Background: Identifying environmental health initiatives that can interrupt Strep A transmission, particularly in remote communities, is a research and public health priority. Increasing access to laundry facilities is one such initiative that may help to control Strep A and other interrelated skin pathogens. Consequently, remote community laundries are increasingly promoted. However, whether viable Strep A can persist on fabrics or be transmitted by fabric fomites remains unclear. The fundamental role of clothes and bedding in Strep A transmission and infection, and the value of washing/laundering as a direct control measure is therefore unknown.
Methods: A systematic review of the survival and transmission of eight priority skin pathogens (Strep A, Staphylococcus aureus, scabies, tinea, head/body lice, molluscum contagiosum, and bed bugs) via fabric fomites was conducted. Data on effective laundering specifications were also extracted. Results from articles investigating Strep A were analysed separately for this presentation.
Results: Searches of scientific databases returned over 2000 hits, eventually screened to over 200 articles included in the review covering all eight pathogens. However, only a small proportion of these articles were related to Strep A. We draw on this subset of data to describe what is known and unknown about Strep A survival and transmission via fabric fomites and discuss outstanding needs for definitive experimental work.
Conclusion: Knowledge regarding Strep A transmission via fabrics and the direct relevance of laundering is incomplete. Further experimental work is warranted. This will contribute to the development of comprehensive, evidence-based guidance for laundering to control skin pathogens.