Epidemiology of group a streptococcal pharyngitis & impetigo: A cross-sectional & follow up study in a rural community of northern India.
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Date
2009-12
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Abstract
Background & objectives: Group A streptococcus (GAS) causes a wide array of human diseases.
Epidemiological picture of streptococcal infection in India is not complete. Hence, disease burden due to
GAS in 5-15 yr old school children in northern India was studied and emm typing of GAS isolates was
carried out to help in designing prevention strategies.
Methods: A cross-sectional survey was carried out among 4249 school children (5-15 yr) from Raipur Rani
Block of Panchkula district in Haryana during 2000-2002; 334 children were followed up fortnightly for
one year. Standard clinical and microbiological procedures were used for collection of swabs from throat
and skin and confirmation of GAS and its emm types.
Results: Of the 4249 children studied, 658 (15.5%) had pharyngitis; 579 of them could be swabbed, of
which 2.8 per cent had GAS. From 3591 children without pharyngitis, 3385 who could be swabbed, GAS
was found in 1.3 per cent of them. Impetigo was rare (0.7%), but 7.1 per cent (2/28) children had GAS.
In the followup study, 17.4 per cent (776/4447 child-contacts) had pharyngitis, 761 could be swabbed
and 2.4 per cent had GAS; among those without pharyngitis, 2016 swabs could be taken and GAS was
found in 1.3 per cent; whereas only 2.6 per cent (2/75) of skin sores had GAS. Three children had GAS
pharyngitis twice during follow up. Fourteen different GAS emm types were found. emm 71, 77 and 81
constituted 69 per cent of the pharyngeal isolates. GAS pharyngitis and impetigo were more common in
winters and summers respectively.
Interpretation & conclusions: In north India, pharyngitis was more common than impetigo. Most prevalent emm types of GAS in this region differ from those included in M protein-based vaccines.
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Keywords
Group A streptococcus (GAS), emm types, impetigo, pharyngitis, prevalence
Citation
Kumar R, Vohra H, Chakraborty A, Sharma Y P, Bandhopadhya S, Dhanda V, Sagar V, Sharma M, Shah B, Ganguly N K. Epidemiology of group a streptococcal pharyngitis & impetigo: A cross-sectional & follow up study in a rural community of northern India. Indian Journal of Medical Research. 2009 Dec; 130(6): 765-771.