背景:化脓性链球菌每年在全球造成超过50万人死亡,这在低收入和中等收入国家不成比例地发生。化脓性S皮肤和咽部运输在传播中的作用尚不清楚。我们旨在调查高负担环境下化脓性S无症状携带和感染的临床流行病学和家庭传播动态。
方法:我们进行了为期1年的前瞻性研究,纵向,家庭队列研究,从苏库塔的家庭招募健康的参与者,冈比亚。如果家庭至少由三名成员组成,他们就有资格,包括一个18岁以下的孩子,如果超过一半的家庭成员拒绝参加,则被排除在外。根据人口普查数据得出的随机GPS坐标确定了家庭。在每月的访问中,收集咽部和正常皮肤拭子进行化脓性S培养,和社会人口统计数据是通过访谈记录的。捕获了偶发的咽炎和脓皮病感染。培养的分离株进行了emm基因分型。主要结局指标是化脓性S的携带和疾病的发生率。其他结果是化脓性S皮肤和咽部运输的患病率,化脓性S皮肤和咽部清除时间,化脓性SEMM型,运输和疾病事件的危险因素,家庭二次攻击率,和emm相关的家庭传播事件。这项研究在ClinicalTrials.gov上注册,NCT05117528。
结果:在2021年7月27日至2022年9月28日之间,来自44个家庭的442名参与者被招募。中位年龄为15岁(IQR6-28),女性为233(53%)。我们确定了17例咽炎和99例脓皮病事件以及49例咽部和39例皮肤化脓性S运输获取事件。化脓性S咽部携带的平均每月患病率为1·4%(95%CI1·1-1·9),而化脓性S皮肤携带的平均每月患病率为1·2%(0·9-1·6)。化脓性咽部运输的发病率为120/1000人年(95%CI87-166),每1000人年(90-170)124个化脓性S皮肤运输,51/1000人年(31-84)的S化脓性咽炎,化脓性S脓皮病为每1000人年263例(212-327)。雨季咽部携带风险较高(HR5·67,95%CI2·19-14·69)和较大家庭(每增加1·03,1·00-1·05),咽炎风险(雨季:3·00,1·10-8·22;家庭规模:1·04,1·02-1·07)。皮肤携带风险不受季节或家庭大小的影响,但女性参与者低于男性参与者(0·45,0·22-0·92),5岁以下儿童与成年人(22·69,3·08-167·21)相比最高,脓皮病的发现相似(女性:0·34,0·19-0·61;年龄<5岁:7·00,2·78-17·64)。皮肤(IQR3·5-7·0)和咽部(3·5-7·3)的平均清除时间为4·0天。流行病学相关的化脓性S事件的平均家庭二次发作率为4·9(95%CI3·5-6·3),与emm相关的化脓性S事件的平均家庭二次发作率为0·74(0·3-1·2)。在204起运输和疾病事件中,emm类型为179种(88%)。仅确定了18个与emm相关的访问间家庭传播事件。在18种与emm相关的传播中,有11种(61%)是化脓性S的家庭传播的最常见来源。观察到咽部到皮肤和皮肤到咽部的传播事件。
结论:化脓性链球菌的携带和感染在冈比亚很常见,特别是在儿童中。大多数活动是非家庭收购,但是皮肤运输和脓皮病在化脓性S的家庭传播和皮肤和咽部之间的双向传播中具有重要作用。
背景:惠康信托基金,ChadwickTrust,国家科学基金会(比利时),欧洲儿科传染病学会,和医学研究理事会(英国)。
BACKGROUND: Streptococcus pyogenes causes more than 500 000 deaths per year globally, which occur disproportionately in low-income and middle-income countries. The roles of S pyogenes skin and pharyngeal carriage in transmission are unclear. We aimed to investigate the clinical epidemiology and household transmission dynamics of both S pyogenes asymptomatic carriage and infection in a high-burden setting.
METHODS: We did a 1-year prospective, longitudinal, household cohort study, recruiting healthy participants from households in Sukuta, The Gambia. Households were eligible if they comprised at least three members, including one child younger than 18 years, and were excluded if more than half of household members declined to participate. Households were identified by random GPS coordinates derived from census data. At monthly visits, pharyngeal and normal skin swabs were collected for S pyogenes culture, and sociodemographic data were recorded by interview. Incident pharyngitis and
pyoderma infections were captured. Cultured isolates underwent emm genotyping. The primary outcome measures were incidence of S pyogenes carriage and disease. Additional outcomes were prevalence of S pyogenes skin and pharyngeal carriage, S pyogenes skin and pharyngeal clearance time, S pyogenes emm type, risk factors for carriage and disease events, household secondary attack rate, and emm-linked household transmission events. The study is registered on ClinicalTrials.gov, NCT05117528.
RESULTS: Between July 27, 2021, and Sept 28, 2022, 442 participants were enrolled from 44 households. The median age was 15 years (IQR 6-28) and 233 (53%) were female. We identified 17 pharyngitis and 99
pyoderma events and 49 pharyngeal and 39 skin S pyogenes carriage acquisition events. Mean monthly prevalence was 1·4% (95% CI 1·1-1·9) for S pyogenes pharyngeal carriage and 1·2% (0·9-1·6) for S pyogenes skin carriage. Incidence was 120 per 1000 person-years (95% CI 87-166) for S pyogenes pharyngeal carriage, 124 per 1000 person-years (90-170) for S pyogenes skin carriage, 51 per 1000 person-years (31-84) for S pyogenes pharyngitis, and 263 per 1000 person-years (212-327) for S pyogenes pyoderma. Pharyngeal carriage risk was higher during the rainy season (HR 5·67, 95% CI 2·19-14·69) and in larger households (per additional person: 1·03, 1·00-1·05), as was pharyngitis risk (rainy season: 3·00, 1·10-8·22; household size: 1·04, 1·02-1·07). Skin carriage risk was not affected by season or household size, but was lower in female than in male participants (0·45, 0·22-0·92) and highest in children younger than 5 years compared with adults (22·69, 3·08-167·21), with similar findings for
pyoderma (female sex: 0·34, 0·19-0·61; age <5 years: 7·00, 2·78-17·64). Median clearance time after carriage acquisition was 4·0 days for both skin (IQR 3·5-7·0) and pharynx (3·5-7·3). The mean household secondary attack rate was 4·9 (95% CI 3·5-6·3) for epidemiologically linked S pyogenes events and 0·74 (0·3-1·2) for emm-linked S pyogenes events. Of the 204 carriage and disease events, emm types were available for 179 (88%). Only 18 emm-linked between-visit household transmission events were identified.
Pyoderma was the most common source of S pyogenes household transmissions in 11 (61%) of 18 emm-linked transmissions. Both pharynx to skin and skin to pharynx transmission events were observed.
CONCLUSIONS: S pyogenes carriage and infection are common in The Gambia, particularly in children. Most events are non-household acquisitions, but skin carriage and
pyoderma have an important role in S pyogenes household transmission and bidirectional transmission between skin and pharynx occurs.
BACKGROUND: Wellcome Trust, Chadwick Trust, Fonds National de la Recherche Scientifique (Belgium), European Society for Paediatric Infectious Diseases, and Medical Research Council (UK).