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Mala K, Baker MG, Stanley J, Bennett J. The epidemiology of repeatedly positive bacterial skin infections in Auckland children, New Zealand. J Infect 2025; 90:106484. [PMID: 40216088 DOI: 10.1016/j.jinf.2025.106484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2024] [Revised: 03/30/2025] [Accepted: 04/03/2025] [Indexed: 04/29/2025]
Abstract
OBJECTIVE Māori and Pacific New Zealanders are disproportionately affected by Acute rheumatic fever (ARF) and rheumatic heart disease (RHD). Repeated S. pyogenes skin infections in childhood are thought to increase the risk of developing ARF/RHD. This study investigated the epidemiology of repeated bacterial skin infections within Auckland, New Zealand. METHOD Microbiology results from wound swabs collected in primary care between 2010 and 2020 were used to estimate the rate of repeatedly positive infections, along with rate ratios and 95% CIs, across demographic groups. RESULTS S. aureus infections impacted all groups; but Māori (Rate Ratio: 10.0, 95% CI: 8.5-11.6) and Pacific children (Rate Ratio: 14.6, 95% CI: 12.6-17.0) under 10 years of age were at a greater risk of repeated S. pyogenes infections compared to their non-Māori/non-Pacific counterparts. The relative risk of subsequent S. pyogenes infection was 4.1 times higher (95% CI: 4.0-4.3) following an initial S. pyogenes infection compared to those negative for S. pyogenes. CONCLUSION Māori and Pacific children's heightened vulnerability to repeated S. pyogenes skin infections supports the immune priming theory of ARF/RHD. Targeted public health initiatives, primary care interventions and Group A Streptococcal vaccine are crucial to reduce repeated S. pyogenes exposure and potentially lower ARF risks.
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Affiliation(s)
- Krishtika Mala
- Department of Public Health, University of Otago, Wellington, New Zealand.
| | - Michael G Baker
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - James Stanley
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Julie Bennett
- Department of Public Health, University of Otago, Wellington, New Zealand
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2
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Langworthy K, Taggart M, Smith R, Levy A, Knight DR, Hui S, Fulurija A, Morici M, Raby E, Manning L. Serological Responses to Target Streptococcus pyogenes Vaccine Antigens in Patients With Proven Invasive β-Hemolytic Streptococcal Infections. J Infect Dis 2025; 231:913-920. [PMID: 39383256 DOI: 10.1093/infdis/jiae496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 09/26/2024] [Accepted: 10/08/2024] [Indexed: 10/11/2024] Open
Abstract
BACKGROUND Rising incidence of invasive β-hemolytic streptococcal (iBHS) infections has prompted consideration of vaccination as a preventative strategy for at-risk populations. The benefits of a vaccine targeting Lancefield group A (Streptococcus pyogenes; Strep A) would increase if cross-species immunity against Lancefield groups C/G (Streptococcus dysgalactiae subspecies equisimilis; SDSE) and B (Streptococcus agalactiae; GBS) was demonstrated. METHODS A prospective, observational study of adult patients with iBHS infections due to Strep A, SDSE, or GBS. Antibody responses to 6 Strep A candidate antigens were assayed on acute and convalescent sera. A serological response was defined as an increase of >0.2 log10 arbitrary units/mL (AU/mL). RESULTS Sixty-seven participants were enrolled. Thirty-three participants were included in the final analysis (12, 11, and 10 with Strep A, SDSE, and GBS, respectively). The median serological response for participants with Strep A was significant for all tested antigens (median >0.2 log10 difference between acute and convalescent samples; P < .05 for all). Those with SDSE had comparable and significant median responses to streptolysin-O (0.65 log10 AU/mL; interquartile range [IQR], 0.36-1.67; P = .004), S. pyogenes adhesion and division protein (0.68 log10 AU/mL; IQR, 0.36-1.63; P = .005), and C5a peptidase (ScpA; 0.30 log10 AU/mL; IQR, 0.23-1.06; P = .004). GBS responses were limited to ScpA only (0.34 log10 AU/mL; IQR, 0.08-0.52; P = .05). CONCLUSIONS Patients with invasive Strep A infection mount robust antibody responses to 6 non-M protein vaccine candidate antigens. Similar significant responses to C5a peptidase in those with invasive SDSE and GBS infection highlight the importance of further research into cross-species protection and immunological correlates of vaccine efficacy.
