PDF(Pubmed)
Abstract：
UNASSIGNED: Group A streptococcal (GAS) infections can trigger an immune-mediated response resulting in acute rheumatic fever (ARF). The role of social and environmental risk factors for GAS pharyngitis and skin infections are not well understood. This study aimed to identify factors associated with GAS pharyngitis and skin infections, and to determine if these are the same as those for ARF.
UNASSIGNED: A case-control study, including 733 children aged 5-14 years, was undertaken between March 2018 and October 2019 in Auckland, New Zealand. Healthy controls (n = 190) and symptomatic cases including GAS pharyngitis (n = 210), GAS seronegative carriers (n = 182), and GAS skin infections (n = 151) were recruited. Trained interviewers administered a comprehensive, pre-tested, face-to-face questionnaire.
UNASSIGNED: Multivariable analysis identified strong associations between barriers to accessing primary healthcare and having GAS pharyngitis (adjusted OR 3·3; 95% CI 1·8-6·0), GAS carriage (aOR 2·9; 95% CI 1·5-6·0) or a GAS skin infection (aOR 3·5; 95% CI 1·6-7·6). Children who had GAS skin infections were more likely than all other groups to report living in a crowded home (aOR 1·9; 95% CI 1·0-3·4), have Māori or Pacific grandparents (aOR 3·0; 95% CI 1·2-7·6), a family history of ARF (aOR 2·2; 95% CI 1·1-4·3), or having a previous diagnosis of eczema (aOR 3·9; 95% CI 2·2-6·9).
UNASSIGNED: Reducing barriers to accessing primary healthcare (including financial restrictions, the inability to book an appointment, lack of transport, and lack of childcare for other children) to treat GAS pharyngitis and skin infections could potentially reduce these infections and lead to a reduction in their sequelae, including ARF. These strategies should be co-designed and culturally appropriate for the communities being served and carefully evaluated.
UNASSIGNED: This work was supported by the Health Research Council of New Zealand (HRC), award number 16/005.
UNASSIGNED: A case-control study, including 733 children aged 5-14 years, was undertaken between March 2018 and October 2019 in Auckland, New Zealand. Healthy controls (n = 190) and symptomatic cases including GAS pharyngitis (n = 210), GAS seronegative carriers (n = 182), and GAS skin infections (n = 151) were recruited. Trained interviewers administered a comprehensive, pre-tested, face-to-face questionnaire.
UNASSIGNED: Multivariable analysis identified strong associations between barriers to accessing primary healthcare and having GAS pharyngitis (adjusted OR 3·3; 95% CI 1·8-6·0), GAS carriage (aOR 2·9; 95% CI 1·5-6·0) or a GAS skin infection (aOR 3·5; 95% CI 1·6-7·6). Children who had GAS skin infections were more likely than all other groups to report living in a crowded home (aOR 1·9; 95% CI 1·0-3·4), have Māori or Pacific grandparents (aOR 3·0; 95% CI 1·2-7·6), a family history of ARF (aOR 2·2; 95% CI 1·1-4·3), or having a previous diagnosis of eczema (aOR 3·9; 95% CI 2·2-6·9).
UNASSIGNED: Reducing barriers to accessing primary healthcare (including financial restrictions, the inability to book an appointment, lack of transport, and lack of childcare for other children) to treat GAS pharyngitis and skin infections could potentially reduce these infections and lead to a reduction in their sequelae, including ARF. These strategies should be co-designed and culturally appropriate for the communities being served and carefully evaluated.
UNASSIGNED: This work was supported by the Health Research Council of New Zealand (HRC), award number 16/005.
摘要：
■A组链球菌（GAS）感染可引发免疫介导的反应，导致急性风湿热（ARF）。社会和环境危险因素对GAS咽炎和皮肤感染的作用尚不清楚。本研究旨在确定与GAS咽炎和皮肤感染相关的因素，并确定这些是否与ARF相同。
■病例对照研究，包括733名5-14岁的儿童，于2018年3月至2019年10月在奥克兰进行，新西兰。健康对照（n=190）和有症状的病例，包括GAS咽炎（n=210），GAS血清阴性携带者（n=182），和GAS皮肤感染（n=151）被招募。训练有素的面试官管理全面，预先测试,面对面的问卷调查。
■多变量分析确定了获得初级医疗保健的障碍与患有GAS咽炎之间的强关联（调整后的OR3·3；95％CI1·8-6·0），GAS携带(aOR2·9;95%CI1·5-6·0)或GAS皮肤感染(aOR3·5;95%CI1·6-7·6)。患有GAS皮肤感染的儿童比所有其他人群更有可能报告生活在拥挤的家中（aOR1·9;95％CI1·0-3·4），有毛利人或太平洋祖父母(aOR3·0；95%CI1·2-7·6)，ARF家族史（aOR2·2；95%CI1·1-4·3），或既往诊断为湿疹（aOR3·9；95%CI2·2-6·9）。
■减少获得初级医疗保健的障碍（包括财务限制，无法预约，缺乏运输,以及其他儿童缺乏托儿服务）来治疗GAS咽炎和皮肤感染可能会减少这些感染并减少后遗症，包括ARF。这些战略应共同设计，并在文化上适合所服务和仔细评估的社区。
■这项工作得到了新西兰健康研究委员会（HRC）的支持，奖励编号16/005。
■病例对照研究，包括733名5-14岁的儿童，于2018年3月至2019年10月在奥克兰进行，新西兰。健康对照（n=190）和有症状的病例，包括GAS咽炎（n=210），GAS血清阴性携带者（n=182），和GAS皮肤感染（n=151）被招募。训练有素的面试官管理全面，预先测试,面对面的问卷调查。
■多变量分析确定了获得初级医疗保健的障碍与患有GAS咽炎之间的强关联（调整后的OR3·3；95％CI1·8-6·0），GAS携带(aOR2·9;95%CI1·5-6·0)或GAS皮肤感染(aOR3·5;95%CI1·6-7·6)。患有GAS皮肤感染的儿童比所有其他人群更有可能报告生活在拥挤的家中（aOR1·9;95％CI1·0-3·4），有毛利人或太平洋祖父母(aOR3·0；95%CI1·2-7·6)，ARF家族史（aOR2·2；95%CI1·1-4·3），或既往诊断为湿疹（aOR3·9；95%CI2·2-6·9）。
■减少获得初级医疗保健的障碍（包括财务限制，无法预约，缺乏运输,以及其他儿童缺乏托儿服务）来治疗GAS咽炎和皮肤感染可能会减少这些感染并减少后遗症，包括ARF。这些战略应共同设计，并在文化上适合所服务和仔细评估的社区。
■这项工作得到了新西兰健康研究委员会（HRC）的支持，奖励编号16/005。
