1
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Egoroff N, Bloomfield H, Gondarra W, Yambalpal B, Guyula T, Forward D, Lyons G, O'Connor E, Sanderson L, Dowden M, Williams D, de Dassel J, Coffey P, Dhurrkay ER, Gondarra V, Holt DC, Krause VL, Currie BJ, Griffiths K, Dempsey K, Glynn-Robinson A. An outbreak of acute rheumatic fever in a remote Aboriginal community. Aust N Z J Public Health 2023; 47:100077. [PMID: 37625204 DOI: 10.1016/j.anzjph.2023.100077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 07/08/2023] [Accepted: 07/12/2023] [Indexed: 08/27/2023] Open
Abstract
OBJECTIVES We describe the public health response to an outbreak of acute rheumatic fever (ARF) in a remote Aboriginal community. METHODS In August 2021, the Northern Territory Rheumatic Heart Disease Control Program identified an outbreak of acute rheumatic fever in a remote Aboriginal community. A public health response was developed using a modified acute poststreptococcal glomerulonephritis protocol and the National Acute Rheumatic Fever Guideline for Public Health Units. RESULTS 12 cases were diagnosed during the outbreak; six-times the average number of cases in the same period in the five years prior (n=1.8). Half (n=6) of the outbreak cases were classified as recurrent episodes with overdue secondary prophylaxis. Contact tracing and screening of 11 households identified 86 close contacts. CONCLUSIONS This outbreak represented an increase in both first episodes and recurrences of acute rheumatic fever and highlights the critical need for strengthened delivery of acute rheumatic fever secondary prophylaxis, and for improvements to the social determinants of health in the region. IMPLICATIONS FOR PUBLIC HEALTH Outbreaks of acute rheumatic fever are rare despite continuing high rates of acute rheumatic fever experienced by remote Aboriginal communities. Nevertheless, there can be improvements in the current national public health guidance relating to acute rheumatic fever cluster and outbreak management.
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Affiliation(s)
- Natasha Egoroff
- National Centre for Epidemiology and Population Health, Australian National University, Australia; Miwatj Health Aboriginal Corporation, Australia; Centre for Disease Control, Northern Territory Health, Australia.
| | - Hilary Bloomfield
- Miwatj Health Aboriginal Corporation, Australia; Centre for Disease Control, Northern Territory Health, Australia.
| | | | | | - Terrence Guyula
- Centre for Disease Control, Northern Territory Health, Australia.
| | - Demi Forward
- Miwatj Health Aboriginal Corporation, Australia.
| | - Gemma Lyons
- Miwatj Health Aboriginal Corporation, Australia.
| | - Emer O'Connor
- Miwatj Health Aboriginal Corporation, Australia; Centre for Disease Control, Northern Territory Health, Australia; Rheumatic Heart Disease Australia, Australia.
| | | | | | - Desley Williams
- Centre for Disease Control, Northern Territory Health, Australia.
| | | | | | | | | | - Deborah C Holt
- Menzies School of Health Research, Charles Darwin University, Australia.
| | - Vicki L Krause
- Centre for Disease Control, Northern Territory Health, Australia.
| | - Bart J Currie
- Menzies School of Health Research, Charles Darwin University, Australia; Rheumatic Heart Disease Australia, Australia.
| | - Kalinda Griffiths
- Menzies School of Health Research, Charles Darwin University, Australia; University of New South Wales, Australia; University of Melbourne, Australia.
| | | | - Anna Glynn-Robinson
- National Centre for Epidemiology and Population Health, Australian National University, Australia.
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Meumann EM, Krause VL, Baird R, Currie BJ. Using Genomics to Understand the Epidemiology of Infectious Diseases in the Northern Territory of Australia. Trop Med Infect Dis 2022; 7:tropicalmed7080181. [PMID: 36006273 PMCID: PMC9413455 DOI: 10.3390/tropicalmed7080181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/09/2022] [Accepted: 08/11/2022] [Indexed: 11/16/2022] Open
Abstract
The Northern Territory (NT) is a geographically remote region of northern and central Australia. Approximately a third of the population are First Nations Australians, many of whom live in remote regions. Due to the physical environment and climate, and scale of social inequity, the rates of many infectious diseases are the highest nationally. Molecular typing and genomic sequencing in research and public health have provided considerable new knowledge on the epidemiology of infectious diseases in the NT. We review the applications of genomic sequencing technology for molecular typing, identification of transmission clusters, phylogenomics, antimicrobial resistance prediction, and pathogen detection. We provide examples where these methodologies have been applied to infectious diseases in the NT and discuss the next steps in public health implementation of this technology.