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Affiliation(s)
- Kristyn Langworthy
- Department of Infectious Diseases, Fiona Stanley Fremantle Hospitals Group, Murdoch, Western Australia, Australia
| | - Michael Taggart
- Department of Infectious Diseases, Fiona Stanley Fremantle Hospitals Group, Murdoch, Western Australia, Australia
| | - Rosemary Smith
- General Medicine Department, Rockingham General Hospital, Cooloongup, Western Australia, Australia
| | - Avram Levy
- School of Biomedical Science, Faculty of Health and Medical Sciences, The University of Western Australia, Crawley, Western Australia, Australia
- Department of Microbiology, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Nedlands, Western Australia, Australia
| | - Daniel R Knight
- School of Biomedical Science, Faculty of Health and Medical Sciences, The University of Western Australia, Crawley, Western Australia, Australia
- Department of Microbiology, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Nedlands, Western Australia, Australia
| | - Siong Hui
- Department of Infectious Diseases, Fiona Stanley Fremantle Hospitals Group, Murdoch, Western Australia, Australia
- Faculty of Health Sciences, Curtin Medical School, Curtin University, Bentley, Western Australia, Australia
| | - Alma Fulurija
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Michael Morici
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Edward Raby
- Department of Infectious Diseases, Fiona Stanley Fremantle Hospitals Group, Murdoch, Western Australia, Australia
- Department of Microbiology, PathWest Laboratory Medicine, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Laurens Manning
- Department of Infectious Diseases, Fiona Stanley Fremantle Hospitals Group, Murdoch, Western Australia, Australia
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- Faculty of Health and Medical Sciences, Medical School, The University of Western Australia, Crawley, Western Australia, Australia
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Gashaw Y, Getaneh A, Kasew D, Tigabie M, Gelaw B. Streptococcus pyogenes carriage rate, associated factors and antimicrobial susceptibility profiles among urban and rural schoolchildren at Gondar city, Northwest Ethiopia. Sci Rep 2025; 15:2057. [PMID: 39814816 PMCID: PMC11735781 DOI: 10.1038/s41598-024-82009-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 12/02/2024] [Indexed: 01/18/2025] Open
Abstract
Streptococcus pyogenes remains one of the top ten causes of mortality from infectious diseases. Children in low-income nations have high carrier rates of Streptococcus pyogenes, which can serve as a source of infections, including simple superficial infections that may lead to invasive and post-streptococcal diseases, particularly among schoolchildren. This study aimed to assess the prevalence of Streptococcus pyogenes, associated factors, and antimicrobial susceptibility profiles among urban and rural public schoolchildren in Gondar City, Northwest Ethiopia. A school-based comparative cross-sectional study was conducted via a multistage sampling technique among elementary schoolchildren from April to June 2022 in Gondar City. Sociodemographic and clinical data were collected via a pretested structured questionnaire. Standard microbiological methods were used to collect and process throat swabs to isolate Streptococcus pyogenes. An antimicrobial susceptibility test was performed via the disk diffusion method. Epi-Info version 7.2.5 was used to enter the data, which were then exported to SPSS version 25 for analysis. Logistic regression analysis was used to determine the strength of associations between variables, and p < 0.05 was considered statistically significant. The overall prevalence of Streptococcus pyogenes in 438 children was 11.2% (n = 49), with 71.43% (35/49) being urban and 28.57% (14/49) being rural. Low-income parents, hospital admission history, and cigarette smoking in the home were found to be substantially linked with Streptococcus pyogenes carriage among students (p < 0.05). All the Streptococcus pyogenes isolates were susceptible (100%) to penicillin and cefotaxime, but 18.8% and 12.25% of the isolates were resistant to amoxicillin and tetracycline, respectively. The prevalence of Streptococcus pyogenes throat carriage among was intermediate. All the isolates were sensitive to penicillin and cefotaxime, but 18.8% and 12.25% of the isolates were resistant to amoxicillin and tetracycline, respectively. Thus, regular screening and surveillance of Streptococcus pyogenes among schoolchildren should be conducted to minimize carriage or infections and maintain the rational use of antimicrobials. Health education about cigarette smoking in the house also needs to be provided to and the community.
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Affiliation(s)
- Yalewayker Gashaw
- Medical Microbiology, Department of Medical Laboratory Sciences, Woldia University, Woldia, Ethiopia.
| | - Alem Getaneh
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia
| | - Desie Kasew
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia
| | - Mitkie Tigabie
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia
| | - Baye Gelaw
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia
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Jespersen MG, Hayes AJ, Tong SYC, Davies MR. Pangenome evaluation of gene essentiality in Streptococcus pyogenes. Microbiol Spectr 2024; 12:e0324023. [PMID: 39012116 PMCID: PMC11323703 DOI: 10.1128/spectrum.03240-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 06/23/2024] [Indexed: 07/17/2024] Open
Abstract
Bacterial species often consist of strains with variable gene content, collectively referred to as the pangenome. Variations in the genetic makeup of strains can alter bacterial physiology and fitness. To define biologically relevant genes of a genome, genome-wide transposon mutant libraries have been used to identify genes essential for survival or virulence in a given strain. Such phenotypic studies have been conducted in four different genotypes of the human pathogen Streptococcus pyogenes, yet challenges exist in comparing results across studies conducted in different genetic backgrounds and conditions. To advance genotype to phenotype inferences across different S. pyogenes strains, we built a pangenome database of 249 S. pyogenes reference genomes. We systematically re-analyzed publicly available transposon sequencing datasets from S. pyogenes using a transposon sequencing-specific analysis pipeline, Transit. Across four genetic backgrounds and nine phenotypic conditions, 355 genes were essential for survival, corresponding to ~24% of the core genome. Clusters of Orthologous Genes (COG) categories related to coenzyme and lipid transport and growth functions were overrepresented as essential. Finally, essential operons across S. pyogenes genotypes were defined, with an increased number of essential operons detected under in vivo conditions. This study provides an extendible database to which new studies can be added, and a searchable html-based resource to direct future investigations into S. pyogenes biology.IMPORTANCEStreptococcus pyogenes is a human-adapted pathogen occupying restricted ecological niches. Understanding the essentiality of genes across different strains and experimental conditions is important to direct research questions and efforts to prevent the large burden of disease caused by S. pyogenes. To this end we systematically reanalyzed transposon sequencing studies in S. pyogenes using transposon sequencing-specific methods, integrating them into an extendible meta-analysis framework. This provides a repository of gene essentiality in S. pyogenes which was used to highlight specific genes of interest and for the community to guide future phenotypic studies.
