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Expanded antibiotic prophylaxis for household contacts significantly reduced the risk of invasive group A streptococcus (iGAS) disease. This policy change in the Netherlands demonstrated the effectiveness of prophylaxis in preventing secondary iGAS infections.

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Area of Science:

  • Infectious Diseases
  • Public Health Policy
  • Epidemiology

Background:

  • Household contacts of invasive group A streptococcus (iGAS) patients face an elevated risk of infection.
  • The Netherlands updated its iGAS public health policy in January 2023, expanding antibiotic prophylaxis to all household contacts of iGAS patients.

Purpose of the Study:

  • To estimate the risk of iGAS in the general population and among contacts of iGAS patients.
  • To evaluate the impact of the policy change on iGAS risk among household contacts.

Main Methods:

  • A nationwide, population-based, open cohort study linked registry and laboratory data from April 2022 to December 2024.
  • Estimated incidence rate ratios (IRR) and secondary attack rates (SAR) for iGAS among household contacts before and after the policy change.
  • Adjusted for age, sex, socioeconomic status, and year quarter.

Main Results:

  • The IRR for household contacts decreased from 235.25 before the policy change to 74.00 after.
  • The secondary attack rate among household contacts dropped from 0.219% to 0.047% post-policy change (adjusted OR, 0.17).

Conclusions:

  • The expanded antibiotic prophylaxis policy led to a significant reduction in secondary iGAS risk among household contacts.
  • Antibiotic prophylaxis for household contacts is effective in preventing secondary iGAS infections.