To the Editor: The toll of group A Streptococcus is dramatically unappreciated, despite increasing evidence of its burden.1 In Australia and New Zealand, we recently demonstrated that group A streptococcal throat and skin infections cause a sizable burden at the population level — cellulitis is the main contributor to the total burden of all group A streptococcal diseases and acute rheumatic fever and rheumatic heart disease contribute disproportionately relative to their frequency of occurrence.2,3
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