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Affiliation(s)
- Magnus G. Jespersen
- Department of Microbiology and Immunology, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Andrew J. Hayes
- Department of Microbiology and Immunology, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Steven Y. C. Tong
- Department of Infectious Diseases, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Mark R. Davies
- Department of Microbiology and Immunology, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
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Jacob T, Leshno M, Carmel-Neidermann NN, Kampel L, Warshavsky A, Mansour J, Assadi N, Muhanna N, Horowitz G. Antibiotics or Tonsillectomy for Adult Recurrent Tonsillitis: Analyzing the Lesser of Two Evils. Laryngoscope 2024; 134:2153-2161. [PMID: 37937815 DOI: 10.1002/lary.31139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/01/2023] [Accepted: 10/04/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVE To determine the best timing for surgical intervention for adults with recurrent tonsillitis (RT). METHODS A Markov model was constructed using variables and ranges based upon a literature review. A 1-way sensitivity analysis was performed to evaluate the number of yearly bouts at which each algorithm (antibiotics or tonsillectomy) would be favored. A Monte-Carlo probabilistic sensitivity analysis was calculated for gains and cost. Model outcomes were measured with quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICER) for tonsillectomy versus repeat antibiotic treatment. RESULTS Patients expected to sustain a single annual tonsillitis event will have a negative QALY of 0.02 if treated with surgery and those with 2 annual events will have a QALY gain from undergoing tonsillectomy of 0.01, 3 events = 0.03, 4 events = 0.05, 5 events = 0.07, 6 events = 0.09, 7 events = 0.1, and 8 events = 0.11. These gains became meaningful only after 2 years of recurrent bouts. The average cost of tonsillectomy was 3,238 USD, and the overall average cost of RT was 7,069 USD (an incremental cost of 3,831 USD). The ICER of tonsillectomy over antibiotic treatment for 1 QALY gain was 44,741 USD. CONCLUSION Adult patients who sustain more than 3 annual bouts of tonsillitis over a period of at least 2 years will gain QALY after tonsillectomy. These gains increase proportionally to the number of yearly events and perennial episodes. The incremental costs of tonsillectomy fail to meet the NICE guidelines but are within other acceptable reference ranges. LEVEL OF EVIDENCE NA Laryngoscope, 134:2153-2161, 2024.
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Affiliation(s)
- Tommy Jacob
- The Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Moshe Leshno
- The 'Coller' School of Management, Tel-Aviv University, Both Affiliated to the Tel-Aviv Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Narin Nard Carmel-Neidermann
- The Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Liyona Kampel
- The Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Anton Warshavsky
- The Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Joubran Mansour
- The Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Nidal Assadi
- The Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Nidal Muhanna
- The Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Gilad Horowitz
- The Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
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6
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Leung AKC, Lam JM, Barankin B, Leong KF, Hon KL. Group A β-hemolytic Streptococcal Pharyngitis: An Updated Review. Curr Pediatr Rev 2024; 21:2-17. [PMID: 37493159 DOI: 10.2174/1573396320666230726145436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 06/17/2023] [Accepted: 06/20/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Group A ß-hemolytic Streptococcus (GABHS) is the leading bacterial cause of acute pharyngitis in children and adolescents worldwide. OBJECTIVE This article aims to familiarize clinicians with the clinical manifestations, evaluation, diagnosis, and management of GABHS pharyngitis. METHODS A search was conducted in December 2022 in PubMed Clinical Queries using the key term "group A β-hemolytic streptococcal pharyngitis". This review covers mainly literature published in the previous ten years. RESULTS Children with GABHS pharyngitis typically present with an abrupt onset of fever, intense pain in the throat, pain on swallowing, an inflamed pharynx, enlarged and erythematous tonsils, a red and swollen uvula, enlarged tender anterior cervical lymph nodes. As clinical manifestations may not be specific, even experienced clinicians may have difficulties diagnosing GABHS pharyngitis solely based on epidemiologic or clinical grounds alone. Patients suspected of having GABHS pharyngitis should be confirmed by microbiologic testing (e.g., culture, rapid antigen detection test, molecular point-of-care test) of a throat swab specimen prior to the initiation of antimicrobial therapy. Microbiologic testing is generally unnecessary in patients with pharyngitis whose clinical and epidemiologic findings do not suggest GABHS. Clinical score systems such as the Centor score and McIssac score have been developed to help clinicians decide which patients should undergo diagnostic testing and reduce the unnecessary use of antimicrobials. Antimicrobial therapy should be initiated without delay once the diagnosis is confirmed. Oral penicillin V and amoxicillin remain the drugs of choice. For patients who have a non-anaphylactic allergy to penicillin, oral cephalosporin is an acceptable alternative. For patients with a history of immediate, anaphylactic-type hypersensitivity to penicillin, oral clindamycin, clarithromycin, and azithromycin are acceptable alternatives. CONCLUSION Early diagnosis and antimicrobial treatment are recommended to prevent suppurative complications (e.g., cervical lymphadenitis, peritonsillar abscess) and non-suppurative complications (particularly rheumatic fever) as well as to reduce the severity of symptoms, to shorten the duration of the illness and to reduce disease transmission.
