ReviewThe global burden of group A streptococcal diseases
Introduction
Group A streptococcus (GAS) causes a broad spectrum of diseases, all of which are most common in settings of poverty, where systems for collection of accurate disease burden data are usually absent. Therefore, any attempt to measure the global burden of GAS diseases will be hindered by the breadth of information that is needed and the paucity of reliable information from countries where these diseases are most important. There has been no recent attempt to collate such information. The only GAS disease for which global disease burden estimates have been made is rheumatic heart disease.1, 2
We aim to use existing data sources to estimate the global burden of GAS diseases, and to identify the most critical deficiencies in GAS disease burden data. The full report of this project is available at http://www.who.int/child-adolescent-health/publications/CHILD_HEALTH/DP/Topic_2/paper_1.htm. Here, we present a summary of the major findings.
Section snippets
Methods
We did systematic reviews, aiming to include only recent, population-based data where possible. For severe GAS diseases (eg, acute rheumatic fever, rheumatic heart disease, acute post-streptococcal glomerulonephritis, and invasive disease) we searched for publications after Jan 1, 1985. For streptococcal skin and upper respiratory infections, we extended the literature search back to Jan 1, 1980 to include more studies. We also reviewed the proceedings of the 3-yearly meetings of the Lancefield
Prevalence of rheumatic heart disease
We found 57 studies that met our inclusion criteria. There was only one population-based study for each of eastern Europe, China, and the established market economies. Sufficient data were available to include only echocardiographic studies from all regions except eastern Europe, Asia other, and China. The highest calculated regional prevalences were found in sub-Saharan Africa (5·7 cases per 1000), the Pacific and indigenous Australia and New Zealand (3·5 cases per 1000), and south central
Discussion
These estimates suggest that, on a global scale, GAS is an important cause of morbidity and mortality, mainly in less developed countries. For example, the minimum estimate of over 500 000 deaths per year places GAS among the major human pathogens, only exceeded by HIV, Mycobacterium tuberculosis, Plasmodium falciparum, and Streptococcus pneumoniae, and probably comparable to rotavirus, measles, Haemophilus influenzae type b, and hepatitis B (figure 3).60 Group A streptococcus causes more
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