Authors:
Steer AC, Dale JB, Carapetis JR
Authors notes:
Pediatric Infectious Disease Journal. 2013;32(2):180-182
Keywords:
Group A streptococcus, rheumatic fever, rheumatic heart disease, vaccine, burden of disease
Abstract:
Vaccines against Streptococcus pyogenes (the Lancefield group A streptococcus [GAS]) have been a goal of researchers and public health authorities since the beginning of the last century.
The desire for an effective vaccine arises from the large burden of disease caused by the bacterium, particularly rheumatic fever and rheumatic heart disease.
Rheumatic fever is an uncommon disease today in most resource-rich countries including the United States, but it remains the major cause of acquired heart disease in children, adolescents and young adults in the developing world, responsible for at least 350,000 premature deaths per year.
In addition, invasive GAS disease is a frequent cause of sepsis in children and adults and has a high-case fatality rate leading to at least 150,000 deaths worldwide, although this figure is almost certainly an underestimate because of sparse data from many developing countries.
There is no evidence that the burden of GAS diseases is decreasing other than as a result of economic development.
In other words, serious GAS diseases appear to be waning in some middle income countries, probably because of improved living conditions and access to health services.
Current approaches directed specifically at reducing the overall burden of GAS diseases appear to have little impact on the lower income countries where, if anything, these diseases are on the rise.
For this reason, and because even in wealthy countries GAS diseases exact a toll in terms of mortality, morbidity and economic costs, a GAS vaccine is sorely needed.