Poster Presentation Lancefield International Symposium for Streptococci and Streptococcal Diseases 2025

Setting the scene for Group A Streptococcus vaccine studies: The complete clinical spectrum of severe acute disease is present in Auckland, Aotearoa New Zealand (#4)

Andrew Fox-Lewis 1 , Kate Wong She 2 , Emma Wong She 3 , Avinash Sathiyaseelan 3 , Anna Vesty 1 , Sally A Roberts 4 , Susan C Morpeth 5 , Susan Taylor 5 , Anneka Anderson 6 , Julie Bennett 1 7 , Nikki J Moreland 1 , Rachel Webb 8 9 10
  1. Division of Infection and Immunity, Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
  2. Aotearoa Clinical Trials, Middlemore Hospital, Auckland, New Zealand
  3. School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
  4. Microbiology Department, LabPlus, Auckland City Hospital, Auckland, New Zealand
  5. Microbiology Department, Middlemore Hospital, Auckland, New Zealand
  6. Te Kupenga Hauora Māori, University of Auckland, Auckland, New Zealand
  7. Department of Public Health, University of Otago, Wellington, New Zealand
  8. Kidz First Children’s Hospital, Middlemore Hospital, Auckland, New Zealand
  9. Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
  10. Starship Children's Hospital, Auckland, New Zealand

Background

The global health burden of Streptococcus pyogenes (Group A Streptococcus, GAS) disease has led the World Health Organization to declare GAS vaccine development an international priority. Severe acute GAS disease comprises hospitalised infections, toxin-mediated disease (scarlet fever and streptococcal toxic shock syndrome) and immune-mediated disease (acute rheumatic fever [ARF] and acute post-streptococcal glomerulonephritis). This study aimed to characterise the burden and spectrum of severe acute GAS disease in Auckland, New Zealand, to inform future GAS vaccine studies in this setting.

Methods

This population-based, multicentre prospective observational study utilised laboratory data and ARF notifications to capture all hospitalised GAS infections and toxin- and immune-mediated disease cases associated with hospitalisation in Auckland during 2023. The epidemiology, clinical features, incidence and hospitalisation costs of these cases are described.

Results

The complete clinical spectrum of severe acute GAS disease was observed, with 606 cases captured corresponding to 1:2000 people affected annually (52 cases/100,000 population/year). The burden is inequitably distributed across the population, greatest at the intersection of age, ethnicity and socioeconomic deprivation. In the most deprived areas, approximately 1:400 Pacific children <10-years and 1:200 Pacific adults ≥80-years are affected annually (261 and 483 cases/100,000 population/year, respectively). Hospitalisation costs exceeded $13.2 million New Zealand dollars.

Conclusion

This study demonstrates that the complete clinical spectrum of severe acute GAS disease occurs in Auckland and is associated with a substantial health and economic burden. The high incidence and entire range of severe acute GAS disease present make Auckland an ideal location for future vaccine studies.