Prevalence of group A Streptococcal infection in Africa to inform GAS vaccines for rheumatic heart disease: A systematic review and meta-analysis

Dylan D. Barth, Annesinah Moloi, Bongani M. Mayosi, Mark E. Engel

Research output: Contribution to journalReview article

Abstract

Background: The prevalence of group A streptococcal (GAS) disease is estimated at >18.1 million cases with an incidence of >1.78 million cases per year. While a significant cause of mortality and morbidity on the global scale, the burden of GAS disease in Africa is unknown. We conducted a systematic review on the prevalence of GAS disease among children and adults in Africa and the frequency and distribution of emm types among isolates. Methods: We performed a comprehensive literature search in a number of databases, using an African search filter. Two reviewers independently selected articles meeting pre-specified criteria and extracted relevant data as per a data extraction form. We applied the random-effects meta-analysis model to aggregate GAS prevalence estimates with 95% CI for GAS prevalence, incorporating the Freeman-Tukey transformation to account for between-study variability. Results: Twenty-five studies were included. Invasive GAS disease prevalence ranged from 0.6% to 10.8% in samples from normally-sterile sites including blood, CSF and soft tissue. A single study reported a prevalence of 74% in skin infections. Prevalence of emm types varied with up to 88 different strains reported, corresponding to a vaccine coverage of 28% to 65%. The pooled prevalence of GAS in persons presenting with pharyngitis was 21% (95% CI, 17% to 26%). Conclusions: The prevalence of GAS remains high among symptomatic individuals residing in Africa. Data on molecular strain characterisation of GAS in Africa is largely non-existent, thus the need for further studies is warranted to inform current prevention efforts including vaccine development.

Original languageEnglish
JournalInternational Journal of Cardiology
DOIs
Publication statusE-pub ahead of print - 28 Nov 2019

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Streptococcal Vaccines
Rheumatic Heart Disease
Streptococcal Infections
Meta-Analysis
Vaccines
Pharyngitis

Cite this

@article{0ac2d97cfd9249ddb4f1a8a99d369b89,
title = "Prevalence of group A Streptococcal infection in Africa to inform GAS vaccines for rheumatic heart disease: A systematic review and meta-analysis",
abstract = "Background: The prevalence of group A streptococcal (GAS) disease is estimated at >18.1 million cases with an incidence of >1.78 million cases per year. While a significant cause of mortality and morbidity on the global scale, the burden of GAS disease in Africa is unknown. We conducted a systematic review on the prevalence of GAS disease among children and adults in Africa and the frequency and distribution of emm types among isolates. Methods: We performed a comprehensive literature search in a number of databases, using an African search filter. Two reviewers independently selected articles meeting pre-specified criteria and extracted relevant data as per a data extraction form. We applied the random-effects meta-analysis model to aggregate GAS prevalence estimates with 95{\%} CI for GAS prevalence, incorporating the Freeman-Tukey transformation to account for between-study variability. Results: Twenty-five studies were included. Invasive GAS disease prevalence ranged from 0.6{\%} to 10.8{\%} in samples from normally-sterile sites including blood, CSF and soft tissue. A single study reported a prevalence of 74{\%} in skin infections. Prevalence of emm types varied with up to 88 different strains reported, corresponding to a vaccine coverage of 28{\%} to 65{\%}. The pooled prevalence of GAS in persons presenting with pharyngitis was 21{\%} (95{\%} CI, 17{\%} to 26{\%}). Conclusions: The prevalence of GAS remains high among symptomatic individuals residing in Africa. Data on molecular strain characterisation of GAS in Africa is largely non-existent, thus the need for further studies is warranted to inform current prevention efforts including vaccine development.",
keywords = "Africa, Group A Streptococcus, Prevalence, Rheumatic heart disease, Systematic review, Vaccine",
author = "Barth, {Dylan D.} and Annesinah Moloi and Mayosi, {Bongani M.} and Engel, {Mark E.}",
year = "2019",
month = "11",
day = "28",
doi = "10.1016/j.ijcard.2019.11.109",
language = "English",
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Prevalence of group A Streptococcal infection in Africa to inform GAS vaccines for rheumatic heart disease : A systematic review and meta-analysis. / Barth, Dylan D.; Moloi, Annesinah; Mayosi, Bongani M.; Engel, Mark E.

