Virtual Poster 21st Lancefield International Symposium for Streptococci and Streptococcal Diseases 2022

Invasive group A streptococcal disease in pregnant women and young children worldwide; systematic review and meta-analyses (#316)

Emma Sherwood 1 , Stefania Vergnano 2 , Isona Kakuchi 2 , Michael Bruce 3 , Suman Chaurasia 4 , Samara David 5 , Rebecca Guy 6 , Theresa Lamagni 6 , Daniel Levy-Bruhl 7 , Outi Lyytikäinen 8 , Monika Naus 5 , Jennifer Okaro 9 , Oddvar Oppegaard 10 , Didrik Vestrheim 11 , Scarlett Georges 12 , Angela Dramowski 13 , Tammy Zulz 3 , Andrew Steer 14 , Chris Van Beneden 9 , Anna Seale 1
  1. London School of Hygiene and Tropical Medicine, LSHTM, London, LONDON, United Kingdom
  2. University Hospitals Bristol, Bristol, UK
  3. CDC, Anchorage, Alaska, USA
  4. All India Institute of Medical Studies, Delhi, India
  5. British Columbia Center for Disease Control, British Columbia, Canada
  6. Public Health England, London, UK
  7. Sante Publique France, St Maurice, France
  8. National Institute of Health and Welfare, Finland
  9. CDC, Atlanta, Georgia, USA
  10. Haukeland University Hospital, Bergen, Norway
  11. Norwegian Institute of Public Health, Bergen, Norway
  12. Sante Publique France, St Maurice, France
  13. Stellenbosch University, Cape Town, South Africa
  14. Murdoch Children's Research Institute, Victoria, Australia

Background

The incidence of invasive disease caused by group A Streptococcus (GAS) has increased in multiple countries. To inform interventions such as GAS vaccines, we estimated incidence of invasive GAS (iGAS) disease, including death and disability outcomes, among high risk groups—pregnant women and children under 5 years. These represent, to the best of our knowledge, the first available estimates globally. 

Methods

Systematic review and meta-analyses on iGAS outcomes (incidence, case fatality, and neurodevelopmental impairment) in pregnancy and children worldwide. We included published data from 1/1/2000 and unpublished data from an investigator group formed from collaborators worldwide.

Results

We identified 950 published and 29 unpublished datasets. 20 studies (seven unpublished) from 12 countries provided sufficient data to be included in meta-analyses. We did not identify studies reporting iGAS incidence during pregnancy, or on neurodevelopmental impairment in LMICs. Worldwide iGAS incidence was, 0·12/1000 live births (95%CI 0·11-0·14) in pregnancy/post-postpartum; 0·04/1000 live births (0·03-0·05) for neonates; 0·13/1000 live births (0·10-0·16) for infants; and, 0·09/1000 person-years ( 0·07-0·10) for children (0-5years). Incidence was higher in LMICs, particularly in neonates (0·12/1000 live births; 0·00-0·24) compared to (0·02/1000 live births; 0·00-0.03) in HICs. Case fatality risks were high, particularly among neonates in LMICs (61%; 33-89%).

Conclusions

We found high disease incidence and case fatality among young children with iGAS, particularly in LMICs. Notably, for LMICs, limited data are available for children, and no data are available for pregnant women. Incidences are likely underestimates, particularly in LMICs, due to limited GAS surveillance. Improving available data is essential to inform GAS vaccine development and evaluation.