Abstract
To determine the extent of group A Streptococcus (GAS) infections in sub-Saharan Africa and the serotypes that cause disease, we analyzed surveillance data for 64,741 hospital admissions in Kilifi, Kenya, during 1998-2011. We evaluated incidence, clinical presentations, and emm types that cause invasive GAS infection. We detected 370 cases; of the 369 for which we had data, most were skin and soft tissue infections (70%), severe pneumonia (23%), and primary bacteremia (14%). Overall case-fatality risk was 12%. Incidence of invasive GAS infection was 0.6 cases/1,000 live births among neonates, 101/100,000 person-years among children <1 year of age, and 35/100,000 among children <5 years of age. Genome sequencing identified 88 emm types. GAS causes serious disease in children in rural Kenya, especially neonates, and the causative organisms have considerable genotypic diversity. Benefit from the most advanced GAS type-specific vaccines may be limited, and efforts must be directed to protect against disease in regions of high incidence.
Highlights
To determine the extent of group A Streptococcus (GAS) infections in sub-Saharan Africa and the serotypes that cause disease, we analyzed surveillance data for 64,741 hospital admissions in Kilifi, Kenya, during 1998–2011
From 20 children, >1 GAS isolate was identified: 7 children had invasive GAS isolated from both blood and cerebrospinal fluid (CSF); 2 children had repeat positive blood cultures; 2 children had invasive GAS isolated from blood and a swab sample; 1 child had invasive GAS isolated from CSF and a swab sample; 7 children had invasive GAS isolated from 2 swab samples; and 1 child had invasive GAS isolated from 3 swab samples
A total of 94 (25.5%) cases of invasive GAS were in neonates (Table 1)
Summary
To determine the extent of group A Streptococcus (GAS) infections in sub-Saharan Africa and the serotypes that cause disease, we analyzed surveillance data for 64,741 hospital admissions in Kilifi, Kenya, during 1998–2011. The Young Infant Study of invasive bacterial disease conducted in the late 1990s in The Gambia, Ethiopia, Papua New Guinea, and the Philippines reported GAS in 29 (17%) of 167 bacterial isolates from blood cultures and in 3 (7.5%) of 40 cerebrospinal fluid (CSF) cultures [4] This finding meant that GAS was the third most commonly isolated bacterium after S. pneumoniae and Staphylococcus aureus, research into associated invasive GAS infections has been limited. Data about the emm types causing invasive GAS disease in sub-Saharan Africa are critical for assessing potential vaccine serotype coverage. We used wholegenome sequencing to determine emm types and phylogenetic variations of invasive GAS isolates
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