Invasive Group A Streptococcus Infection among Children, Rural Kenya
EID FEB 2016 V.22 N.2
Anna C. Seale, Mark R. Davies, Kirimi Anampiu, Susan C. Morpeth, Sammy Nyongesa, Salim Mwarumba, Pierre R. Smeesters, Androulla Efstratiou, Rosylene Karugutu, Neema Mturi, Thomas N. Williams, J. Anthony G. Scott, Samuel Kariuki, Gordon Dougan, and James A. Berkley
KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya (A.C. Seale, K. Anampiu, S.C. Morpeth, S. Nyongesa, S. Mwarumba, N. Mturi, T.N. Williams, J.A.G. Scott, J.A. Berkley); University of Oxford, Oxford, UK (A.C. Seale, J.A. Berkley); University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Parkville, Victoria, Australia (M.R. Davies); University of Queensland, Brisbane, Queensland, Australia (M.R. Davies); The Wellcome Trust Sanger Institute, Cambridge, UK (M.R. Davies, S. Kariuki, G. Dougan); London School of Hygiene and Tropical Medicine, London, UK (S.C. Morpeth, J.A.G. Scott); Murdoch Children’s Research Institute, Melbourne, Victoria, Australia (P.R. Smeesters); University of Melbourne, Melbourne (P.R. Smeesters); Public Health England, London (A. Efstratiou); Imperial College, London (A. Efstratiou, T.N. Williams); The Kenya Medical Research Institute, Nairobi, Kenya (R. Karugutu, S. Kariuki)
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.