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Affiliation(s)
- Alexander K C Leung
- Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Joseph M Lam
- Department of Pediatrics and Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Benjamin Barankin
- Department of Dermatology, Toronto Dermatology Centre, Toronto, Ontario, Canada
| | - Kin F Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | - Kam L Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong, China
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong, China
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7
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Brouwer S, Rivera-Hernandez T, Curren BF, Harbison-Price N, De Oliveira DMP, Jespersen MG, Davies MR, Walker MJ. Pathogenesis, epidemiology and control of Group A Streptococcus infection. Nat Rev Microbiol 2023; 21:431-447. [PMID: 36894668 PMCID: PMC9998027 DOI: 10.1038/s41579-023-00865-7] [Citation(s) in RCA: 128] [Impact Index Per Article: 64.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 03/11/2023]
Abstract
Streptococcus pyogenes (Group A Streptococcus; GAS) is exquisitely adapted to the human host, resulting in asymptomatic infection, pharyngitis, pyoderma, scarlet fever or invasive diseases, with potential for triggering post-infection immune sequelae. GAS deploys a range of virulence determinants to allow colonization, dissemination within the host and transmission, disrupting both innate and adaptive immune responses to infection. Fluctuating global GAS epidemiology is characterized by the emergence of new GAS clones, often associated with the acquisition of new virulence or antimicrobial determinants that are better adapted to the infection niche or averting host immunity. The recent identification of clinical GAS isolates with reduced penicillin sensitivity and increasing macrolide resistance threatens both frontline and penicillin-adjunctive antibiotic treatment. The World Health Organization (WHO) has developed a GAS research and technology road map and has outlined preferred vaccine characteristics, stimulating renewed interest in the development of safe and effective GAS vaccines.
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Affiliation(s)
- Stephan Brouwer
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia
- Australian Infectious Diseases Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia
| | | | - Bodie F Curren
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia
- Australian Infectious Diseases Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Nichaela Harbison-Price
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia
- Australian Infectious Diseases Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia
| | - David M P De Oliveira
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia
- Australian Infectious Diseases Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia
| | - Magnus G Jespersen
- Department of Microbiology and Immunology, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Mark R Davies
- Department of Microbiology and Immunology, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Mark J Walker
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia.
- Australian Infectious Diseases Research Centre, The University of Queensland, Brisbane, Queensland, Australia.
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia.
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8
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Giannini F, Cannon JW, Cadarette D, Bloom DE, Moore HC, Carapetis J, Abbas K. Modeling the potential health impact of prospective Strep A vaccines. NPJ Vaccines 2023; 8:90. [PMID: 37301930 PMCID: PMC10256967 DOI: 10.1038/s41541-023-00668-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 05/10/2023] [Indexed: 06/12/2023] Open
Abstract
The World Health Organization published the preferred product characteristics for a Group A Streptococcus (Strep A) vaccine in 2018. Based on these parameters for the age of vaccination, vaccine efficacy, duration of protection from vaccine-derived immunity, and vaccination coverage, we developed a static cohort model to estimate the projected health impact of Strep A vaccination at the global, regional, and national levels and by country-income category. We used the model to analyse six strategic scenarios. Based on Strep A vaccine introduction between 2022 and 2034 for the primary scenario, we estimated vaccination at birth for 30 vaccinated cohorts could avert 2.5 billion episodes of pharyngitis, 354 million episodes of impetigo, 1.4 million episodes of invasive disease, 24 million episodes of cellulitis, and 6 million cases of rheumatic heart disease globally. Vaccination impact in terms of burden averted per fully vaccinated individual is highest in North America for cellulitis and in Sub-Saharan Africa for rheumatic heart disease.
