Streptococcal pharyngitis in schoolchildren in Bamako, Mali

Milagritos D. Tapia, Samba O. Sow, Boubou Tamboura, Mahamadou M. Keita, Abdoulaye Berthe, Mariam Samake, James P. Nataro, Uma O. Onwuchekwa, Thomas A. Penfound, William Blackwelder, James Dale, Karen L. Kotloff

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Group A streptococcus (GAS) pharyngitis is associated with high rates of rheumatic heart disease in developing countries. We sought to identify guidelines for empiric treatment of pharyngitis in low-resource settings. To inform the design of GAS vaccines, we determined the emm types associated with pharyngitis among African schoolchildren. Methods: Surveillance for pharyngitis was conducted among children 5-16 years of age attending schools in Bamako, Mali. Students were encouraged to visit a study clinician when they had a sore throat. Enrollees underwent evaluation and throat swab for isolation of GAS. Strains were emm typed by standard methods. Results: GAS was isolated from 449 (25.5%) of the 1,759 sore throat episodes. Painful cervical adenopathy was identified in 403 children (89.8%) with GAS infection and was absent in 369 uninfected children (28.2%). Emm type was determined in 396 (88.2%) of the 449 culture-positive children; 70 types were represented and 14 types accounted for 49% of isolates. Based on the proportion of the 449 isolates bearing emm types included in the 30-valent vaccine (31.0%) plus nonvaccine types previously shown to react to vaccine-induced bactericidal antibodies (44.1%), the vaccine could protect against almost 75% of GAS infections among Bamako schoolchildren. Conclusions: Two promising strategies could reduce rheumatic heart disease in low-resource settings. Administering antibiotics to children with sore throat and tender cervical adenopathy could treat most GAS-positive children while reducing use of unnecessary antibiotics for uninfected children. Broad coverage against M types associated with pharyngitis in Bamako schoolchildren might be achieved with the 30-valent GAS vaccine under development.

Original languageEnglish (US)
Pages (from-to)463-468
Number of pages6
JournalPediatric Infectious Disease Journal
Volume34
Issue number5
DOIs
StatePublished - May 21 2015

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Mali
Pharyngitis
Streptococcus
Vaccines
Rheumatic Heart Disease
Anti-Bacterial Agents
Pharynx
Infection
Developing Countries
Guidelines
Students
Antibodies

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Microbiology (medical)
  • Infectious Diseases

Cite this

Tapia, M. D., Sow, S. O., Tamboura, B., Keita, M. M., Berthe, A., Samake, M., ... Kotloff, K. L. (2015). Streptococcal pharyngitis in schoolchildren in Bamako, Mali. Pediatric Infectious Disease Journal, 34(5), 463-468. https://doi.org/10.1097/INF.0000000000000608

Streptococcal pharyngitis in schoolchildren in Bamako, Mali. / Tapia, Milagritos D.; Sow, Samba O.; Tamboura, Boubou; Keita, Mahamadou M.; Berthe, Abdoulaye; Samake, Mariam; Nataro, James P.; Onwuchekwa, Uma O.; Penfound, Thomas A.; Blackwelder, William; Dale, James; Kotloff, Karen L.

In: Pediatric Infectious Disease Journal, Vol. 34, No. 5, 21.05.2015, p. 463-468.

Research output: Contribution to journalArticle

Tapia, MD, Sow, SO, Tamboura, B, Keita, MM, Berthe, A, Samake, M, Nataro, JP, Onwuchekwa, UO, Penfound, TA, Blackwelder, W, Dale, J & Kotloff, KL 2015, 'Streptococcal pharyngitis in schoolchildren in Bamako, Mali', Pediatric Infectious Disease Journal, vol. 34, no. 5, pp. 463-468. https://doi.org/10.1097/INF.0000000000000608
Tapia MD, Sow SO, Tamboura B, Keita MM, Berthe A, Samake M et al. Streptococcal pharyngitis in schoolchildren in Bamako, Mali. Pediatric Infectious Disease Journal. 2015 May 21;34(5):463-468. https://doi.org/10.1097/INF.0000000000000608
Tapia, Milagritos D. ; Sow, Samba O. ; Tamboura, Boubou ; Keita, Mahamadou M. ; Berthe, Abdoulaye ; Samake, Mariam ; Nataro, James P. ; Onwuchekwa, Uma O. ; Penfound, Thomas A. ; Blackwelder, William ; Dale, James ; Kotloff, Karen L. / Streptococcal pharyngitis in schoolchildren in Bamako, Mali. In: Pediatric Infectious Disease Journal. 2015 ; Vol. 34, No. 5. pp. 463-468.
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abstract = "Background: Group A streptococcus (GAS) pharyngitis is associated with high rates of rheumatic heart disease in developing countries. We sought to identify guidelines for empiric treatment of pharyngitis in low-resource settings. To inform the design of GAS vaccines, we determined the emm types associated with pharyngitis among African schoolchildren. Methods: Surveillance for pharyngitis was conducted among children 5-16 years of age attending schools in Bamako, Mali. Students were encouraged to visit a study clinician when they had a sore throat. Enrollees underwent evaluation and throat swab for isolation of GAS. Strains were emm typed by standard methods. Results: GAS was isolated from 449 (25.5{\%}) of the 1,759 sore throat episodes. Painful cervical adenopathy was identified in 403 children (89.8{\%}) with GAS infection and was absent in 369 uninfected children (28.2{\%}). Emm type was determined in 396 (88.2{\%}) of the 449 culture-positive children; 70 types were represented and 14 types accounted for 49{\%} of isolates. Based on the proportion of the 449 isolates bearing emm types included in the 30-valent vaccine (31.0{\%}) plus nonvaccine types previously shown to react to vaccine-induced bactericidal antibodies (44.1{\%}), the vaccine could protect against almost 75{\%} of GAS infections among Bamako schoolchildren. Conclusions: Two promising strategies could reduce rheumatic heart disease in low-resource settings. Administering antibiotics to children with sore throat and tender cervical adenopathy could treat most GAS-positive children while reducing use of unnecessary antibiotics for uninfected children. Broad coverage against M types associated with pharyngitis in Bamako schoolchildren might be achieved with the 30-valent GAS vaccine under development.",
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