Bocking Natalie, Matsumoto Cai-Lei, Loewen Kassandra, Teatero Sarah, Marchand-Austin Alex, Gordon Janet, Fittipaldi Nahuel, McGeer Allison
Sioux Lookout First Nations Health Authority, Canada.
Anishinaabe Bimaadiziwin Research Program, Sioux Lookout, Canada.
Open Forum Infect Dis. 2016 Dec 7;4(1):ofw243. doi: 10.1093/ofid/ofw243. eCollection 2017 Winter.
Worldwide, indigenous populations appear to be at increased risk for invasive group A streptococcal (iGAS) infections. Although there is empirical evidence that the burden of iGAS disease is significant among remote First Nations communities in Northwestern Ontario, Canada, the epidemiology of iGAS infections in the area remains poorly characterized.
Individuals that met case definition for iGAS disease and whose laboratory specimens were processed by Meno Ya Win Health Centre in Sioux Lookout, Canada or who were reported to Thunder Bay District Health Unit, Canada were identified for the period 2009 to 2014. Case demographics, clinical severity, comorbidities, and risk factors were collected through chart review. Strain typing and antibiotic susceptibility were determined when possible. Basic descriptive statistics were calculated.
Sixty-five cases of iGAS disease were identified, for an annualized incidence of 56.2 per 100 000. Primary bacteremia was present in 26.2% of cases, and cellulitis was identified in 55.4% of cases. The most common comorbidities identified were diabetes (38.5%) and skin conditions (38.5%). Prevalent risk factors included alcohol dependence (25%). Fourteen different types were identified among 42 isolates, with the most common being (17.4%), (15.2%), and (13.0%). Resistance to erythromycin and clindamycin was found in 24.6% of isolates.
Rural and remote First Nations communities in Northwestern Ontario experience iGAS infections at a rate 10 times the provincial and national average. Compared with other North American series, a lower proportion of isolates causing infection were of types included in candidate GAS vaccines.
在全球范围内，原住民群体似乎面临侵袭性A组链球菌（iGAS）感染的风险增加。虽然有经验证据表明，在加拿大安大略省西北部偏远的原住民社区中，iGAS疾病负担很重，但该地区iGAS感染的流行病学特征仍不清楚。
确定2009年至2014年期间符合iGAS疾病病例定义且实验室标本由加拿大苏圣卢克斯的梅诺亚温健康中心处理或报告给加拿大桑德贝地区卫生部门的个体。通过病历审查收集病例人口统计学、临床严重程度、合并症和危险因素。尽可能确定菌株分型和抗生素敏感性。计算基本描述性统计量。
确定了65例iGAS疾病病例，年化发病率为每10万人56.2例。26.2%的病例存在原发性菌血症，55.4%的病例确诊为蜂窝织炎。确定的最常见合并症是糖尿病（38.5%）和皮肤病（38.5%）。常见危险因素包括酒精依赖（25%）。在42株分离株中鉴定出14种不同类型，最常见的是（17.4%）、（15.2%）和（13.0%）。24.6%的分离株对红霉素和克林霉素耐药。
安大略省西北部农村和偏远的原住民社区iGAS感染率是该省和全国平均水平的10倍。与其他北美系列相比，引起感染的分离株中，候选GAS疫苗所含类型的比例较低。
