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Abstract：
BACKGROUND: Streptoccocal A (Strep A, GAS) infections in Australia are responsible for significant morbidity and mortality through both invasive (iGAS) and post-streptococcal (postGAS) diseases as well as preceding superficial (sGAS) skin and throat infection. The burden of iGAS and postGAS are addressed in some jurisdictions by mandatory notification systems; in contrast, the burden of preceding sGAS has no reporting structure, and is less well defined. This review provides valuable, contemporaneous evidence on the epidemiology of sGAS presentations in Australia, informing preventative health projects such as a Streptococcal A vaccine and standardisation of primary care notification.
RESULTS: MEDLINE, Scopus, EMBASE, Web of Science, Global Health, Cochrane, CINAHL databases and the grey literature were searched for studies from an Australian setting relating to the epidemiology of sGAS infections between 1970 and 2020 inclusive. Extracted data were pooled for relevant population and subgroup analysis. From 5157 titles in the databases combined with 186 grey literature reports and following removal of duplicates, 4889 articles underwent preliminary title screening. The abstract of 519 articles were reviewed with 162 articles identified for full text review, and 38 articles identified for inclusion. The majority of data was collected for impetigo in Aboriginal and Torres Strait Islander populations, remote communities, and in the Northern Territory, Australia. A paucity of data was noted for Aboriginal and Torres Strait Islander people living in urban centres or with pharyngitis. Prevalence estimates have not significantly changed over time. Community estimates of impetigo point prevalence ranged from 5.5-66.1%, with a pooled prevalence of 27.9% [95% CI: 20.0-36.5%]. All studies excepting one included >80% Aboriginal and Torres Strait Islander people and all excepting two were in remote or very remote settings. Observed prevalence of impetigo as diagnosed in healthcare encounters was lower, with a pooled estimate of 10.6% [95% CI: 3.1-21.8%], and a range of 0.1-50.0%. Community prevalence estimates for pharyngitis ranged from 0.2-39.4%, with a pooled estimate of 12.5% [95% CI: 3.5-25.9%], higher than the prevalence of pharyngitis in healthcare encounters; ranging from 1.0-5.0%, and a pooled estimate of 2.0% [95% CI: 1.3-2.8%]. The review was limited by heterogeneity in study design and lack of comparator studies for some populations.
CONCLUSIONS: Superficial Streptococcal A infections contribute to an inequitable burden of disease in Australia and persists despite public health interventions. The burden in community studies is generally higher than in health-services settings, suggesting under-recognition, possible normalisation and missed opportunities for treatment to prevent postGAS. The available, reported epidemiology is heterogeneous. Standardised nation-wide notification for sGAS disease surveillance must be considered in combination with the development of a Communicable Diseases Network of Australia (CDNA) Series of National Guideline (SoNG), to accurately define and address disease burden across populations in Australia.
BACKGROUND: This review is registered with PROSPERO. Registration number: CRD42019140440.
RESULTS: MEDLINE, Scopus, EMBASE, Web of Science, Global Health, Cochrane, CINAHL databases and the grey literature were searched for studies from an Australian setting relating to the epidemiology of sGAS infections between 1970 and 2020 inclusive. Extracted data were pooled for relevant population and subgroup analysis. From 5157 titles in the databases combined with 186 grey literature reports and following removal of duplicates, 4889 articles underwent preliminary title screening. The abstract of 519 articles were reviewed with 162 articles identified for full text review, and 38 articles identified for inclusion. The majority of data was collected for impetigo in Aboriginal and Torres Strait Islander populations, remote communities, and in the Northern Territory, Australia. A paucity of data was noted for Aboriginal and Torres Strait Islander people living in urban centres or with pharyngitis. Prevalence estimates have not significantly changed over time. Community estimates of impetigo point prevalence ranged from 5.5-66.1%, with a pooled prevalence of 27.9% [95% CI: 20.0-36.5%]. All studies excepting one included >80% Aboriginal and Torres Strait Islander people and all excepting two were in remote or very remote settings. Observed prevalence of impetigo as diagnosed in healthcare encounters was lower, with a pooled estimate of 10.6% [95% CI: 3.1-21.8%], and a range of 0.1-50.0%. Community prevalence estimates for pharyngitis ranged from 0.2-39.4%, with a pooled estimate of 12.5% [95% CI: 3.5-25.9%], higher than the prevalence of pharyngitis in healthcare encounters; ranging from 1.0-5.0%, and a pooled estimate of 2.0% [95% CI: 1.3-2.8%]. The review was limited by heterogeneity in study design and lack of comparator studies for some populations.
CONCLUSIONS: Superficial Streptococcal A infections contribute to an inequitable burden of disease in Australia and persists despite public health interventions. The burden in community studies is generally higher than in health-services settings, suggesting under-recognition, possible normalisation and missed opportunities for treatment to prevent postGAS. The available, reported epidemiology is heterogeneous. Standardised nation-wide notification for sGAS disease surveillance must be considered in combination with the development of a Communicable Diseases Network of Australia (CDNA) Series of National Guideline (SoNG), to accurately define and address disease burden across populations in Australia.
