Skip to main content Accessibility help
×
Home

High burden of invasive group A streptococcal disease in the Northern Territory of Australia

  • R. BOYD (a1), M. PATEL (a2), B. J. CURRIE (a3) (a4), D. C. HOLT (a4), T. HARRIS (a4) and V. KRAUSE (a1)...

Summary

Although the incidence of invasive group A streptococcal disease in northern Australia is very high, little is known of the regional epidemiology and molecular characteristics. We conducted a case series of Northern Territory residents reported between 2011 and 2013 with Streptococcus pyogenes isolates from a normally sterile site. Of the 128 reported episodes, the incidence was disproportionately high in the Indigenous population at 69·7/100 000 compared to 8·8/100 000 in the non-Indigenous population. Novel to the Northern Territory is the extremely high incidence in haemodialysis patients of 2205·9/100 000 population; and for whom targeted infection control measures could prevent transmission. The incidences in the tropical north and semi-arid Central Australian regions were similar. Case fatality was 8% (10/128) and streptococcal toxic shock syndrome occurred in 14 (11%) episodes. Molecular typing of 82 isolates identified 28 emm types, of which 63 (77%) were represented by four emm clusters. Typing confirmed transmission between infant twins. While the diverse range of emm types presents a challenge for effective coverage by vaccine formulations, the limited number of emm clusters raises optimism should cluster-specific cross-protection prove efficacious. Further studies are required to determine effectiveness of chemoprophylaxis for contacts and to inform public health response.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      High burden of invasive group A streptococcal disease in the Northern Territory of Australia
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      High burden of invasive group A streptococcal disease in the Northern Territory of Australia
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      High burden of invasive group A streptococcal disease in the Northern Territory of Australia
      Available formats
      ×

Copyright

Corresponding author

*Author for correspondence: Ms. R. Boyd, Centre for Disease Control, Royal Darwin Hospital, Block 4, Rocklands Drive, Tiwi, NT 0810, Australia. (Email: Rowena.Boyd@nt.gov.au)

