Prospective Surveillance of Streptococcal Sore Throat in a Tropical Country
Prospective Surveillance of Streptococcal Sore Throat in a Tropical Country
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DOI：
10.1097/inf.0b013e318194b2af
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发表时间：
2009-06-01
影响因子：
3.6
通讯作者：
Carapetis, Jonathan R.
中科院分区：
文献类型：
--
作者：
Steer, Andrew C.;Jenney, Adam W. J.;Carapetis, Jonathan R.
背景：急性风湿热和风湿性心脏病在斐济和周围的太平洋岛国造成很高的疾病负担，但对该地区a群链球菌咽炎的流行病学知之甚少。我们设计了一项研究来估计斐济学龄儿童携带乙型溶血性链球菌（BHS）的患病率和BHS培养阳性喉咙痛的发病率。方法：2006年，我们对斐济4所学校的5至14岁学龄儿童进行了为期9个月的前瞻性监测，每周两次，在咽拭子的初始阶段后，确定BHS携带的流行情况。结果：纳入685例患儿，GAS携带率为6.0%，C组链球菌（GCS）和G组链球菌（GGS）携带率分别为6.9%和12%。在研究期间，有61例GAS培养阳性的喉咙痛发作，相当于每100个儿童年14.7例的发病率（95% CI, 11.2-18.8）。GCS/GGS培养阳性溃疡威胁发生率为28.8例/ 100儿童年（95% CI, 23.9-34.5）。GAS培养阳性喉咙痛的临床性质比培养阴性喉咙痛更严重，但与以往研究相比总体较轻。在具有emm序列分型的101株GAS分离株中，有45株emm型无优势型。在工业化国家常见的emm类型很少，本研究中发现的45种emm类型中只有9种是正在进行临床试验的26价GAS疫苗中包含的emm类型。结论：GAS培养阳性的咽喉炎较预期更为常见。C组和G组链球菌在喉部培养中经常被分离出来，尽管它们对咽部感染的贡献尚不清楚。在我们的研究中，咽部气体的分子流行病学与工业化国家有很大不同，这对斐济和其他热带发展中国家的气体疫苗临床研究有影响。
Background: Acute rheumatic fever and rheumatic heart disease cause a high burden of disease in Fiji and surrounding Pacific Island countries, but little is known about the epidemiology of group A streptococcal (GAS) pharyngitis in the region. We designed a study to estimate the prevalence of carriage of beta-hemolytic streptococci (BHS) and the incidence of BHS culture-positive sore throat in school aged children in Fiji.Methods: We conducted twice-weekly prospective surveillance of school children aged 5 to 14 years in 4 schools in Fiji during a 9-month period in 2006, after an initial phase of pharyngeal swabbing to determine the prevalence of BHS carriage.Results: We enrolled 685 children, The prevalence of GAS carriage was 6.0%, while the prevalence of group C streptococcal (GCS) and group G streptococcal (GGS) carriage was 6.9% and 12%, respectively. There were 61 episodes of GAS culture-positive sore throat during the study period equating to an incidence of 14.7 cases per 100 child-years (95% CI, 11.2-18.8). The incidence of GCS/GGS culture-positive sore threat was 28.8 cases per 100 child-years (95% CI, 23.9-34.5). The clinical nature of GAS culture-positive sore throat was more severe than culture-negative sore throat, but overall was mild compared with that found in previous Studies. Of the 10 1 GAS isolates that emm sequence typed there were 45 emm types with no dominant types. There were very few emm types commonly encountered in industrialized nations and only 9 of the 45 emm types found in this study are emm types included in the 26-valent GAS vaccine undergoing clinical trials.Conclusions: GAS culture-positive sore throat was more common than expected. Group C and group G streptococci were frequently isolated in throat cultures, although their contribution to pharyngeal infection is not clear. The molecular epidemiology of pharyngeal GAS in our study differed greatly from that in industrialized nations and this has implications for GAS vaccine clinical research in Fiji and other tropical developing countries.