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Affiliation(s)
- Ella M. Meumann
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia
- Department of Infectious Diseases, Division of Medicine, Royal Darwin Hospital, Darwin 0810, Australia
- Correspondence:
| | - Vicki L. Krause
- Northern Territory Centre for Disease Control, Northern Territory Government, Darwin 0810, Australia
| | - Robert Baird
- Territory Pathology, Royal Darwin Hospital, Darwin 0810, Australia
| | - Bart J. Currie
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia
- Department of Infectious Diseases, Division of Medicine, Royal Darwin Hospital, Darwin 0810, Australia
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3
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Echocardiographic Parameters, Clinical Profile and Presence of Streptococcus pyogenes Virulent Genes in Pharyngitis and Rheumatic Fever. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2022. [DOI: 10.22207/jpam.16.2.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Streptococcus pyogenes is a gram positive pathogen causing pharyngitis, mild infections to chronic complications (Rheumatic Heart Disease, RHD). In this study, echocardiographic and clinical profile in pharyngitis, rheumatic fever patients were compared with virulent genes emm, spe A, spe B and sof. Nearly 107 subjects were classified into Group I – Pharyngitis (n=30), Group II – Rheumatic Fever (n=30) and Group III – healthy controls (n=47). The isolated S.pyogenes from Group I and Group II patient’s throat swab were subjected to 16S rRNA gene sequence. Multiplex PCR was done for identification of virulent genes. Electrocardiogram and Echocardiography was done for all the groups. For statistical analysis ANOVA and t-test were used. Comparison between groups were done by Tukey’s Multiple Comparison test. Among 107 isolates, 16.7% emm gene were detected in Group I and 23.3% in Group II, 56.67 % of spe B in Group I and 73.33 % in Group II, 36.67% of sof gene in Group I and 40% in Group II. Mitral Regurgitation was most commonly encountered in rheumatic fever. Hemoglobin (<0.001) and RDW (<0.001) was significantly lower in Rheumatic Fever whereas Platelet count (<0.001) and Neutrophil (<0.001) was significantly higher when compared with control subjects by Tukey’s Multiple Comparison test. When we compared the genetic relationship with the Echocardiographic findings, presence of one, two or three genes showed moderate to severe regurgitation in Rheumatic Fever subjects.
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Ralph AP, Webb R, Moreland NJ, McGregor R, Bosco A, Broadhurst D, Lassmann T, Barnett TC, Benothman R, Yan J, Remenyi B, Bennett J, Wilson N, Mayo M, Pearson G, Kollmann T, Carapetis JR. Searching for a technology-driven acute rheumatic fever test: the START study protocol. BMJ Open 2021; 11:e053720. [PMID: 34526345 PMCID: PMC8444258 DOI: 10.1136/bmjopen-2021-053720] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION The absence of a diagnostic test for acute rheumatic fever (ARF) is a major impediment in managing this serious childhood condition. ARF is an autoimmune condition triggered by infection with group A Streptococcus. It is the precursor to rheumatic heart disease (RHD), a leading cause of health inequity and premature mortality for Indigenous peoples of Australia, New Zealand and internationally. METHODS AND ANALYSIS: 'Searching for a Technology-Driven Acute Rheumatic Fever Test' (START) is a biomarker discovery study that aims to detect and test a biomarker signature that distinguishes ARF cases from non-ARF, and use systems biology and serology to better understand ARF pathogenesis. Eligible participants with ARF diagnosed by an expert clinical panel according to the 2015 Revised Jones Criteria, aged 5-30 years, will be recruited from three hospitals in Australia and New Zealand. Age, sex and ethnicity-matched individuals who are healthy or have non-ARF acute diagnoses or RHD, will be recruited as controls. In the discovery cohort, blood samples collected at baseline, and during convalescence in a subset, will be interrogated by comprehensive profiling to generate possible diagnostic biomarker signatures. A biomarker validation cohort will subsequently be used to test promising combinations of biomarkers. By defining the first biomarker signatures able to discriminate between ARF and other clinical conditions, the START study has the potential to transform the approach to ARF diagnosis and RHD prevention. ETHICS AND DISSEMINATION The study has approval from the Northern Territory Department of Health and Menzies School of Health Research ethics committee and the New Zealand Health and Disability Ethics Committee. It will be conducted according to ethical standards for research involving Indigenous Australians and New Zealand Māori and Pacific Peoples. Indigenous investigators and governance groups will provide oversight of study processes and advise on cultural matters.