References

Hide All
1. Davies, HD, et al. Invasive group A streptococcal infections in Ontario, Canada. New England Journal of Medicine 1996; 335: 547554.
2. Hoge, CW, et al. The changing epidemiology of invasive group A streptococcal infections and the emergence of streptococcal toxic shock-like syndrome: a retrospective population-based study. Journal of the American Medical Association 1993; 269: 384389.
3. Lepoutre, A, et al. Epidemiology of invasive Streptococcus pyogenes infections in France in 2007. Journal of Clinical Microbiology 2011; 49: 40944100.
4. O Grady, K, et al. The epidemiology of invasive group A streptococcal disease in Victoria, Australia. Medical Journal of Australia 2007; 186: 565569.
5. O'Loughlin, RE, et al. The epidemiology of invasive group A streptococcal infection and potential vaccine implications: United States, 2000–2004. Clinical Infectious Diseases 2007; 45: 853862.
6. Safar, A, et al. Invasive group A streptococcal infection and vaccine implications, Auckland, New Zealand. Emerging Infectious Diseases 2011; 17: 983989.
7. Steer, AC, et al. Prospective surveillance of invasive group A streptococcal disease, Fiji, 2005–2007. Emerging Infectious Diseases 2009; 15: 216222.
8. Carapetis, J, et al. Clinical and epidemiological features of group A streptococcal bacteraemia in a region with hyperendemic superficial streptococcal infection. Epidemiology and Infection 1999; 122: 5965.
9. Gear, R, et al. Changes in the clinical and epidemiological features of group A streptococcal bacteraemia in Australia's Northern Territory. Tropical Medicine & International Health 2014; 20: 4047
10. Norton, R, et al. Invasive group A streptococcal disease in North Queensland (1996–2001). Indian Journal of Medical Research 2004; 119: 148151.
11. Lamagni, T, et al. Predictors of death after severe streptococcus pyogenes infection. Emerging Infectious Diseases 2009; 15: 13041307.
12. Australian Institute of Health and Welfare. The health and welfare of Australia's Aboriginal and Torres Strait Islander people 2011. (http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=10737418955&libID=10737418954.). Accessed 6 August 2013.
13. Bailie, RS, et al. Skin infection, housing and social circumstances in children living in remote Indigenous communities: testing conceptual and methodological approaches. BMC Public Health 2005; 5: 128139.
14. Carapetis, JR, Wolff, DR, Currie, BJ. Acute rheumatic fever and rheumatic heart disease in the top end of Australia's Northern Territory. Medical Journal of Australia 1996; 164: 146149.
15. Hanna, JN, Heazlewood, RJ. The epidemiology of acute rheumatic fever in Indigenous people in north Queensland. Australian and New Zealand Journal of Public Health 2005; 29: 313317.
16. Marshall, CS, et al. Acute post-streptococcal glomerul phritis in the Northern Territory of Australia: a review of 16 years data and comparison with the literature. American Journal of Tropical Medicine and Hygiene 2011; 85: 703710.
17. McMillan, DJ, et al. Updated model of group A Streptococcus M proteins based on a comprehensive worldwide study. Clinical Microbiology and Infection 2013; 19: E222E229.
18. Steer, AC, Dale, JB, Carapetis, JR. Progress toward a global group a streptococcal vaccine. The Pediatric Infectious Disease Journal 2013; 32: 180182.
19. Australian Bureau of Statistics. Regional statistics. Northern Territory: environment, Northern Territory climate (http://www.abs.gov.au/ausstats/abs@.nsf/Latestproducts/1362.7Main%20Features5Mar%202011?opendocument&tabname=Summary&prodno=1362.7&issue=Mar%202011&num=&view=.) Accessed 18 November 2012.
20. Australian Bureau of Statistics. Census of population and housing: characteristics of Aboriginal and Torres Strait Islander Australians, 2011 (http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/2076.0main+features1102011). Accessed 6 Dec 2011.
21. Australia & New Zealand Dialysis & Transplant Registry. ANZDATA Registry 2012 (http://www.anzdata.org.au/v1/report_2012.html.) Accessed 1 October 2013.
22. Breiman, RF, et al. Defining the group A streptococcal toxic shock syndrome: rationale and consensus definition. Journal of the American Medical Association 1993; 269: 390391.
23. Centers for Disease Control and Prevention. Protocols for emm typing. 2008. (http://www.cdc.gov/streplab/protocol-emm-type.html). Accessed 27 January 2015.
24. Sanderson-Smith, M, et al. A systematic and functional classification of Streptococcus pyogenes that serves as a new tool for molecular typing and vaccine development. Journal of Infectious Diseases 2014; 210: 13251338.
25. Northern Territory Government: Department of Treasury and Finance. Population projections 2011 (http://www.treasury.nt.gov.au/Economy/populationprojections/Pages/PopulationProjections2011.aspx.). Accessed 6 August 2013.
26. Laupland, KB, et al. Invasive group A streptococcal disease in children and association with varicella-zoster virus infection. Pediatrics 2000; 105: e60e69.
27. Middleton, B, Morris, P, Carapetis, J. Invasive group A streptococcal infection in the Northern Territory, Australia: Case report and review of the literature. Journal of Paediatrics and Child Health 2014; 50: 869873.
28. Australian Institute of Health and Welfare. Chronic kidney disease in Aboriginal and Torres Strait Islander people. Cat no. PHE 151 Canberra 2011. (http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=10737420068.). Accessed 30 September 2013.
29. Currie, BJ, Carapetis, JR. Skin infections and infestations in Aboriginal communities in northern Australia. Australasian Journal of Dermatology 2000; 41: 139143.
30. McDonald, MI, et al. Low rates of streptococcal pharyngitis and high rates of pyoderma in Australian aboriginal communities where acute rheumatic fever is hyperendemic. Clinical Infectious Diseases 2006; 43: 683689.
31. Clucas, DB, et al. Disease burden and health-care clinic attendances for young children in remote Aboriginal communities of northern Australia. Bulletin of the World Health Organization 2008; 86: 275281.
32. Bessen, DE, et al. Contrasting molecular epidemiology of group A streptococci causing tropical and nontropical infections of the skin and throat. Journal of Infectious Diseases 2000; 182: 11091116.
33. Towers, RJ, et al. Extensive diversity of Streptococcus pyogenes in a remote human population reflects global-scale transmission rather than localised diversification. PLoS ONE 2013; 8: e73851.
34. Richardson, LJ, et al. Diversity of emm sequence types in group A beta-haemolytic streptococci in two remote Northern Territory Indigenous communities: Implications for vaccine development. Vaccine 2010; 28: 53015305.
35. Steer, AC, et al. Global emm type distribution of group A streptococci: systematic review and implications for vaccine development. Lancet Infectious Diseases 2009; 9: 611616.
36. Dale, JB, et al. New 30-valent M protein-based vaccine evokes cross-opsonic antibodies against non-vaccine serotypes of group A streptococci. Vaccine 2011; 29: 81758178.
37. Australian Institute of Health and Welfare. National drug strategy household survey report. Canberra. 2011, cat. no. PHE 145, 2010.
38. Moore, M, et al. Prevention of invasive group A streptococcal disease among household contacts of case patients and among postpartum and postsurgical patients: recommendations from the Centers for Disease Control and Prevention. Clinical Infectious Diseases 2002; 35: 950959.
39. Public Health Agency of Canada. Guidelines for the prevention and control of invasive group A streptococcal disease. Canada Communicable Disease Report 2006; 32 (S2): 126.
40. Northern Territory Government: Department of Health. Management of contacts of patients with group A streptococcus, 2014, pp. 1–21.

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed