Streptococcal pharyngitis in schoolchildren in Bamako, Mali

Area of Science:

• Infectious Diseases
• Vaccinology
• Global Health

Background:

• Group A Streptococcus (GAS) pharyngitis is a significant cause of rheumatic heart disease in developing countries.
• Limited guidelines exist for the empiric treatment of pharyngitis in low-resource settings.
• Understanding GAS emm types is vital for developing effective GAS vaccines.

Purpose of the Study:

• To identify guidelines for the empiric treatment of pharyngitis in low-resource settings.
• To determine the emm types of GAS causing pharyngitis in African schoolchildren to inform GAS vaccine design.

Main Methods:

• Pharyngitis surveillance was conducted among 5-16 year olds in Bamako, Mali.
• Throat swabs were collected for GAS isolation and emm typing from students with sore throats.
• Clinical signs, including cervical adenopathy, were recorded.

Main Results:

• GAS was isolated from 25.5% of sore throat episodes.
• Painful cervical adenopathy was a strong indicator of GAS infection (89.8% of GAS-positive children).
• A 30-valent GAS vaccine could potentially protect against nearly 75% of GAS infections in this population, covering 14 prevalent emm types.

Conclusions:

• Targeted antibiotic administration for children with sore throat and tender cervical adenopathy can effectively treat GAS while minimizing unnecessary antibiotic use.
• A broadly covering GAS vaccine, targeting prevalent emm types in Bamako, shows promise for reducing rheumatic heart disease in low-resource settings.