

The Arctic Investigations Program (AIP) began surveillance for invasive group A streptococcal (GAS) infections in Alaska in 2000 as part of the invasive bacterial diseases population-based laboratory surveillance program. Between 2001 and 2013, there were 516 cases of GAS infection reported, for an overall annual incidence of 5.8 cases per 100,000 persons with 56 deaths (case fatality rate, 10.7%). Of the 516 confirmed cases of invasive GAS infection, 422 (82%) had isolates available for laboratory analysis. All isolates were susceptible to penicillin, cefotaxime, and levofloxacin. Resistance to tetracycline, erythromycin, and clindamycin was seen in 11% (n= 8), 5.8% (n= 20), and 1.2% (n= 4) of the isolates, respectively. A total of 51emmtypes were identified, of whichemm1 (11.1%) was the most prevalent, followed byemm82 (8.8%),emm49 (7.8%),emm12 andemm3 (6.6% each),emm89 (6.2%),emm108 (5.5%),emm28 (4.7%),emm92 (4%), andemm41 (3.8%). The five most commonemmtypes accounted for 41% of isolates. Theemmtypes in the proposed 26-valent and 30-valent vaccines accounted for 56% and 78% of all cases, respectively. GAS remains an important cause of invasive bacterial disease in Alaska. Continued surveillance of GAS infections will help improve understanding of the epidemiology of invasive disease, with an impact on disease control, notification of outbreaks, and vaccine development.

scholarly journals Streptococcus pyogenes evades adaptive immunity through specific IgG glycan hydrolysis

2019 ◽  
Vol 216 (7) ◽  
pp. 1615-1629 ◽  
Author(s):  
Andreas Naegeli ◽  
Eleni Bratanis ◽  
Christofer Karlsson ◽  
Oonagh Shannon ◽  
Raja Kalluru ◽  
...  
Keyword(s):  
Streptococcus Pyogenes ◽  
Vaccine Development ◽  
Group A Streptococcus ◽  
Invasive Infection ◽  
Invasive Infections ◽  
Life Threatening ◽  
Group A ◽  
Specific Igg

Streptococcus pyogenes (Group A streptococcus; GAS) is a human pathogen causing diseases from uncomplicated tonsillitis to life-threatening invasive infections. GAS secretes EndoS, an endoglycosidase that specifically cleaves the conserved N-glycan on IgG antibodies. In vitro, removal of this glycan impairs IgG effector functions, but its relevance to GAS infection in vivo is unclear. Using targeted mass spectrometry, we characterized the effects of EndoS on host IgG glycosylation during the course of infections in humans. Substantial IgG glycan hydrolysis occurred at the site of infection and systemically in the severe cases. We demonstrated decreased resistance to phagocytic killing of GAS lacking EndoS in vitro and decreased virulence in a mouse model of invasive infection. This is the first described example of specific bacterial IgG glycan hydrolysis during infection and thereby verifies the hypothesis that EndoS modifies antibodies in vivo. This mechanisms of immune evasion could have implications for treatment of severe GAS infections and for future efforts at vaccine development.

scholarly journals Paediatric Active Enhanced Disease Surveillance (PAEDS) 2017 and 2018: Prospective hospital-based surveillance for serious paediatric conditions

2020 ◽  
Vol 44 ◽  
Author(s):  
Jocelynne E McRae ◽  
Helen E Quinn ◽  
Gemma L Saravanos ◽  
Samantha J Carlson ◽  
Philip N Britton ◽  
...  
Keyword(s):  
Herpes Zoster ◽  
Disease Surveillance ◽  
Hospital Admissions ◽  
Group A Streptococcus ◽  
Parental Attitudes ◽  
Vaccine Uptake ◽  
World Health ◽  
Invasive Group ◽  
Rotavirus Vaccines ◽  
Group A

