Tapia Milagritos D, Sow Samba O, Tamboura Boubou, Keita Mahamadou M, Berthe Abdoulaye, Samake Mariam, Nataro James P, Onwuchekwa Uma O, Penfound Thomas A, Blackwelder William, Dale James B, Kotloff Karen L
From the *Division of Infectious Disease and Tropical Pediatrics, Department of Pediatrics and ¶Division of Geographic Medicine, Department of Medicine, Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland; †Centre pour le Développement des Vaccins-Mali, Bamako, Mali; ‡Department of Pediatrics, University of Virginia, Charlottesville, Virginia; and §University of Tennessee Health Science Center and Veterans Affairs Medical Center Research Service, Memphis, Tennessee.
Pediatr Infect Dis J. 2015 May;34(5):463-8. doi: 10.1097/INF.0000000000000608.
Group A streptococcus (GAS) pharyngitis is associated with high rates of rheumatic heart disease in developing countries. We sought to identify guidelines for empiric treatment of pharyngitis in low-resource settings. To inform the design of GAS vaccines, we determined the emm types associated with pharyngitis among African schoolchildren.
Surveillance for pharyngitis was conducted among children 5-16 years of age attending schools in Bamako, Mali. Students were encouraged to visit a study clinician when they had a sore throat. Enrollees underwent evaluation and throat swab for isolation of GAS. Strains were emm typed by standard methods.
GAS was isolated from 449 (25.5%) of the 1,759 sore throat episodes. Painful cervical adenopathy was identified in 403 children (89.8%) with GAS infection and was absent in 369 uninfected children (28.2%). Emm type was determined in 396 (88.2%) of the 449 culture-positive children; 70 types were represented and 14 types accounted for 49% of isolates. Based on the proportion of the 449 isolates bearing emm types included in the 30-valent vaccine (31.0%) plus nonvaccine types previously shown to react to vaccine-induced bactericidal antibodies (44.1%), the vaccine could protect against almost 75% of GAS infections among Bamako schoolchildren.
Two promising strategies could reduce rheumatic heart disease in low-resource settings. Administering antibiotics to children with sore throat and tender cervical adenopathy could treat most GAS-positive children while reducing use of unnecessary antibiotics for uninfected children. Broad coverage against M types associated with pharyngitis in Bamako schoolchildren might be achieved with the 30-valent GAS vaccine under development.
在发展中国家，A 组链球菌（GAS）咽炎与风湿性心脏病的高发病率相关。我们试图确定在资源匮乏地区对咽炎进行经验性治疗的指南。为了为 GAS 疫苗的设计提供信息，我们确定了与非洲学童咽炎相关的 emm 型别。
在马里巴马科上学的 5 - 16 岁儿童中开展咽炎监测。学生出现喉咙痛时，鼓励他们去看研究临床医生。入组者接受评估并进行咽拭子检查以分离 GAS。通过标准方法对菌株进行 emm 分型。
在 1759 例喉咙痛发作中，分离出 GAS 的有 449 例（25.5%）。403 例（89.8%）感染 GAS 的儿童出现疼痛性颈淋巴结肿大，369 例未感染儿童中无此症状（28.2%）。在 449 例培养阳性儿童中，396 例（88.2%）确定了 emm 型别；共出现 70 种型别，其中 14 种型别占分离株的 49%。根据 449 株分离株中包含在 30 价疫苗中的 emm 型别的比例（31.0%），加上先前显示对疫苗诱导的杀菌抗体有反应的非疫苗型别（44.1%），该疫苗可预防巴马科学童中近 75%的 GAS 感染。
两种有前景的策略可在资源匮乏地区减少风湿性心脏病。对喉咙痛且颈淋巴结触痛的儿童使用抗生素可治疗大多数 GAS 阳性儿童，同时减少对未感染儿童使用不必要的抗生素。正在研发的 30 价 GAS 疫苗可能实现对巴马科学童中与咽炎相关的 M 型别的广泛覆盖。
