Streptococcal pharyngitis in schoolchildren in Bamako, Mali.


BACKGROUND Group A streptococcus (GAS) pharyngitis is associated with high rates of rheumatic heart disease in developing countries. We sought to identify guidelines for empiric treatment of pharyngitis in low-resource settings. To inform the design of GAS vaccines, we determined the emm types associated with pharyngitis among African schoolchildren. METHODS Surveillance for pharyngitis was conducted among children 5-16 years of age attending schools in Bamako, Mali. Students were encouraged to visit a study clinician when they had a sore throat. Enrollees underwent evaluation and throat swab for isolation of GAS. Strains were emm typed by standard methods. RESULTS GAS was isolated from 449 (25.5%) of the 1,759 sore throat episodes. Painful cervical adenopathy was identified in 403 children (89.8%) with GAS infection and was absent in 369 uninfected children (28.2%). Emm type was determined in 396 (88.2%) of the 449 culture-positive children; 70 types were represented and 14 types accounted for 49% of isolates. Based on the proportion of the 449 isolates bearing emm types included in the 30-valent vaccine (31.0%) plus nonvaccine types previously shown to react to vaccine-induced bactericidal antibodies (44.1%), the vaccine could protect against almost 75% of GAS infections among Bamako schoolchildren. CONCLUSIONS Two promising strategies could reduce rheumatic heart disease in low-resource settings. Administering antibiotics to children with sore throat and tender cervical adenopathy could treat most GAS-positive children while reducing use of unnecessary antibiotics for uninfected children. Broad coverage against M types associated with pharyngitis in Bamako schoolchildren might be achieved with the 30-valent GAS vaccine under development.

DOI: 10.1097/INF.0000000000000608

Cite this paper

@article{Tapia2015StreptococcalPI, title={Streptococcal pharyngitis in schoolchildren in Bamako, Mali.}, author={Milagritos D. Tapia and Samba Ousmane Sow and Boubou Tamboura and Mahamadou Minamba Keita and Abdoulaye Berthe and Mariam Samake and James P Nataro and Uma O Onwuchekwa and Thomas A Penfound and William C Blackwelder and James B Dale and Karen L. Kotloff}, journal={The Pediatric infectious disease journal}, year={2015}, volume={34 5}, pages={463-8} }