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Affiliation(s)
- Fiona Giannini
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia.
| | - Jeffrey W Cannon
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
- Harvard T.H. Chan School of Public Health, Boston, USA
| | | | - David E Bloom
- Harvard T.H. Chan School of Public Health, Boston, USA
| | - Hannah C Moore
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
- School of Population Health, Curtin University, Perth, Australia
| | - Jonathan Carapetis
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
- Perth Children's Hospital, Perth, Australia
| | - Kaja Abbas
- London School of Hygiene & Tropical Medicine, London, UK
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9
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Lee JS, Kim S, Excler JL, Kim JH, Mogasale V. Global economic burden per episode for multiple diseases caused by group A Streptococcus. NPJ Vaccines 2023; 8:69. [PMID: 37188693 PMCID: PMC10184078 DOI: 10.1038/s41541-023-00659-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 04/11/2023] [Indexed: 05/17/2023] Open
Abstract
Considering the lack of existing evidence on economic burden for diseases caused by group A Streptococcus, we estimated the economic burden per episode for selected diseases. Each cost component of direct medical costs (DMCs), direct non-medical costs (DNMCs), and indirect costs (ICs) was separately extrapolated and aggregated to estimate the economic burden per episode by income group as classified by the World Bank. Adjustment factors for DMC and DNMC were generated to overcome related data insufficiencies. To address uncertainty surrounding input parameters, a probabilistic multivariate sensitivity was carried out. The average economic burden per episode ranged from $22 to $392 for pharyngitis, $25 to $2,903 for impetigo, $47 to $2,725 for cellulitis, $662 to $34,330 for invasive and toxin-mediated infections, $231 to $6,332 for acute rheumatic fever (ARF), $449 to $11,717 for rheumatic heart disease (RHD), and $949 to $39,560 for severe RHD across income groups. The economic burden for multiple Group A Streptococcus diseases underscores an urgent need to develop effective prevention strategies including vaccines.
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Affiliation(s)
- Jung-Seok Lee
- International Vaccine Institute, Seoul, South Korea.
| | - Sol Kim
- International Vaccine Institute, Seoul, South Korea
| | | | - Jerome H Kim
- International Vaccine Institute, Seoul, South Korea
- College of Natural Sciences, Seoul National University, Seoul, South Korea
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10
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Rentta NN, Bennett J, Leung W, Webb R, Jack S, Harwood M, Baker MG, Lund M, Wilson N. Medical Treatment for Rheumatic Heart Disease: A Narrative Review. Heart Lung Circ 2022; 31:1463-1470. [PMID: 35987720 DOI: 10.1016/j.hlc.2022.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 07/03/2022] [Accepted: 07/06/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are rare in high-income countries; however, in Aotearoa New Zealand ARF and RHD disproportionately affect Indigenous Māori and Pacific Peoples. This narrative review explores the evidence regarding non-surgical management of patients with clinically significant valve disease or heart failure due to RHD. METHODS Medline, EMBASE and Scopus databases were searched, and additional publications were identified through cross-referencing. Included were 28 publications from 1980 onwards. RESULTS Of the available interventions, improved anticoagulation management and a national RHD register could improve RHD outcomes in New Zealand. Where community pharmacy anticoagulant management services (CPAMS) are available good anticoagulation control can be achieved with a time in the therapeutic range (TTR) of more than 70%, which is above the internationally recommended level of 60%. The use of pharmacists in anticoagulation control is cost-effective, acceptable to patients, pharmacists, and primary care practitioners. There is a lack of local data available to fully assess other interventions; including optimal therapy for heart failure, equitable access to specialist RHD care, prevention, and management of endocarditis. CONCLUSION As RHD continues to disproportionately affect Indigenous and minority groups, pro-equity tertiary prevention interventions should be fully evaluated to ensure they are reducing disease burden and improving outcomes in patients with RHD.
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Affiliation(s)
| | - Julie Bennett
- Department of Public Health, University of Otago, Wellington, New Zealand.
| | - William Leung
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Rachel Webb
- Auckland District Health Board, Auckland, New Zealand; University of Auckland, Department of Paediatrics: Child and Youth Health, Auckland, New Zealand
| | - Susan Jack
- Public Health South, Southern District Health Board, Dunedin, New Zealand
| | - Matire Harwood
- General Practice and Primary Healthcare, University of Auckland, Auckland, New Zealand
| | - Michael G Baker
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Mayanna Lund
- Counties Manukau District Health Board, Auckland, New Zealand
| | - Nigel Wilson
- Green Lane Paediatric and Congenital Cardiac Services, Starship Children's Hospital, Auckland, New Zealand; Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand
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11
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Malik A, Mahajan N, Dar TA, Kim CB. C10Pred: A First Machine Learning Based Tool to Predict C10 Family Cysteine Peptidases Using Sequence-Derived Features. Int J Mol Sci 2022; 23:ijms23179518. [PMID: 36076915 PMCID: PMC9455582 DOI: 10.3390/ijms23179518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/17/2022] [Accepted: 08/20/2022] [Indexed: 12/02/2022] Open
Abstract
Streptococcus pyogenes, or group A Streptococcus (GAS), a gram-positive bacterium, is implicated in a wide range of clinical manifestations and life-threatening diseases. One of the key virulence factors of GAS is streptopain, a C10 family cysteine peptidase. Since its discovery, various homologs of streptopain have been reported from other bacterial species. With the increased affordability of sequencing, a significant increase in the number of potential C10 family-like sequences in the public databases is anticipated, posing a challenge in classifying such sequences. Sequence-similarity-based tools are the methods of choice to identify such streptopain-like sequences. However, these methods depend on some level of sequence similarity between the existing C10 family and the target sequences. Therefore, in this work, we propose a novel predictor, C10Pred, for the prediction of C10 peptidases using sequence-derived optimal features. C10Pred is a support vector machine (SVM) based model which is efficient in predicting C10 enzymes with an overall accuracy of 92.7% and Matthews’ correlation coefficient (MCC) value of 0.855 when tested on an independent dataset. We anticipate that C10Pred will serve as a handy tool to classify novel streptopain-like proteins belonging to the C10 family and offer essential information.