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Affiliation(s)
- Anna P Ralph
- Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Rachel Webb
- KidzFirst Hospital, Counties Manukau District Health Board, Auckland, New Zealand
- Starship Children's Hospital, Auckland, New Zealand
- Department of Paediatrics; Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Nicole J Moreland
- School of Medical Sciences and Maurice Wilkins Centre, The University of Auckland, Auckland, New Zealand
| | - Reuben McGregor
- School of Medical Sciences and Maurice Wilkins Centre, The University of Auckland, Auckland, New Zealand
| | - Anthony Bosco
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
| | - David Broadhurst
- Centre for Integrative Metabolomics and Computational Biology, Edith Cowan University, Perth, Western Australia, Australia
| | - Timo Lassmann
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Timothy C Barnett
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Rym Benothman
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Jennifer Yan
- Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Bo Remenyi
- Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Julie Bennett
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Nigel Wilson
- Starship Children's Hospital, Auckland, New Zealand
| | - Mark Mayo
- Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Glenn Pearson
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Tobias Kollmann
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Jonathan R Carapetis
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
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5
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Francis JR, Whalley GA, Kaethner A, Fairhurst H, Hardefeldt H, Reeves B, Auld B, Marangou J, Horton A, Wheaton G, Robertson T, Ryan C, Brown S, Smith G, Dos Santos J, Flavio R, Embaum K, da Graca Noronha M, Lopes Belo S, Madeira Santos C, Georginha Dos Santos M, Cabral J, do Rosario I, Harries J, Francis LA, Draper ADK, James CL, Davis K, Yan J, Mitchell A, da Silva Almeida I, Engelman D, Roberts KV, Ralph AP, Remenyi B. Single-View Echocardiography by Nonexpert Practitioners to Detect Rheumatic Heart Disease: A Prospective Study of Diagnostic Accuracy. Circ Cardiovasc Imaging 2021; 14:e011790. [PMID: 34384239 PMCID: PMC8373443 DOI: 10.1161/circimaging.120.011790] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Echocardiographic screening can detect asymptomatic cases of rheumatic heart disease (RHD), facilitating access to treatment. Barriers to implementation of echocardiographic screening include the requirement for expensive equipment and expert practitioners. We aimed to evaluate the diagnostic accuracy of an abbreviated echocardiographic screening protocol (single parasternal-long-axis view with a sweep of the heart) performed by briefly trained, nonexpert practitioners using handheld ultrasound devices. Methods: Participants aged 5 to 20 years in Timor-Leste and the Northern Territory of Australia had 2 echocardiograms: one performed by an expert echocardiographer using a GE Vivid I or Vivid Q portable ultrasound device (reference test), and one performed by a nonexpert practitioner using a GE Vscan handheld ultrasound device (index test). The accuracy of the index test, compared with the reference test, for identifying cases with definite or borderline RHD was determined. Results: There were 3111 enrolled participants; 2573 had both an index test and reference test. Median age was 12 years (interquartile range, 10–15); 58.2% were female. Proportion with definite or borderline RHD was 5.52% (95% CI, 4.70–6.47); proportion with definite RHD was 3.23% (95% CI, 2.61–3.98). Compared with the reference test, sensitivity of the index test for definite or borderline RHD was 70.4% (95% CI, 62.2–77.8), specificity was 78.1% (95% CI, 76.4–79.8). Conclusions: Nonexpert practitioners can be trained to perform single parasternal-long-axis view with a sweep of the heart echocardiography. However, the specificity and sensitivity are inadequate for echocardiographic screening. Improved training for nonexpert practitioners should be investigated.
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Affiliation(s)
- Joshua R Francis
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Australia (J.R.F., H.F., J.M., J.Y., A.P.R., B.R.).,Department of Pediatrics, Royal Darwin Hospital, Australia (J.R.F., H.H., A.H., L.A.F., K.D., J.Y., K.V.R., B.R.).,Maluk Timor, Timor-Leste (J.R.F., J.D.S., R.F., K.E.)
| | - Gillian A Whalley
- Dunedin School of Medicine, University of Otago, New Zealand (G.A.W.)
| | | | - Helen Fairhurst
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Australia (J.R.F., H.F., J.M., J.Y., A.P.R., B.R.)
| | - Hilary Hardefeldt
- Department of Pediatrics, Royal Darwin Hospital, Australia (J.R.F., H.H., A.H., L.A.F., K.D., J.Y., K.V.R., B.R.)
| | | | - Benjamin Auld
- Department of Cardiology, Queensland Children's Hospital, Australia (B.A.)