Introduction The Paediatric Active Enhanced Disease Surveillance (PAEDS) network is a hospital-based active surveillance system employing prospective case ascertainment for selected serious childhood conditions, particularly vaccine-preventable diseases and potential adverse events following immunisation (AEFI). This report presents surveillance data for 2017 and 2018. Methods Specialist nurses screened hospital admissions, emergency department (ED) records, laboratory and other data on a daily basis in seven paediatric tertiary referral hospitals across Australia to identify children with the conditions under surveillance. In 2017 and 2018 these included acute flaccid paralysis (AFP; a syndrome associated with poliovirus infection), acute childhood encephalitis (ACE), influenza, intussusception (IS; a potential AEFI with rotavirus vaccines), pertussis, varicella-zoster virus infection (varicella and herpes zoster), invasive meningococcal, and invasive Group A streptococcus diseases. An additional social research component was added to evaluate parental attitudes to vaccination. Results PAEDS captured 1,580 and 925 cases for 2017 and 2018, respectively, across all conditions under surveillance. Key outcomes of PAEDS included: contribution to national AFP surveillance to reach the World Health Organization reporting targets; identification of a third human parechovirus outbreak among other infectious diseases linked to ACE; demonstration of variable influenza activity between 2017 and 2018, with vaccine effectiveness (VE) analysis demonstrating that the protection offered through vaccination is season-dependent. All IS cases associated with vaccine receipt were reported to the relevant state health department. Varicella and herpes zoster case numbers remained unchanged, with vaccine uptake found to be suboptimal among eligible children under the NIP. Enhanced pertussis surveillance continues to capture controls for VE estimation. Surveillance for invasive meningococcal disease showed predominance for serotype B at 57% over 2 years among 77 cases where serotyping was available, and surveillance for invasive group A streptococcus captured severe disease in children. Conclusions PAEDS continues to provide unique policy-relevant data on serious paediatric conditions using hospital-based sentinel surveillance.

scholarly journals Paediatric Active Enhanced Disease Surveillance (PAEDS) annual report 2016: Prospective hospital-based surveillance for serious paediatric conditions

2019 ◽  
Vol 43 ◽  
Author(s):  
Jocelynne.E McRae ◽  
Helen.E Quinn ◽  
Gemma.L Saravanos ◽  
Alissa McMinn ◽  
Philip N Britton ◽  
...  
Keyword(s):  
Public Health ◽  
Emergency Department ◽  
Herpes Zoster ◽  
Disease Surveillance ◽  
Acute Flaccid Paralysis ◽  
Group A Streptococcus ◽  
Invasive Group ◽  
Varicella Zoster ◽  
Vaccine Preventable Diseases ◽  
Group A

Introduction The Paediatric Active Enhanced Disease Surveillance (PAEDS) network is a hospital-based active surveillance system employing prospective case ascertainment for selected serious childhood conditions, particularly vaccine preventable diseases and potential adverse events following immunisation (AEFI). PAEDS data is used to better understand these conditions, inform policy and practice under the National Immunisation Program, and enable rapid public health responses for certain conditions of public health importance. PAEDS enhances data available from other Australian surveillance systems by providing prospective, detailed clinical and laboratory information on children with selected conditions. This is the third annual PAEDS report, and presents surveillance data for 2016. Methods Specialist nurses screened hospital admissions, emergency department records, laboratory and other data, on a daily basis in 5 paediatric tertiary referral hospitals in New South Wales, Victoria, South Australia, Western Australia and Queensland to identify children with the conditions under surveillance. Retrospective data on some conditions was also captured by an additional hospital in the Northern Territory. Standardised protocols and case definitions were used across all sites. Conditions under surveillance in 2016 included acute flaccid paralysis (AFP) (a syndrome associated with poliovirus infection), acute childhood encephalitis (ACE), influenza, intussusception (IS; a potential AEFI with rotavirus vaccines), pertussis, varicella-zoster virus infection (varicella and herpes zoster), invasive meningococcal and invasive Group A streptococcus diseases. Most protocols restrict eligibility to hospitalisations; Emergency Department (ED) only presentations are also included for some conditions. Results In 2016, there were 673 cases identified across all conditions under surveillance. Key outcomes of PAEDS included: contribution to national AFP surveillance to reach World Health Organization (WHO) reporting targets; identification of the leading infectious causes of acute encephalitis which included human parechovirus, influenza, enteroviruses, Mycoplasma pneumoniae, and bacterial meningo-encephalitis; demonstration of high influenza activity with vaccine effectiveness (VE) analysis demonstrating some protection offered through vaccination. All IS cases associated with vaccine receipt were reported to the relevant state health department. Varicella and herpes zoster case numbers increased from previous years associated with suboptimal vaccination in up to 40% of cases identified. Pertussis surveillance continued in 2016 with the addition of test negative controls captured for estimating vaccine effectiveness. Surveillance for invasive meningococcal disease showed predominance for serotype B in absence of immunisation, and new invasive group A streptococcus surveillance captured severe disease in children.   Conclusions PAEDS continues to provide unique policy-relevant data on serious paediatric conditions using hospital-based sentinel surveillance. Keywords: paediatric, surveillance, child, hospital, vaccine preventable diseases, adverse event following immunisation, acute flaccid paralysis, encephalitis, influenza, intussusception, pertussis, varicella zoster virus, meningococcal, group A streptococcus.

