The unacceptably high prevalence among Indigenous people and people who need dialysis warrants a clinical trial of prophylactic antibiotics
Relatively little is known about the epidemiology of invasive group A streptococcal (iGAS) disease in Australia. In this issue of the MJA, Birrell and colleagues report that the iGAS disease burden in the Northern Territory continues to fall largely on Indigenous Australians and people undergoing haemodialysis.1 This raises the question of whether antibiotic prophylaxis should be provided to those at greatest risk. Their report is timely, as national public health guidelines are being developed following the listing of iGAS disease as nationally notifiable in July 2021.2
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- 1. Birrell JM, Boyd R, Currie BJ, et al. Invasive group A streptococcal disease in the Northern Territory and the impact of melioidosis antibiotic prophylaxis. Med J Aust 2022; 217: 544‐545.
- 2. Australian Department of Health and Aged Care. Group A streptococcal disease: invasive (iGAS). Updated 14 June 2022. https://www.health.gov.au/diseases/group‐a‐streptococcal‐disease‐invasive‐igas (viewed Oct 2022).
- 3. Thomson TN, Campbell PT, Gibney KB. The epidemiology of invasive group A streptococcal disease in Victoria, 2007–2017: an analysis of linked datasets. Aust N Z J Public Health 2022; doi: https://doi.org/10.1111/1753‐6405.13290 [online ahead of print].
- 4. May PJ, Bowen AC, Carapetis JR. The inequitable burden of group A streptococcal diseases in Indigenous Australians. Med J Aust 2016; 205: 201‐203. https://www.mja.com.au/journal/2016/205/5/inequitable‐burden‐group‐streptococcal‐diseases‐indigenous‐australians
- 5. Close RM, McAuley JB. Disparate effects of invasive group A Streptococcus on Native Americans. Emerg Infect Dis 2020; 26: 1971‐1977.
- 6. Wright CM, Moorin R, Pearson G, et al. Increasing incidence of invasive group A streptococcal disease in Western Australia, particularly among Indigenous people. Med J Aust 2021; 215: 36‐41. https://www.mja.com.au/journal/2021/215/1/increasing‐incidence‐invasive‐group‐streptococcal‐disease‐western‐australia
- 7. Steer AC, Lamagni T, Curtis N, Carapetis JR. Invasive group a streptococcal disease: epidemiology, pathogenesis and management. Drugs 2012; 72: 1213‐1227.
- 8. Boyd R, Patel M, Currie BJ, et al. High burden of invasive group A streptococcal disease in the Northern Territory of Australia. Epidemiol Infect 2016; 144: 1018‐1027.
- 9. Merridew N, Birrell J; NT Health. Public health management of invasive group A streptococcal disease in the Northern Territory guideline, version 2.0. 18 May 2022. https://health.nt.gov.au/__data/assets/pdf_file/0009/1111122/invasive‐group‐A‐streptococcal‐disease‐northern‐territory‐guidelines.pdf (viewed Oct 2022).
- 10. You JQ, Lawton P, Zhao Y, et al. Renal replacement therapy demand study, Northern Territory, 2001 to 2022. Mar 2015. Darwin: NT Department of Health. https://digitallibrary.health.nt.gov.au/prodjspui/bitstream/10137/633/1/Renal%20Replacement%20Therapy%20Demand%20Study%20NT%202001%20to%202022.pdf (viewed Oct 2022).
- 11. Mearkle R, Saavedra‐Campos M, Lamagni T, et al. Household transmission of invasive group A Streptococcus infections in England: a population‐based study, 2009, 2011 to 2013. Euro Surveill 2017; 22: 30532.
- 12. Oliver J, Wilmot M, Strachan J, et al. Recent trends in invasive group A Streptococcus disease in Victoria. Comm Dis Intell (2018) 2019; 43.
Katherine Gibney receives salary support from a Medical Research Future Fund (MRFF) fellowship awarded in 2020.
No relevant disclosures.