| | - James Marangou
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Australia (J.R.F., H.F., J.M., J.Y., A.P.R., B.R.).,NT Cardiac, Australia (A.K., J.M., B.R.)
| | - Ari Horton
- Department of Pediatrics, Royal Darwin Hospital, Australia (J.R.F., H.H., A.H., L.A.F., K.D., J.Y., K.V.R., B.R.)
| | - Gavin Wheaton
- Department of Cardiology, Women's and Children's Hospital, Australia (G.W., T.R.)
| | - Terry Robertson
- Department of Cardiology, Women's and Children's Hospital, Australia (G.W., T.R.)
| | - Chelsea Ryan
- Maningrida Health Center (C.R., S.B., G.S.), Top End Health Services, Australia
| | - Shannon Brown
- Maningrida Health Center (C.R., S.B., G.S.), Top End Health Services, Australia
| | - Greg Smith
- Maningrida Health Center (C.R., S.B., G.S.), Top End Health Services, Australia
| | | | | | | | - Mario da Graca Noronha
- Department of Pediatrics, Hospital Nacional Guido Valadares, Timor-Leste (M.d.G.N., S.L.B., C.M.S., M.G.d.S., J.C., I.d.R., I.d.S.A.)
| | - Sonia Lopes Belo
- Department of Pediatrics, Hospital Nacional Guido Valadares, Timor-Leste (M.d.G.N., S.L.B., C.M.S., M.G.d.S., J.C., I.d.R., I.d.S.A.)
| | - Carla Madeira Santos
- Department of Pediatrics, Hospital Nacional Guido Valadares, Timor-Leste (M.d.G.N., S.L.B., C.M.S., M.G.d.S., J.C., I.d.R., I.d.S.A.)
| | - Maria Georginha Dos Santos
- Department of Pediatrics, Hospital Nacional Guido Valadares, Timor-Leste (M.d.G.N., S.L.B., C.M.S., M.G.d.S., J.C., I.d.R., I.d.S.A.)
| | - Jose Cabral
- Department of Pediatrics, Hospital Nacional Guido Valadares, Timor-Leste (M.d.G.N., S.L.B., C.M.S., M.G.d.S., J.C., I.d.R., I.d.S.A.)
| | - Ivonia do Rosario
- Department of Pediatrics, Hospital Nacional Guido Valadares, Timor-Leste (M.d.G.N., S.L.B., C.M.S., M.G.d.S., J.C., I.d.R., I.d.S.A.)
| | | | - Laura A Francis
- Department of Pediatrics, Royal Darwin Hospital, Australia (J.R.F., H.H., A.H., L.A.F., K.D., J.Y., K.V.R., B.R.).,Center for Disease Control (L.A.F., A.D.K.D., C.L.J.), Top End Health Services, Australia
| | - Anthony D K Draper
- Center for Disease Control (L.A.F., A.D.K.D., C.L.J.), Top End Health Services, Australia
| | - Christian L James
- Center for Disease Control (L.A.F., A.D.K.D., C.L.J.), Top End Health Services, Australia
| | - Kimberly Davis
- Department of Pediatrics, Royal Darwin Hospital, Australia (J.R.F., H.H., A.H., L.A.F., K.D., J.Y., K.V.R., B.R.)
| | - Jennifer Yan
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Australia (J.R.F., H.F., J.M., J.Y., A.P.R., B.R.).,Department of Pediatrics, Royal Darwin Hospital, Australia (J.R.F., H.H., A.H., L.A.F., K.D., J.Y., K.V.R., B.R.)
| | | | - Ines da Silva Almeida
- Department of Pediatrics, Hospital Nacional Guido Valadares, Timor-Leste (M.d.G.N., S.L.B., C.M.S., M.G.d.S., J.C., I.d.R., I.d.S.A.)
| | - Daniel Engelman
- Tropical Diseases, Murdoch Children's Research Institute, Australia (D.E.)
| | - Kathryn V Roberts
- Department of Pediatrics, Royal Darwin Hospital, Australia (J.R.F., H.H., A.H., L.A.F., K.D., J.Y., K.V.R., B.R.)
| | - Anna P Ralph
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Australia (J.R.F., H.F., J.M., J.Y., A.P.R., B.R.).,Division of Medicine, Royal Darwin Hospital, Australia (A.P.R.)
| | - Bo Remenyi
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Australia (J.R.F., H.F., J.M., J.Y., A.P.R., B.R.).,Department of Pediatrics, Royal Darwin Hospital, Australia (J.R.F., H.H., A.H., L.A.F., K.D., J.Y., K.V.R., B.R.).,NT Cardiac, Australia (A.K., J.M., B.R.).,Department of Pediatrics, Cairns Base Hospital, Australia (B.R.)