scholarly journals 215. Invasive Group A Streptococcus-Associated Hospitalizations and Risk Factors for In-Hospital Mortality Among Adults in California, 2000–2016

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S126-S127
Author(s):  
Ellora Karmarkar ◽  
Seema Jain ◽  
Gail L Sondermeyer Cooksey ◽  
Jennifer Myers ◽  
Amanda Kamali
Keyword(s):  
Risk Factors ◽  
Group A Streptococcus ◽  
Continuous Variable ◽  
Incidence Rates ◽  
Severe Illness ◽  
Hospital Death ◽  
Discharge Data ◽  
Invasive Group ◽  
Group A ◽  
Race Ethnicity

Abstract Background Invasive group A Streptococcus (iGAS) causes severe illness and death but is not vaccine preventable or nationally notifiable. We describe the epidemiology of adult patients hospitalized with iGAS in California and risk factors for in-hospital death. Methods Using 2000–2016 California hospital discharge data, we extracted records for adults (≥18 years) with ≥1 group A Streptococcus (GAS)-associated International Classification of Diseases, Ninth or Tenth Revision discharge diagnosis code (e.g., unspecified GAS; GAS-specific pharyngitis, pneumonia, and sepsis) or known GAS-associated syndromes (e.g., acute rheumatic fever, erysipelas, scarlet fever). To identify patients hospitalized with iGAS, we selected extracted records that also had codes consistent with invasive disease (e.g., sepsis, pneumonia, intubation, or central line placement). We calculated iGAS-associated hospitalization incidence rates per 100,000 population and described patient demographics and comorbidities. We calculated the odds of in-hospital death using multivariable logistic regression (P < 0.05). Results During 2000–2016 in California, 37,532 adults were hospitalized with iGAS; 1,045 (3%) died in-hospital. Mean annual hospitalization incidence was 9.4/100,000 population, and was highest (16.3/100,000) in 2016 (Figure 1). Most patients were male (56%), aged 40–65 (45%) or ≥65 (28%) years, and white (60%); 18% were immunocompromised. The percent of patients who died in-hospital increased with age and was highest among those with comorbidities such as malnutrition, cardiovascular disease (CVD), and chronic kidney disease (CKD) (Figure 2). In a multivariable model including age as a continuous variable, sex, and race-ethnicity, the odds of in-hospital death was significantly increased for patients with diagnosis codes for malnutrition, liver disease, CVD, immunosuppression, and CKD (Figure 2); within the race/ethnicity variable Asian/Pacific Islander patients had a higher odds of death compared with white patients. Conclusion Hospitalization and subsequent in-hospital death due to iGAS is substantial in California. Adults with iGAS who have specific comorbidities are at greater risk for death when hospitalized with iGAS. Disclosures All authors: No reported disclosures.

scholarly journals Canada-Wide Epidemic of emm74 Group A Streptococcus Invasive Disease

2018 ◽  
Vol 5 (5) ◽  
Author(s):  
Sarah Teatero ◽  
Allison McGeer ◽  
Gregory J Tyrrell ◽  
Linda Hoang ◽  
Hanan Smadi ◽  
...  
Keyword(s):  
Group A Streptococcus ◽  
Invasive Disease ◽  
Drug Usage ◽  
Rare Type ◽  
Invasive Group ◽  
Intravenous Drug Usage ◽  
Clinical Data Analysis ◽  
Invasive Infections ◽  
Group A ◽  
Canadian Provinces

Abstract Background The number of invasive group A Streptococcus (iGAS) infections due to hitherto extremely rare type emm74 strains has increased in several Canadian provinces since late 2015. We hypothesized that the cases recorded in the different provinces are linked and caused by strains of an emm74 clone that recently emerged and expanded explosively. Methods We analyzed both active and passive surveillance data for iGAS infections and used whole-genome sequencing to investigate the phylogenetic relationships of the emm74 strains responsible for these invasive infections country-wide. Results Genome analysis showed that highly clonal emm74 strains, genetically different from emm74 organisms previously circulating in Canada, were responsible for a country-wide epidemic of &gt;160 invasive disease cases. The emerging clone belonged to multilocus sequence typing ST120. The analysis also revealed dissemination patterns of emm74 subclonal lineages across Canadian provinces. Clinical data analysis indicated that the emm74 epidemic disproportionally affected middle-aged or older male individuals. Homelessness, alcohol abuse, and intravenous drug usage were significantly associated with invasive emm74 infections. Conclusions In a period of 20 months, an emm74 GAS clone emerged and rapidly spread across several Canadian provinces located more than 4500 km apart, causing invasive infections primarily among disadvantaged persons.