In: International Journal of Cardiology, 28.11.2019.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Prevalence of group A Streptococcal infection in Africa to inform GAS vaccines for rheumatic heart disease

T2 - A systematic review and meta-analysis

AU - Barth, Dylan D.

AU - Moloi, Annesinah

AU - Mayosi, Bongani M.

AU - Engel, Mark E.

PY - 2019/11/28

Y1 - 2019/11/28

N2 - Background: The prevalence of group A streptococcal (GAS) disease is estimated at >18.1 million cases with an incidence of >1.78 million cases per year. While a significant cause of mortality and morbidity on the global scale, the burden of GAS disease in Africa is unknown. We conducted a systematic review on the prevalence of GAS disease among children and adults in Africa and the frequency and distribution of emm types among isolates. Methods: We performed a comprehensive literature search in a number of databases, using an African search filter. Two reviewers independently selected articles meeting pre-specified criteria and extracted relevant data as per a data extraction form. We applied the random-effects meta-analysis model to aggregate GAS prevalence estimates with 95% CI for GAS prevalence, incorporating the Freeman-Tukey transformation to account for between-study variability. Results: Twenty-five studies were included. Invasive GAS disease prevalence ranged from 0.6% to 10.8% in samples from normally-sterile sites including blood, CSF and soft tissue. A single study reported a prevalence of 74% in skin infections. Prevalence of emm types varied with up to 88 different strains reported, corresponding to a vaccine coverage of 28% to 65%. The pooled prevalence of GAS in persons presenting with pharyngitis was 21% (95% CI, 17% to 26%). Conclusions: The prevalence of GAS remains high among symptomatic individuals residing in Africa. Data on molecular strain characterisation of GAS in Africa is largely non-existent, thus the need for further studies is warranted to inform current prevention efforts including vaccine development.

AB - Background: The prevalence of group A streptococcal (GAS) disease is estimated at >18.1 million cases with an incidence of >1.78 million cases per year. While a significant cause of mortality and morbidity on the global scale, the burden of GAS disease in Africa is unknown. We conducted a systematic review on the prevalence of GAS disease among children and adults in Africa and the frequency and distribution of emm types among isolates. Methods: We performed a comprehensive literature search in a number of databases, using an African search filter. Two reviewers independently selected articles meeting pre-specified criteria and extracted relevant data as per a data extraction form. We applied the random-effects meta-analysis model to aggregate GAS prevalence estimates with 95% CI for GAS prevalence, incorporating the Freeman-Tukey transformation to account for between-study variability. Results: Twenty-five studies were included. Invasive GAS disease prevalence ranged from 0.6% to 10.8% in samples from normally-sterile sites including blood, CSF and soft tissue. A single study reported a prevalence of 74% in skin infections. Prevalence of emm types varied with up to 88 different strains reported, corresponding to a vaccine coverage of 28% to 65%. The pooled prevalence of GAS in persons presenting with pharyngitis was 21% (95% CI, 17% to 26%). Conclusions: The prevalence of GAS remains high among symptomatic individuals residing in Africa. Data on molecular strain characterisation of GAS in Africa is largely non-existent, thus the need for further studies is warranted to inform current prevention efforts including vaccine development.

KW - Africa

KW - Group A Streptococcus

KW - Prevalence

KW - Rheumatic heart disease

KW - Systematic review

KW - Vaccine

UR - http://www.scopus.com/inward/record.url?scp=85076836181&partnerID=8YFLogxK

U2 - 10.1016/j.ijcard.2019.11.109

DO - 10.1016/j.ijcard.2019.11.109

M3 - Review article

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

ER -