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Affiliation(s)
- Adeel Malik
- Institute of Intelligence Informatics Technology, Sangmyung University, Seoul 03016, Korea
- Correspondence: (A.M.); (C.-B.K.)
| | - Nitin Mahajan
- Department of Pediatrics, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Tanveer Ali Dar
- Department of Clinical Biochemistry, University of Kashmir, Srinagar 190006, India
| | - Chang-Bae Kim
- Department of Biotechnology, Sangmyung University, Seoul 03016, Korea
- Correspondence: (A.M.); (C.-B.K.)
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12
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Moore HC, Cannon JW, Kaslow DC, Lamagni T, Bowen AC, Miller KM, Cherian T, Carapetis J, Van Beneden C. A systematic framework for prioritising burden of disease data required for vaccine development and implementation: the case for group A streptococcal diseases. Clin Infect Dis 2022; 75:1245-1254. [PMID: 35438130 PMCID: PMC9525082 DOI: 10.1093/cid/ciac291] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/04/2022] [Indexed: 12/30/2022] Open
Abstract
Vaccine development and implementation decisions need to be guided by accurate and robust burden of disease data. We developed an innovative systematic framework outlining the properties of such data that are needed to advance vaccine development and evaluation, and prioritize research and surveillance activities. We focus on 4 objectives—advocacy, regulatory oversight and licensure, policy and post-licensure evaluation, and post-licensure financing—and identify key stakeholders and specific requirements for burden of disease data aligned with each objective. We apply this framework to group A Streptococcus, a pathogen with an underrecognized global burden, and give specific examples pertinent to 8 clinical endpoints. This dynamic framework can be adapted for any disease with a vaccine in development and can be updated as vaccine candidates progress through clinical trials. This framework will also help with research and innovation priority setting of the Immunization Agenda 2030 (IA2030) and accelerate development of future vaccines.
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Affiliation(s)
- Hannah C Moore
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Jeffrey W Cannon
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | | | - Asha C Bowen
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,Perth Children's Hospital, Perth, Western Australia, Australia
| | - Kate M Miller
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | | | - Jonathan Carapetis
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,Perth Children's Hospital, Perth, Western Australia, Australia
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13
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Takahashi R, Radcliff FJ, Proft T, Tsai CJ. Pilus proteins from
Streptococcus pyogenes
stimulate innate immune responses through Toll‐like receptor 2. Immunol Cell Biol 2022; 100:174-185. [PMID: 35124861 PMCID: PMC9303359 DOI: 10.1111/imcb.12523] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/27/2022] [Accepted: 02/02/2022] [Indexed: 11/28/2022]
Abstract
The group A Streptococcus (GAS) pilus is a long, flexible, hair‐like structure anchored to the cell surface that facilitates the adherence of GAS to host cells, thus playing a critical role in initiating infections. Because of its important role in GAS virulence, the pilus has become an attractive target for vaccine development. While current research mainly focuses on pilus function and its potential as a vaccine component, there is a lack of knowledge on how the host immune system recognizes and responds to this abundant surface structure. Here we show that both assembled GAS pili and individual pilus proteins induce a potent release of the proinflammatory cytokines tumor necrosis factor and interleukin‐8. We further show that the surface‐exposed backbone pilin and ancillary pilin 1 subunits are Toll‐like receptor 2 (TLR2) agonists. Using reporter cell lines coexpressing human TLR2 in combination with either TLR1 or TLR6, we determined that activation was mediated by the TLR2/TLR6 heterodimer. Finally, we used solid‐phase and flow cytometry binding assays to illustrate a direct interaction between the pilus subunits and TLR2. These results provide further support for the suitability of the pilus as a vaccine component and opens potential avenues for using GAS pili as an adjuvant or immune‐modulation agent.