BACKGROUND: This review is registered with PROSPERO. Registration number: CRD42019140440.
摘要：
背景：链球菌A（链球菌A，澳大利亚的GAS）感染是由于侵袭性（iGAS）和链球菌后（post-GAS）疾病以及先前的浅表（sGAS）皮肤和喉咙感染而导致的重大发病率和死亡率。在某些司法管辖区，iGAS和postGAS的负担由强制性通知系统解决；相比之下，之前的SGAS负担没有报告结构，并且不太明确。这篇评论提供了有价值的，关于澳大利亚sGAS报告流行病学的同期证据，告知预防性健康项目，如链球菌A疫苗和初级保健通知的标准化。
结果：MEDLINE，Scopus,EMBASE,WebofScience,全球卫生,科克伦,搜索CINAHL数据库和灰色文献，以寻找来自澳大利亚的与1970年至2020年之间sGAS感染流行病学有关的研究。收集提取的数据进行相关人群和亚组分析。从数据库中的5157个标题加上186个灰色文献报告，并在删除重复项之后，4889篇文章进行了初步标题筛选。519篇文章的摘要进行了审查，162篇文章确定为全文审查，和确定列入的38篇文章。大多数数据是针对土著和托雷斯海峡岛民的脓疱病收集的，偏远社区,在北领地，澳大利亚。据指出，居住在城市中心或患有咽炎的原住民和托雷斯海峡岛民的数据很少。患病率估计随着时间的推移没有显著变化。社区对脓疱病流行点的估计范围为5.5-66.1％，合并患病率为27.9%[95%CI：20.0-36.5%]。除一项研究外，所有研究均包括>80％的原住民和托雷斯海峡岛民，除两项外，所有研究均处于偏远或非常偏远的环境中。在医疗保健中诊断出的脓疱病患病率较低，合并估计值为10.6%[95%CI：3.1-21.8%]，和0.1-50.0%的范围。社区对咽炎的患病率估计为0.2-39.4%，合并估计值为12.5%[95%CI：3.5-25.9%]，高于医疗保健中咽炎的患病率；范围为1.0-5.0%，合并估计值为2.0%[95%CI：1.3-2.8%]。该综述受到研究设计的异质性和某些人群缺乏比较研究的限制。
结论：在澳大利亚，浅表性链球菌A感染导致疾病负担不均，尽管采取了公共卫生干预措施，但仍持续存在。社区研究的负担通常高于卫生服务环境，暗示认识不足，可能的正常化和错过的治疗机会，以防止GAS后。可用的，报告的流行病学是异质性的。必须将sGAS疾病监测的标准化全国通知与澳大利亚传染病网络（CDNA）国家指南（SoNG）系列的发展相结合，准确定义和解决澳大利亚人群的疾病负担。
背景：本评论已在PROSPERO注册。注册号:CRD42019140440.
结果：MEDLINE，Scopus,EMBASE,WebofScience,全球卫生,科克伦,搜索CINAHL数据库和灰色文献，以寻找来自澳大利亚的与1970年至2020年之间sGAS感染流行病学有关的研究。收集提取的数据进行相关人群和亚组分析。从数据库中的5157个标题加上186个灰色文献报告，并在删除重复项之后，4889篇文章进行了初步标题筛选。519篇文章的摘要进行了审查，162篇文章确定为全文审查，和确定列入的38篇文章。大多数数据是针对土著和托雷斯海峡岛民的脓疱病收集的，偏远社区,在北领地，澳大利亚。据指出，居住在城市中心或患有咽炎的原住民和托雷斯海峡岛民的数据很少。患病率估计随着时间的推移没有显著变化。社区对脓疱病流行点的估计范围为5.5-66.1％，合并患病率为27.9%[95%CI：20.0-36.5%]。除一项研究外，所有研究均包括>80％的原住民和托雷斯海峡岛民，除两项外，所有研究均处于偏远或非常偏远的环境中。在医疗保健中诊断出的脓疱病患病率较低，合并估计值为10.6%[95%CI：3.1-21.8%]，和0.1-50.0%的范围。社区对咽炎的患病率估计为0.2-39.4%，合并估计值为12.5%[95%CI：3.5-25.9%]，高于医疗保健中咽炎的患病率；范围为1.0-5.0%，合并估计值为2.0%[95%CI：1.3-2.8%]。该综述受到研究设计的异质性和某些人群缺乏比较研究的限制。
结论：在澳大利亚，浅表性链球菌A感染导致疾病负担不均，尽管采取了公共卫生干预措施，但仍持续存在。社区研究的负担通常高于卫生服务环境，暗示认识不足，可能的正常化和错过的治疗机会，以防止GAS后。可用的，报告的流行病学是异质性的。必须将sGAS疾病监测的标准化全国通知与澳大利亚传染病网络（CDNA）国家指南（SoNG）系列的发展相结合，准确定义和解决澳大利亚人群的疾病负担。
背景：本评论已在PROSPERO注册。注册号:CRD42019140440.
