Risk factors for group A streptococcal pharyngitis and skin infections: A case control study
Summary: Background: Group A streptococcal (GAS) infections can trigger an immune-mediated response resulting in acute rheumatic fever (ARF). The role of social and environmental risk factors for GAS pharyngitis and skin infections are not well understood. This study aimed to identify factors assoc...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-09-01
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| Series: | The Lancet Regional Health. Western Pacific |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666606522001225 |
| _version_ | 1818219089670176768 |
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| author | Julie Bennett Nicole J. Moreland Jane Zhang Julian Crane Dianne Sika-Paotonu Jonathan Carapetis Deborah A. Williamson Michael G. Baker |
| author_facet | Julie Bennett Nicole J. Moreland Jane Zhang Julian Crane Dianne Sika-Paotonu Jonathan Carapetis Deborah A. Williamson Michael G. Baker |
| author_sort | Julie Bennett |
| collection | DOAJ |
| description | Summary: Background: Group A streptococcal (GAS) infections can trigger an immune-mediated response resulting in acute rheumatic fever (ARF). The role of social and environmental risk factors for GAS pharyngitis and skin infections are not well understood. This study aimed to identify factors associated with GAS pharyngitis and skin infections, and to determine if these are the same as those for ARF. Methods: A case-control study, including 733 children aged 5-14 years, was undertaken between March 2018 and October 2019 in Auckland, New Zealand. Healthy controls (n = 190) and symptomatic cases including GAS pharyngitis (n = 210), GAS seronegative carriers (n = 182), and GAS skin infections (n = 151) were recruited. Trained interviewers administered a comprehensive, pre-tested, face-to-face questionnaire. Findings: Multivariable analysis identified strong associations between barriers to accessing primary healthcare and having GAS pharyngitis (adjusted OR 3·3; 95% CI 1·8-6·0), GAS carriage (aOR 2·9; 95% CI 1·5-6·0) or a GAS skin infection (aOR 3·5; 95% CI 1·6-7·6). Children who had GAS skin infections were more likely than all other groups to report living in a crowded home (aOR 1·9; 95% CI 1·0-3·4), have Māori or Pacific grandparents (aOR 3·0; 95% CI 1·2-7·6), a family history of ARF (aOR 2·2; 95% CI 1·1-4·3), or having a previous diagnosis of eczema (aOR 3·9; 95% CI 2·2-6·9). Interpretation: Reducing barriers to accessing primary healthcare (including financial restrictions, the inability to book an appointment, lack of transport, and lack of childcare for other children) to treat GAS pharyngitis and skin infections could potentially reduce these infections and lead to a reduction in their sequelae, including ARF. These strategies should be co-designed and culturally appropriate for the communities being served and carefully evaluated. Funding: This work was supported by the Health Research Council of New Zealand (HRC), award number 16/005. |
| first_indexed | 2024-12-12T07:34:07Z |
| format | Article |
| id | doaj.art-8535974f070e4b2a87e59e0de54cc593 |
| institution | Directory Open Access Journal |
| issn | 2666-6065 |
| language | English |
| last_indexed | 2024-12-12T07:34:07Z |
| publishDate | 2022-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Regional Health. Western Pacific |
| spelling | doaj.art-8535974f070e4b2a87e59e0de54cc5932022-12-22T00:32:57ZengElsevierThe Lancet Regional Health. Western Pacific2666-60652022-09-0126100507Risk factors for group A streptococcal pharyngitis and skin infections: A case control studyJulie Bennett0Nicole J. Moreland1Jane Zhang2Julian Crane3Dianne Sika-Paotonu4Jonathan Carapetis5Deborah A. Williamson6Michael G. Baker7Department of Public Health, University of Otago, 23A Mein Street, Newtown, Wellington 6021, New Zealand; Corresponding author.School of Medical Sciences, the University of Auckland, 85 Park Road, Grafton, Auckland 1023, New Zealand; Maurice Wilkins Centre, the University of Auckland, 85 Park Road, Grafton, Auckland 1023, New ZealandDepartment of Public Health, University of Otago, 23A Mein Street, Newtown, Wellington 6021, New ZealandDepartment