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6
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Wiegele S, McKinnon E, Wyber R, Noonan K. Protocol for the systematic review of the epidemiology of superficial Streptococcal A infections (skin and throat) in Australia. PLoS One 2021; 16:e0255789. [PMID: 34379660 PMCID: PMC8357163 DOI: 10.1371/journal.pone.0255789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 07/16/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE We have produced a protocol for the comprehensive systematic review of the current literature around superficial group A Streptococcal infections in Australia. METHODS MEDLINE, Scopus, EMBASE, Web of Science, Global Health, Cochrane, CINAHL databases and the gray literature will be methodically and thoroughly searched for studies relating to the epidemiology of superficial group A Streptococcal infections between the years 1970 and 2019. Data will be extracted to present in the follow up systematic review. CONCLUSION A rigorous and well-organised search of the current literature will be performed to determine the current and evolving epidemiology of superficial group A Streptococcal infections in Australia.
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Affiliation(s)
- Sophie Wiegele
- Clinical Medicine, Perth Children’s Hospital, Perth, Western Australia, Australia
| | | | - Rosemary Wyber
- Research, Telethon Kid’s Institute, Perth, Western Australia, Australia
| | - Katharine Noonan
- Research, Telethon Kid’s Institute, Perth, Western Australia, Australia
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McMillan DJ, Rafeek RAM, Norton RE, Good MF, Sriprakash KS, Ketheesan N. In Search of the Holy Grail: A Specific Diagnostic Test for Rheumatic Fever. Front Cardiovasc Med 2021; 8:674805. [PMID: 34055941 PMCID: PMC8160110 DOI: 10.3389/fcvm.2021.674805] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/22/2021] [Indexed: 12/13/2022] Open
Abstract
Current diagnosis of Acute Rheumatic Fever and Rheumatic Heart Disease (ARF/RHD) relies on a battery of clinical observations aided by technologically advanced diagnostic tools and non-specific laboratory tests. The laboratory-based assays fall into two categories: those that (1) detect "evidence of preceding streptococcal infections" (ASOT, anti-DNAse B, isolation of the Group A Streptococcus from a throat swab) and (2) those that detect an ongoing inflammatory process (ESR and CRP). These laboratory tests are positive during any streptococcal infection and are non-specific for the diagnosis of ARF/RHD. Over the last few decades, we have accumulated considerable knowledge about streptococcal biology and the immunopathological mechanisms that contribute to the development, progression and exacerbation of ARF/RHD. Although our knowledge is incomplete and many more years will be devoted to understanding the exact molecular and cellular mechanisms involved in the spectrum of clinical manifestations of ARF/RHD, in this commentary we contend that there is sufficient understanding of the disease process that using currently available technologies it is possible to identify pathogen associated peptides and develop a specific test for ARF/RHD. It is our view that with collaboration and sharing of well-characterised serial blood samples from patients with ARF/RHD from different regions, antibody array technology and/or T-cell tetramers could be used to identify streptococcal peptides specific to ARF/RHD. The availability of an appropriate animal model for this uniquely human disease can further facilitate the determination as to whether these peptides are pathognomonic. Identification of such peptides will also facilitate testing of potential anti-streptococcal vaccines for safety and avoid potential candidates that may pre-dispose potential vaccine recipients to adverse outcomes. Such peptides can also be readily incorporated into a universally affordable point of care device for both primary and tertiary care.