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Affiliation(s)
- Risa Takahashi
- Department of Molecular Medicine and Pathology, School of Medical Sciences The University of Auckland Auckland New Zealand
| | - Fiona J Radcliff
- Department of Molecular Medicine and Pathology, School of Medical Sciences The University of Auckland Auckland New Zealand
- Maurice Wilkins Centre for Biomolecular Discoveries The University of Auckland Auckland New Zealand
| | - Thomas Proft
- Department of Molecular Medicine and Pathology, School of Medical Sciences The University of Auckland Auckland New Zealand
- Maurice Wilkins Centre for Biomolecular Discoveries The University of Auckland Auckland New Zealand
| | - Catherine J‐Y Tsai
- Department of Molecular Medicine and Pathology, School of Medical Sciences The University of Auckland Auckland New Zealand
- Maurice Wilkins Centre for Biomolecular Discoveries The University of Auckland Auckland New Zealand
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14
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Whitcombe AL, McGregor R, Bennett J, Gurney JK, Williamson DA, Baker MG, Moreland NJ. OUP accepted manuscript. J Infect Dis 2022; 226:167-176. [PMID: 35134931 PMCID: PMC9373162 DOI: 10.1093/infdis/jiac043] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/01/2022] [Indexed: 11/26/2022] Open
Abstract
Background Group A Streptococcus (GAS) causes superficial pharyngitis and skin infections as well as serious autoimmune sequelae such as acute rheumatic fever (ARF) and subsequent rheumatic heart disease. ARF pathogenesis remains poorly understood. Immune priming by repeated GAS infections is thought to trigger ARF, and there is growing evidence for the role of skin infections in this process. Methods We utilized our recently developed 8-plex immunoassay, comprising antigens used in clinical serology for diagnosis of ARF (SLO, DNase B, SpnA), and 5 conserved putative GAS vaccine antigens (Spy0843, SCPA, SpyCEP, SpyAD, Group A carbohydrate), to characterize antibody responses in sera from New Zealand children with a range of clinically diagnosed GAS disease: ARF (n = 79), GAS-positive pharyngitis (n = 94), GAS-positive skin infection (n = 51), and matched healthy controls (n = 90). Results The magnitude and breadth of antibodies in ARF was very high, giving rise to a distinct serological profile. An average of 6.5 antigen-specific reactivities per individual was observed in ARF, compared to 4.2 in skin infections and 3.3 in pharyngitis. Conclusions ARF patients have a unique serological profile, which may be the result of repeated precursor pharyngitis and skin infections that progressively boost antibody breadth and magnitude.
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Affiliation(s)
- Alana L Whitcombe
- School of Medical Sciences and Maurice Wilkins Centre, University of Auckland, Auckland, New Zealand
| | - Reuben McGregor
- School of Medical Sciences and Maurice Wilkins Centre, University of Auckland, Auckland, New Zealand
| | - Julie Bennett
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Jason K Gurney
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Deborah A Williamson
- University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Michael G Baker
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Nicole J Moreland
- Correspondence: Nicole J. Moreland, BSc, PhD, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand ()
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15
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Brusco NK, Oliver J, McMinn A, Steer A, Crawford N. The cost of care for children hospitalised with Invasive Group A Streptococcal Disease in Australia. BMC Health Serv Res 2021; 21:1340. [PMID: 34906126 PMCID: PMC8670128 DOI: 10.1186/s12913-021-07265-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 10/27/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Invasive Group A Streptococcal (iGAS) disease exerts an important burden among Australian children. No Australian hospitalisation cost estimates for treating children with iGAS disease exist, so the financial impact of this condition is unknown. AIM To determine the minimum annual healthcare cost for children (< 18 years) hospitalised with iGAS disease in Australia from a healthcare sector perspective. METHODS A cost analysis including children with laboratory-confirmed iGAS disease hospitalised at the Royal Children's Hospital (Victoria, Australia; July 2016 to June 2019) was performed. Results were extrapolated against the national minimum iGAS disease incidence. This analysis included healthcare cost from the 7 days prior to the index admission via General Practitioner (GP) and Emergency Department (ED) consultations; the index admission itself; and the 6 months post index admission via rehabilitation admissions, acute re-admissions and outpatient consultations. Additional extrapolations of national cost data by age group, Aboriginal and Torres Strait Islander ethnicity and jurisdiction were performed. RESULTS Of the 65 included children, 35% (n = 23) were female, 5% (n = 3) were Aboriginal and Torres Strait Islander, and the average age was 4.4 years (SD 4.6; 65% aged 0-4). The iGAS disease related healthcare cost per child was $67,799 (SD $92,410). These costs were distributed across the 7 days prior to the index admission via GP and ED consultations (0.2 and 1.1% of total costs, respectively), the index admission itself (88.7% of the total costs); and the 6 months post index admission via rehabilitation admissions, acute re-admissions and outpatient consultations (5.3, 4.5 and 0.1% of total costs, respectively). Based on a national minimum paediatric incidence estimation of 1.63 per 100,000 children aged < 18 (95%CI: 1.11-2.32), the total annual healthcare cost for children with iGAS in 2019 was $6,200,862. The financial burden reflects the overrepresentation of Aboriginal and Torres Strait Islander people in the occurrence of iGAS disease. Costs were concentrated among children aged 0-4 years (62%). CONCLUSION As these cost estimations were based on a minimum incidence, true costs may be higher. Strengthening of surveillance and control of iGAS disease, including a mandate for national notification of iGAS disease, is warranted. TRIAL REGISTRATION The current study is a part of ongoing iGAS surveillance work across seven paediatric health services in Australia. As this is not a clinical trial, it has not undergone trial registration.
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Affiliation(s)
- Natasha K Brusco
- Alpha Crucis Group, Health Economics, Langwarrin, Australia
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Peninsula Campus, Frankston, Australia
- College of Science Health and Engineering, La Trobe University, Bundoora, Victoria, Australia
| | - Jane Oliver
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, Australia
- Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Australia
| | - Alissa McMinn
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
| | - Andrew Steer
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Nigel Crawford
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
- Murdoch Children's Research Institute and Department of General Medicine, Royal Children's Hospital, Melbourne, Australia.
