Barth Dylan D, Daw Jessica, Enkel Stephanie L, McRae Tracy, Carapetis Jonathan R, Wyber Rosemary, Bowen Asha C, Engel Mark E
Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA, Australia.
Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia.
Front Public Health. 2025 Sep 4;13:1630054. doi: 10.3389/fpubh.2025.1630054. eCollection 2025.
The transmission of Group A (Strep A) through respiratory droplets has been considered the dominant mode of transmission to date; however, little is known about the relative contribution of other modes of transmission. This review systematically summarises the contemporary evidence regarding the transmission of Strep A.
A comprehensive search strategy was implemented to identify studies on Strep A transmission published in English between 1980 and 2019. Full-text articles were screened and included based on the predefined criteria. Studies were included if molecular techniques were used to identify the same Strep A strain in both clinical and environmental swabs. A random-effects meta-analysis model was used to aggregate attack rate estimates with 95% confidence intervals (CI), incorporating the Freeman-Tukey transformation to account for variability between studies.
A total of 34 transmission cohorts were included in this study. The overall attack rate of Strep A was 18.4% (95% CI, 13.1-24.2%, I = 95.9%), for direct contact, it was 20.5% (95% CI, 8.3-35.4%), and for indirect contact, it was 19.1% (95% CI, 13.2-25.7%). When pooled by geographical location, the attack rate was 30.38% (95% CI, 20.89-40.75%) in non-urban settings and 7.36% (95% CI, 2.60-14.21%) in urban settings.
Direct contact is no longer the dominant form of Strep A transmission. Our contemporary findings have implications for the development of evidence-based environmental health strategies aimed at reducing Strep A transmission.
https://www.crd.york.ac.uk/PROSPERO/view/CRD42019138472, CRD42019138472.
迄今为止，A组链球菌（A群链球菌）经呼吸道飞沫传播一直被视为主要传播方式；然而，对于其他传播方式的相对贡献却知之甚少。本综述系统地总结了关于A群链球菌传播的当代证据。
实施全面的检索策略，以识别1980年至2019年间以英文发表的关于A群链球菌传播的研究。根据预先设定的标准筛选并纳入全文文章。若使用分子技术在临床拭子和环境拭子中鉴定出相同的A群链球菌菌株，则纳入该研究。采用随机效应荟萃分析模型汇总发病率估计值及95%置信区间（CI），并采用弗里曼-图基变换来考虑研究间的变异性。
本研究共纳入34个传播队列。A群链球菌的总体发病率为18.4%（95%CI，13.1 - 24.2%，I = 95.9%），直接接触传播的发病率为20.5%（95%CI，8.3 - 35.4%），间接接触传播的发病率为19.1%（95%CI，13.2 - 25.7%）。按地理位置汇总时，非城市地区的发病率为30.38%（95%CI，20.89 - 40.75%），城市地区为7.36%（95%CI，2.60 - 14.21%）。
直接接触不再是A群链球菌传播的主要形式。我们的当代研究结果对制定旨在减少A群链球菌传播的循证环境卫生策略具有启示意义。
https://www.crd.york.ac.uk/PROSPERO/view/CRD42019138472，CRD42019138472