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Affiliation(s)
- David J. McMillan
- School of Science and Technology, Engineering and Genecology Research Centre, University of the Sunshine Coast, Maroochydore, QLD, Australia
- School of Science and Technology, University of New England, Armidale, NSW, Australia
| | - Rukshan A. M. Rafeek
- School of Science and Technology, University of New England, Armidale, NSW, Australia
| | - Robert E. Norton
- School of Science and Technology, University of New England, Armidale, NSW, Australia
- Pathology Queensland, Townsville University Hospital, Douglas, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Michael F. Good
- Laboratory of Vaccines for the Developing World, Institute for Glycomics, Griffith University, Gold Coast, QLD, Australia
| | - Kadaba S. Sriprakash
- School of Science and Technology, University of New England, Armidale, NSW, Australia
- Queensland Institute of Medical Research Berghofer (QIMR) Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Natkunam Ketheesan
- School of Science and Technology, University of New England, Armidale, NSW, Australia
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8
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Mitchell AG, Diddo J, James AD, Guraylayla L, Jinmarabynana C, Carter A, Rankin SD, Djorlom G, Coleman C, Scholes M, Haynes E, Remenyi B, Yan J, Francis JR. Using community-led development to build health communication about rheumatic heart disease in Aboriginal children: a developmental evaluation. Aust N Z J Public Health 2021; 45:212-219. [PMID: 33970522 DOI: 10.1111/1753-6405.13100] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 02/01/2021] [Accepted: 02/01/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE A high prevalence of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) among Aboriginal children in northern Australia is coupled with low understanding among families. This has negative impacts on children's health, limits opportunities for prevention and suggests that better health communication is needed. METHODS During an RHD echocardiography screening project, Aboriginal teachers in a remote community school created lessons to teach children about RHD in their home languages, drawing on principles of community-led development. Access to community-level RHD data, previously unknown to teachers and families, was a catalyst for this innovative work. Careful, iterative discussions among speakers of four Aboriginal languages ensured a culturally coherent narrative and accompanying teaching resources. RESULTS The evaluation demonstrated the importance of collective work, local Indigenous Knowledge and metaphors. As a result of the lessons, some children showed new responses and attitudes to skin infections and their RHD treatment. Language teachers used natural social networks to disseminate new information. A community interagency collaboration working to prevent RHD commenced. Conclusions and implications for public health: Action to address high rates of RHD must include effective health communication strategies that value Indigenous Knowledge, language and culture, collaborative leadership and respect for Indigenous data sovereignty.
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Affiliation(s)
- Alice G Mitchell
- Menzies School of Health Research, Charles Darwin University, Northern Territory
| | - Joseph Diddo
- Lúrra Language and Culture Unit, Maningrida College, Northern Territory
| | | | - Laurie Guraylayla
- Lúrra Language and Culture Unit, Maningrida College, Northern Territory
| | | | - Abigail Carter
- Lúrra Language and Culture Unit, Maningrida College, Northern Territory
| | | | - Gideon Djorlom
- Lúrra Language and Culture Unit, Maningrida College, Northern Territory
| | - Carolyn Coleman
- Lúrra Language and Culture Unit, Maningrida College, Northern Territory
| | - Mason Scholes
- Lúrra Language and Culture Unit, Maningrida College, Northern Territory
| | - Emma Haynes
- School of Population and Global Health, University of Western Australia, Western Australia
| | - Boglarka Remenyi
- Menzies School of Health Research, Charles Darwin University, Northern Territory.,Department of Paediatrics, Royal Darwin Hospital, Northern Territory
| | - Jennifer Yan
- Menzies School of Health Research, Charles Darwin University, Northern Territory.,Department of Paediatrics, Royal Darwin Hospital, Northern Territory
| | - Joshua Reginald Francis
- Menzies School of Health Research, Charles Darwin University, Northern Territory.,Department of Paediatrics, Royal Darwin Hospital, Northern Territory
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9
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Avire NJ, Whiley H, Ross K. A Review of Streptococcus pyogenes: Public Health Risk Factors, Prevention and Control. Pathogens 2021; 10:pathogens10020248. [PMID: 33671684 PMCID: PMC7926438 DOI: 10.3390/pathogens10020248] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 01/10/2023] Open
Abstract
Streptococcus pyogenes, (colloquially named “group A streptococcus” (GAS)), is a pathogen of public health significance, infecting 18.1 million people worldwide and resulting in 500,000 deaths each year. This review identified published articles on the risk factors and public health prevention and control strategies for mitigating GAS diseases. The pathogen causing GAS diseases is commonly transmitted via respiratory droplets, touching skin sores caused by GAS or through contact with contaminated material or equipment. Foodborne transmission is also possible, although there is need for further research to quantify this route of infection. It was found that GAS diseases are highly prevalent in developing countries, and among indigenous populations and low socioeconomic areas in developed countries. Children, the immunocompromised and the elderly are at the greatest risk of S. pyogenes infections and the associated sequelae, with transmission rates being higher in schools, kindergartens, hospitals and residential care homes. This was attributed to overcrowding and the higher level of social contact in these settings. Prevention and control measures should target the improvement of living conditions, and personal and hand hygiene. Adherence to infection prevention and control practices should be emphasized in high-risk settings. Resource distribution by governments, especially in developed countries, should also be considered.
