Background: New Zealand's Māori and Pacific Peoples experience one of the highest rates of rheumatic fever (ARF) globally. While ARF has traditionally been linked to Group A Streptococcal (GAS) pharyngitis, emerging evidence indicates that GAS skin infections could also be a driver. This paper examines the demographic differences in the susceptibility to GAS skin infections in comparison to other bacterial causes in NZ.
Method: A retrospective analysis was conducted on laboratory-confirmed skin swab data from primary care between 2010-2020 to determine demographic risk factors for two primary causes of skin infections: GAS and S. aureus, using incidence rates and rate ratios.
Results: A comprehensive study analyzing over 556,000 skin infection cases across 14.7 million person-years found that S. aureus infections affected all demographic groups. However, three factors—age, ethnicity, and socioeconomic deprivation —significantly influenced susceptibility to GAS infections. Notably, children under 10-years old, Māori and Pacific Peoples, and socioeconomically deprived people, were particularly vulnerable. The risk for GAS re-infection was nearly four times greater during the first five years of life. Additionally, the research indicated that S. aureus exposure increased the risk of co-infection with GAS, effectively doubling the chances of such occurrences.
Conclusion: In NZ, Māori and Pacific children’s vulnerability to persistent GAS skin infections could contribute to ethnic disparities in ARF. We need to prioritize eradicating GAS skin infections in communities impacted by ARF through better public health initiatives and clinical care. This presents a new opportunity to reduce ARF risks and improve health outcomes for these communities.