Research Projects

Invasive group A streptococcal disease (ISA) – defined as the isolation of group A Strep from a normally sterile site such as blood or CSF – has high morbidity and case fatality rate of ~13% (up to 45% for strep toxic shock syndrome). Clinical manifestations include sepsis, toxic shock syndrome, necrotizing fasciitis, pneumonia, septic arthritis, and meningitis. Household contacts of an index ISA case are at around 2,000-fold increased risk of developing secondary ISA. A prospective cohort study of ISA cases and their household contacts has been piloted at Eastern Health and is now recruiting at Royal Melbourne Hospital, collecting information about ISA cases (demographic, clinical, outcome, genomic) and their household contacts (including Strep A colonization, risk of secondary disease and adherence to recommended antibiotic chemoprophylaxis). The risk of secondary ISA will be inferred through detection of pharyngeal carriage of genetically identical Strep A among close contacts.

This project can be expanded to additional sites to obtain a contemporary picture of clinical, epidemiological and genomic aspects of invasive Strep A in Australia. In particular, there is scope to develop a national study to define the genomics of invasive Strep A isolates, and to define the most appropriate antibiotics for prophylaxis to prevent secondary ISA among household contacts. In the context of ISA becoming nationally notifiable, and Strep A vaccine development, findings will contribute to clinical and public health guidelines management of Strep A cases and their contacts in Australia.

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