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Wyber R, Noonan K, Halkon C, Enkel S, Cannon J, Haynes E, Mitchell AG, Bessarab DC, Katzenellenbogen JM, Bond-Smith D, Seth R, D'Antoine H, Ralph AP, Bowen AC, Brown A, Carapetis JR. Ending rheumatic heart disease in Australia: the evidence for a new approach. Med J Aust 2020; 213 Suppl 10:S3-S31. [PMID: 33190287 DOI: 10.5694/mja2.50853] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
■The RHD Endgame Strategy: the blueprint to eliminate rheumatic heart disease in Australia by 2031 (the Endgame Strategy) is the blueprint to eliminate rheumatic heart disease (RHD) in Australia by 2031. Aboriginal and Torres Strait Islander people live with one of the highest per capita burdens of RHD in the world. ■The Endgame Strategy synthesises information compiled across the 5-year lifespan of the End Rheumatic Heart Disease Centre of Research Excellence (END RHD CRE). Data and results from priority research projects across several disciplines of research complemented literature reviews, systematic reviews and narrative reviews. Further, the experiences of those working in acute rheumatic fever (ARF) and RHD control and those living with RHD to provide the technical evidence for eliminating RHD in Australia were included. ■The lived experience of RHD is a critical factor in health outcomes. All future strategies to address ARF and RHD must prioritise Aboriginal and Torres Strait Islander people's knowledge, perspectives and experiences and develop co-designed approaches to RHD elimination. The environmental, economic, social and political context of RHD in Australia is inexorably linked to ending the disease. ■Statistical modelling undertaken in 2019 looked at the economic and health impacts of implementing an indicative strategy to eliminate RHD by 2031. Beginning in 2019, the strategy would include: reducing household crowding, improving hygiene infrastructure, strengthening primary health care and improving secondary prophylaxis. It was estimated that the strategy would prevent 663 deaths and save the health care system $188 million. ■The Endgame Strategy provides the evidence for a new approach to RHD elimination. It proposes an implementation framework of five priority action areas. These focus on strategies to prevent new cases of ARF and RHD early in the causal pathway from Streptococcus pyogenes exposure to ARF, and strategies that address the critical systems and structural changes needed to support a comprehensive RHD elimination strategy.
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Affiliation(s)
- Rosemary Wyber
- George Institute for Global Health, Sydney, NSW.,Telethon Kids Institute, Perth, WA
| | | | | | | | | | | | | | | | | | | | - Rebecca Seth
- Telethon Kids Institute, Perth, WA.,University of Western Australia, Perth, WA
| | | | | | - Asha C Bowen
- Telethon Kids Institute, Perth, WA.,Perth Children's Hospital, Perth, WA
| | - Alex Brown
- South Australian Health and Medical Research Institute, Adelaide, SA.,University of South Australia, Adelaide, SA
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Carapetis JR, Brown A. Community leadership and empowerment are essential for eliminating rheumatic heart disease. Med J Aust 2020; 213:116-117. [PMID: 32652580 DOI: 10.5694/mja2.50695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Alex Brown
- South Australian Health and Medical Research Institute, Adelaide, SA.,University of Adelaide, Adelaide, SA
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12
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Francis JR, Fairhurst H, Hardefeldt H, Brown S, Ryan C, Brown K, Smith G, Baartz R, Horton A, Whalley G, Marangou J, Kaethner A, Draper ADK, James CL, Mitchell AG, Yan J, Ralph A, Remenyi B. Hyperendemic rheumatic heart disease in a remote Australian town identified by echocardiographic screening. Med J Aust 2020; 213:118-123. [DOI: 10.5694/mja2.50682] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 04/23/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Joshua R Francis
- Menzies School of Health ResearchCharles Darwin University Darwin NT
- Royal Darwin Hospital Darwin NT
| | - Helen Fairhurst
- Menzies School of Health ResearchCharles Darwin University Darwin NT
| | | | - Shannon Brown
- Top End Health ServiceManingrida Health Centre Maningrida NT
| | - Chelsea Ryan
- Top End Health ServiceManingrida Health Centre Maningrida NT
| | - Kurt Brown
- Top End Health ServiceManingrida Health Centre Maningrida NT
| | - Greg Smith
- Top End Health ServiceManingrida Health Centre Maningrida NT
| | - Roz Baartz
- Top End Health ServiceManingrida Health Centre Maningrida NT
| | | | | | | | | | - Anthony DK Draper
- Centre for Disease ControlNorthern Territory Department of Health Darwin NT
| | - Christian L James
- Centre for Disease ControlNorthern Territory Department of Health Darwin NT
| | - Alice G Mitchell
- Menzies School of Health ResearchCharles Darwin University Darwin NT
| | - Jennifer Yan
- Menzies School of Health ResearchCharles Darwin University Darwin NT
- Royal Darwin Hospital Darwin NT