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16
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Whitcombe AL, Han F, McAlister SM, Kirkham LAS, Young PG, Ritchie SR, Atatoa Carr P, Proft T, Moreland NJ. An eight-plex immunoassay for Group A streptococcus serology and vaccine development. J Immunol Methods 2021; 500:113194. [PMID: 34801540 DOI: 10.1016/j.jim.2021.113194] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/11/2021] [Accepted: 11/15/2021] [Indexed: 11/17/2022]
Abstract
Group A Streptococcus (GAS) is a major human pathogen responsible for superficial infections through to life-threatening invasive disease and the autoimmune sequelae acute rheumatic fever (ARF). Despite a significant global economic and health burden, there is no licensed vaccine available to prevent GAS disease. Several pre-clinical vaccines that target conserved GAS antigens are in development. Assays that measure antigen-specific antibodies are essential for vaccine research. The aim of this study was to develop a multiplex beadbased immunoassay that can detect and quantify antibody responses to multiple GAS antigen targets in small volume blood samples. This builds on our existing triplex assay comprised of antigens used in clinical serology for the diagnosis of ARF (SLO, DNase B and SpnA). Five additional conserved putative GAS vaccine antigens (Spy0843, SCPA, SpyCEP, SpyAD and the Group A carbohydrate), were coupled to spectrally unique beads to form an 8-plex antigen panel. After optimisation of the assay protocol, standard curves were generated, and assessments of assay specificity, precision and reproducibility were conducted. A broad range of antibody (IgG) titres were able to be quickly and accurately quantified from a single serum dilution. Assay utility was assessed using a panel of 62 clinical samples including serum from adults with GAS bacteraemia and children with ARF. Circulating IgG to all eight antigens was elevated in patients with GAS disease (n = 23) compared to age-matched controls (n = 39) (P < 0.05). The feasibility of using dried blood samples to quantify antigen-specific IgG was also demonstrated. In summary, a robust and reproducible 8-plex assay has been developed that simultaneously quantifies IgG antibodies to GAS vaccine and diagnostic antigens.
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Affiliation(s)
- Alana L Whitcombe
- School of Medical Sciences, The University of Auckland, New Zealand; Maurice Wilkins Centre for Biodiscovery, The University of Auckland, New Zealand
| | - Franklin Han
- School of Medical Sciences, The University of Auckland, New Zealand
| | - Sonia M McAlister
- Wesfarmers Centre of Vaccines & Infectious Disease, Telethon Kids Institute, Perth, Western Australia, Australia; Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Lea-Ann S Kirkham
- Wesfarmers Centre of Vaccines & Infectious Disease, Telethon Kids Institute, Perth, Western Australia, Australia; Centre for Child Health Research, University of Western Australia, Perth, Australia
| | - Paul G Young
- School of Biological Sciences, The University of Auckland, New Zealand
| | | | | | - Thomas Proft
- School of Medical Sciences, The University of Auckland, New Zealand; Maurice Wilkins Centre for Biodiscovery, The University of Auckland, New Zealand
| | - Nicole J Moreland
- School of Medical Sciences, The University of Auckland, New Zealand; Maurice Wilkins Centre for Biodiscovery, The University of Auckland, New Zealand.
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17
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Lee JS, Kim S, Excler JL, Kim J, Mogasale V. Existing cost-effectiveness analyses for diseases caused by Group A Streptococcus: A systematic review to guide future research. Wellcome Open Res 2021. [DOI: 10.12688/wellcomeopenres.17116.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Group A Streptococcus (Strep A) causes a broad spectrum of disease manifestations, ranging from benign symptoms including throat or skin infections, to fatal illness such as rheumatic heart disease, or chronic renal failure. Currently, there is no vaccine available against Strep A infections. Despite the high burden of Strep A-associated infections worldwide, little attention has been paid to the research of these diseases, including standardized surveillance programs, resulting in a lack of economic evaluations for prevention efforts. This study aims at identifying existing cost-effectiveness analyses (CEA) on any Strep A infections. Methods: A systematic literature review was conducted by searching the PubMed electronic database. Results: Of a total of 321, 44 articles met the criteria for inclusion. Overall, CEA studies on Strep A remain limited in number. In particular, a number of available CEA studies on Strep A are disproportionately lower in low-income countries than in high-income countries. Decision-analytic models were the most popular choice for CEA on Strep A. A majority of the models considered pharyngitis and acute rheumatic fever, but it was rare to observe a model which covered a wide range of disease manifestations. Conclusions: Future research is needed to address missing clinical outcomes, imbalance on study locations by income group, and the transmission dynamic of selected diseases.
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18
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Cannon JW, Bennett J, Baker MG, Carapetis JR. Time to address the neglected burden of group A Streptococcus. Med J Aust 2021; 215:94-94.e1. [PMID: 34169525 DOI: 10.5694/mja2.51149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Jeffrey W Cannon
- Telethon Kids Institute, Perth, WA.,Harvard University, Boston, MA, USA
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