of Medicine, University of Otago, 23A Mein Street, Newtown, Wellington 6021, New ZealandDepartment of Pathology and Molecular Medicine, University of Otago, 23A Mein Street, Newtown, Wellington 6021, New ZealandTelethon Kids Institute, 15 Hospital Ave, Nedlands, Perth, 6009, Western Australia; Centre for Child Health and Research, University of Western Australia, 35 Stirling Hwy, Crawley, Perth 6009, Western Australia; Perth Children's Hospital, 15 Hospital Ave, Nedlands, Perth, 6009, Western AustraliaDepartment of Infectious Disease, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3004, AustraliaDepartment of Public Health, University of Otago, 23A Mein Street, Newtown, Wellington 6021, New Zealand; Maurice Wilkins Centre, the University of Auckland, 85 Park Road, Grafton, Auckland 1023, New ZealandSummary: Background: Group A streptococcal (GAS) infections can trigger an immune-mediated response resulting in acute rheumatic fever (ARF). The role of social and environmental risk factors for GAS pharyngitis and skin infections are not well understood. This study aimed to identify factors associated with GAS pharyngitis and skin infections, and to determine if these are the same as those for ARF. Methods: A case-control study, including 733 children aged 5-14 years, was undertaken between March 2018 and October 2019 in Auckland, New Zealand. Healthy controls (n = 190) and symptomatic cases including GAS pharyngitis (n = 210), GAS seronegative carriers (n = 182), and GAS skin infections (n = 151) were recruited. Trained interviewers administered a comprehensive, pre-tested, face-to-face questionnaire. Findings: Multivariable analysis identified strong associations between barriers to accessing primary healthcare and having GAS pharyngitis (adjusted OR 3·3; 95% CI 1·8-6·0), GAS carriage (aOR 2·9; 95% CI 1·5-6·0) or a GAS skin infection (aOR 3·5; 95% CI 1·6-7·6). Children who had GAS skin infections were more likely than all other groups to report living in a crowded home (aOR 1·9; 95% CI 1·0-3·4), have Māori or Pacific grandparents (aOR 3·0; 95% CI 1·2-7·6), a family history of ARF (aOR 2·2; 95% CI 1·1-4·3), or having a previous diagnosis of eczema (aOR 3·9; 95% CI 2·2-6·9). Interpretation: Reducing barriers to accessing primary healthcare (including financial restrictions, the inability to book an appointment, lack of transport, and lack of childcare for other children) to treat GAS pharyngitis and skin infections could potentially reduce these infections and lead to a reduction in their sequelae, including ARF. These strategies should be co-designed and culturally appropriate for the communities being served and carefully evaluated. Funding: This work was supported by the Health Research Council of New Zealand (HRC), award number 16/005.http://www.sciencedirect.com/science/article/pii/S2666606522001225Group A streptococcuspharyngitisSkin infectionsChildrenAcute rheumatic feverPrimary prevention |
| spellingShingle | Julie Bennett Nicole J. Moreland Jane Zhang Julian Crane Dianne Sika-Paotonu Jonathan Carapetis Deborah A. Williamson Michael G. Baker Risk factors for group A streptococcal pharyngitis and skin infections: A case control study The Lancet Regional Health. Western Pacific Group A streptococcus pharyngitis Skin infections Children Acute rheumatic fever Primary prevention |
| title | Risk factors for group A streptococcal pharyngitis and skin infections: A case control study |
| title_full | Risk factors for group A streptococcal pharyngitis and skin infections: A case control study |
| title_fullStr | Risk factors for group A streptococcal pharyngitis and skin infections: A case control study |
| title_full_unstemmed | Risk factors for group A streptococcal pharyngitis and skin infections: A case control study |
| title_short | Risk factors for group A streptococcal pharyngitis and skin infections: A case control study |
| title_sort | risk factors for group a streptococcal pharyngitis and skin infections a case control study |
| topic | Group A streptococcus pharyngitis Skin infections Children Acute rheumatic fever Primary prevention |
| url | http://www.sciencedirect.com/science/article/pii/S2666606522001225 |
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