| | - Anna Ralph
- Menzies School of Health ResearchCharles Darwin University Darwin NT
| | - Bo Remenyi
- Royal Darwin Hospital Darwin NT
- NT Cardiac Darwin NT
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13
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Giffard PM, Tong SYC, Holt DC, Ralph AP, Currie BJ. Concerns for efficacy of a 30-valent M-protein-based Streptococcus pyogenes vaccine in regions with high rates of rheumatic heart disease. PLoS Negl Trop Dis 2019; 13:e0007511. [PMID: 31269021 PMCID: PMC6634427 DOI: 10.1371/journal.pntd.0007511] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 07/16/2019] [Accepted: 06/03/2019] [Indexed: 11/21/2022] Open
Abstract
The prevalence of rheumatic heart disease (RHD) in the Aboriginal population of the Australian Northern Territory is high, and Streptococcus pyogenes skin infections likely contribute to this. A promising candidate S. pyogenes “30mer” vaccine is composed of 30 pharyngitis associated type-specific antigens from the S. pyogenes M protein. Cross opsonisation experiments suggest that 30mer vaccine protection may extend to non-cognate emm types. A new “emm cluster” scheme for classifying M protein is based on the full-length coding sequence, and correlates with functional and immunological properties, and anatomical tropism. Twenty-seven years of research in the Northern Territory has yielded 1810 S. pyogenes isolates with clinical and emm type data. The primary aim was to analyse these data with reference to the emm cluster scheme and cross opsonisation information, to inform estimation of 30mer vaccine efficacy in the Northern Territory. The isolates encompass 101 emm types. Variants of cluster A-C were enriched in throat isolates, and variants of emm cluster D enriched in skin isolates. Throat isolates were enriched for 30mer vaccine cognate emm types in comparison with skin isolates of which only 25% were vaccine emm types. While cross opsonisation data indicates potential for enhancing 30mer vaccine coverage, more than one third of skin isolates were within 38 emm types untested for cross opsonisation. Emm cluster D variants, in particular emm cluster D4, were not only all non-cognate with the vaccine, but were abundant and diverse, and less likely to be cross-opsonisation positive than other emm clusters. Long term persistence of many emm types in the study area was revealed. It was concluded that the 30mer vaccine efficacy in the Northern Territory will likely require both cross protection, and additional measures to elicit immunity against variants of emm cluster D. The bacterium Streptococcus pyogenes causes throat and skin infections. A danger from such infections is an immune response that attacks human heart tissue, leading to rheumatic heart disease, which is difficult to treat and potentially deadly. Disadvantaged populations such as the Indigenous people in remote tropical northern Australia have high burdens of S. pyogenes skin infection, and rheumatic heart disease. An effective vaccine would be a benefit, but none is approved for clinical use. We analysed data from 1810 S. pyogenes isolates from north Australia obtained over 28 years, to determine the potential of a previously described S. pyogenes vaccine candidate to be effective in this region. Only one quarter of the isolates from skin infections had a surface antigen corresponding to any one of the 30 antigen variants in the candidate vaccine. Previous work in animals indicates potential cross-protection from the vaccine against strains with mismatched antigens. However, even if this occurs in humans, protection against skin infection strains would likely remain compromised, unless there were additional components in the vaccine. Further studies on cross-protection are critical to defining the potential of this type of vaccine in populations burdened with S. pyogenes skin infections and rheumatic heart disease.
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Affiliation(s)
- Philip M. Giffard
- Menzies School of Health Research, Division of Global and Tropical Health, Darwin, Australia
- College of Health and Human Sciences, Charles Darwin University, Darwin, Australia
- * E-mail:
| | - Steven Y. C. Tong
- Menzies School of Health Research, Division of Global and Tropical Health, Darwin, Australia
- Victorian Infectious Disease Service, The Royal Melbourne Hospital, and Doherty Department University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Deborah C. Holt
- Menzies School of Health Research, Division of Global and Tropical Health, Darwin, Australia
- College of Health and Human Sciences, Charles Darwin University, Darwin, Australia
| | - Anna P. Ralph
- Menzies School of Health Research, Division of Global and Tropical Health, Darwin, Australia
- Division of Medicine, Royal Darwin Hospital, Darwin, Australia
| | - Bart J. Currie
- Menzies School of Health Research, Division of Global and Tropical Health, Darwin, Australia
- Division of Medicine, Royal Darwin Hospital, Darwin, Australia
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