scholarly journals Paediatric Active Enhanced Disease Surveillance (PAEDS) 2019: Prospective hospital-based surveillance for serious paediatric conditions

2021 ◽  
Vol 45 ◽  
Author(s):  
Nicole Dinsmore ◽  
Jocelynne E McRae ◽  
Helen E Quinn ◽  
Catherine Glover ◽  
Sonia Dougherty ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Influenza Vaccination ◽  
Disease Surveillance ◽  
Group A Streptococcus ◽  
Parental Attitudes ◽  
Bloodstream Infections ◽  
World Health ◽  
Invasive Group ◽  
Gram Negative ◽  
Group A

Introduction: The Paediatric Active Enhanced Disease Surveillance (PAEDS) network is an Australian hospital-based active surveillance system employing prospective case ascertainment for selected serious childhood conditions, particularly vaccine preventable diseases and potential adverse events following immunisation (AEFI). This report presents surveillance data for 2019. Methods: Specialist nurses screened hospital admissions, emergency department records, laboratory and other data on a daily basis in seven paediatric tertiary referral hospitals across Australia, to identify children with the conditions under surveillance. Standardised protocols and case definitions were used across all sites. In 2019, the conditions under surveillance comprised: acute flaccid paralysis (AFP; a syndrome associated with poliovirus infection), acute childhood encephalitis (ACE), influenza, intussusception (IS; a potential AEFI with rotavirus vaccines), pertussis, varicella-zoster virus infection (varicella and herpes zoster), invasive meningococcal and invasive Group A streptococcus diseases and two new conditions, Kawasaki disease and gram-negative bloodstream infections. An additional social research component continued to evaluate parental attitudes to influenza vaccination. Results: PAEDS captured 2,701 cases for 2019 across all conditions under surveillance. Key outcomes of PAEDS included: contribution to national AFP surveillance to reach the World Health Organization reporting targets for detection of poliomyelitis cases; demonstration of high influenza activity in 2019 and influenza-associated deaths in ACE cases; identification of key barriers to influenza vaccination of children hospitalised for acute respiratory illness; reporting of all IS cases associated with vaccine receipt to relevant state health department; and showing a further reduction nationally in varicella cases. Enhanced pertussis surveillance continued to capture controls to support vaccine efficacy estimation. Invasive meningococcal disease surveillance showed predominance of serotype B and a reduction in cases nationally. Surveillance for invasive group A streptococcus captured severe cases in children. Monitoring of Kawasaki disease incidence and gram-negative bloodstream infections commenced. Conclusions: PAEDS continues to provide unique policy-relevant data on serious paediatric conditions using sentinel hospital-based enhanced surveillance.

scholarly journals Recent Advances in the Development of Peptide Vaccines and Their Delivery Systems Against Group A Streptococcus

Vaccines ◽  
2019 ◽  
Vol 7 (3) ◽  
pp. 58 ◽  
Author(s):  
Azuar ◽  
Jin ◽  
Mukaida ◽  
Hussein ◽  
Toth ◽  
...  
Keyword(s):  
Vaccine Development ◽  
Group A Streptococcus ◽  
Delivery Systems ◽  
Peptide Vaccines ◽  
Peptide Epitope ◽  
The Public ◽  
Life Threatening ◽  
Group A ◽  
Preclinical And Clinical Studies ◽  
Traditional Approaches

Group A Streptococcus (GAS) infection can cause a variety of diseases in humans, ranging from common sore throats and skin infections, to more invasive diseases and life-threatening post-infectious diseases, such as rheumatic fever and rheumatic heart disease. Although research has been ongoing since 1923, vaccines against GAS are still not available to the public. Traditional approaches taken to develop vaccines for GAS failed due to poor efficacy and safety. Fortunately, headway has been made and modern subunit vaccines that administer minimal bacterial components provide an opportunity to finally overcome previous hurdles in GAS vaccine development. This review details the major antigens and strategies used for GAS vaccine development. The combination of antigen selection, peptide epitope modification and delivery systems have resulted in the discovery of promising peptide vaccines against GAS; these are currently in preclinical and clinical studies.

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