A Margaret H. Danchin, PhD a,b,c, Susan Rogers, MSc b, Loraine Kelpie, BHlthSc(Nurs) b, Gowri Selvaraj, BSc b, Nigel Curtis, PhD a,b,c, John B. Carlin, PhD a,b, Terence M. Nolan, PhD b,d and Jonathan R. Carapetis, PhD a,b,c,e a Department of Paediatrics; b Murdoch Children s Research Institute, Parkville, Australia; c Department of General Medicine, Royal Children s Hospital, Melbourne, Australia; d School of Population Health, University of Melbourne, Melbourne, Australia; e Menzies School of Health Research, Charles Darwin University, Darwin, Australia A 2001 8 2002 12 16 mo 3 202 (853)13 12 A 97% 16 mo (5 12 ) A A 33 13 8 / 100 60 20 15 / 100 A 43% 1 13%1 A 13% 8% 16% 2% A (acute pharyngitis); A (group A Streptococci); (incidence); (transmission); (carriage); (serology); (school-aged children) GAS = group A Streptococcus SES = socioeconomic status ASO = antistreptolysin O ADB = anti-dnase B ULN = upper limit of normal CI = confidence interval RR = relative risk Address correspondence to Margaret H. Danchin, PhD, Murdoch Children s Research Institute, Department of Paediatrics, Flemington Road, Parkville 3052, Australia. E-mail: margie. danchin@rch.org.au PEDIATRICS 2008 2 3 2 97
[1] A (GAS) [2] [37] 2060 GAS GAS (GAS ) GAS ( ) [8, 9] GAS GAS GAS 16 mo (Royal Childrens Hospital Ethics in Human Research Committee) 3 Deer Park Essendon North Nepean Deer Park (SES) Deer Park 500 599 (255 305) Essendon NorthNepean 1000 1499 (510 760) [10] 1 3 1 3 12 GAS 5 10 y 250 2 GAS [11] 1 ( ) ( ) GAS1 2wk () 2 wk(3 4wk) 98 DANCHIN et al
1 / n (%) Nepean Essendon North Deer Park P b a 202 6 (3) 196 (97) 66 (34) 67 (34) 63 (32) a 877 49 (6) 828 (94) 286 (35) 300 (36) 242 (29) 393 35 (71) 358 (43) 122 (43) 127 (42) 109 (45) 0.45 188 29 (83) 159 (44) 56 (46) 60 (47) 43 (39) 205 6 (17) 199 (56) 66 (54) 67 (53) 66 (61) 484 14 (28) 470 (57) 164 (57) 173 (58) 133 (55) /y 0.12 5 88 4 (29) 84 (18) 22 (13) 39 (23) 23 (17) 512 339 8 (57) 331 (70) 118 (72) 114 (66) 99 (74) 1318 57 2 (14) 55 (12) 24 (15) 20 (12) 11 (8) 0.64 237 7 (50) 230 (49) 85 (52) 83 (48) 62 (47) 247 7 (50) 240 (51) 79 (48) 90 (52) 71 (53) 0.39 37 2 (14) 35 (8) 13 (8) 9 (6) 13 (11) / 80 2 (14) 78 (18) 25 (16) 34 (22) 19 (16) 327 10 (72) 317 (74) 117 (75) 113 (72) 87 (73) 444 14 (100) 430 (92) 155 (91) 156 (90) 119 (89) a () b 3 χ 2 P 3 4mo GAS GAS ( ) 1 18 18 GAS GAS 2 wk 2 wk GAS ( ) 5 d GAS30 d GAS emm () 3 GASGAS GAS GAS GAS O (ASO) DNase B (ADB) 0.2 log-10 ASOADB ASOADBGAS PEDIATRICS 2008 2 3 2 99
GAS 7d ( [12, 13] )ASO () ADB (ULN) ASOADBULN ULN [14] GAS GASGAS [15] GAS M (Lancefield ) emm (M ) GAS10% 160 ( 240 ) 0.2 95% (CI) (10 4) % (20 5.3) % 20% 200 3 χ 2 Fishers Poisson logistic GASStata 7 (Stata) Amies 24 h37 5% CO 2 24 h [16, 17] (Stretex Oxoid Basingstoke United Kingdom) β- (A C G) Wayne Devenish ASOADB [18] 202 (853)196 (828 ) 97% (1)3Deer Park SES Nepean 1 /3 16% 41% ( 2) 2 GAS A / / / / / / y 100 y 95% CI 95% CI y 100 y y 100 y 95% CI /y 5 37 97 38.1 26.952.6 10 97 10.3 4.919.0 7 97 7.2 2.914.9 512 128 392 32.7 27.238.8 50 392 12.8 9.516.8 32 392 8.2 5.611.5 1318 26 65 40.0 26.158.6 6 65 9.2 3.420.1 3 65 4.6 1.013.5 18 57 422 13.5 10.217.5 20 422 4.7 2.97.3 14 422 3.3 1.85.6 248 977 25.4 22.328.7 86 977 8.8 7.010.9 56 977 5.7 4.37.4 a 102 171 59.6 48.672.4 35 171 20.5 14.328.5 26 171 15.2 9.922.3 a 100 1 100 DANCHIN et al
3 GAS (%) 5 512 1318 18 (n = 828) (n = 84) (n = 331) (n = 55) (n =358) a 248 37 (15) 129 (52) 26 (10) 57 (23) GAS 54 (22) 4 (11) 32 (25) 3 (12) 15 (26) 35 (65) 2 (50) 20 (63) 1 (33) 12 (80) 12 (22) 1 (25) 8 (25) 1 (33) 2 (13) 7 (13) 1 (25) 4 (13) 1 (33) 1 (1) b 19 (35) 2 (50) 11 (34) 1 (33) 5 (33) GAS 32 6 (19) 18 (56) 3 (9) 5 (16) 21 (66) 5 (83) 12 (67) 2 (67) 2 (40) 3 (10) 0 (0) 2 (11) 0 (0) 1 (20) 8 (25) 1 (17) 4 (22) 1 (33) 2 (40) b 9 (28) 3 (75) 4 (22) 0 (0) 2 (40) a GAS GAS b GAS GAS GAS 5432GAS ( 3) 26%GAS 20% 5 12 GAS (25%) 48% (RR) 0.52 (95% CI 0.4 0.7) P 0.000 1 GAS RR 1.2 (95% CI 0.7 2.0)P=0.44 5 12 (3) 41% 2/3 5 12 1GAS 1.8 RR 1.8 (95% CI 1.3 2.4) P =0.003 GAS 19GAS16 GAS (35 3) 19 15 (32%) ASO 10 (21%) ADB ( ) ASO350 U () 733 U32 912 (21) 3 8 8 d GAS GAS GAS GAS5 12 33%13% 8% 14% 5%3% 1 GASGAS PEDIATRICS 2008 2 3 2 101
60% 20% 15% ( 2) GAS ( ) 5 1210% 4% ( 4) 3 GAS 13% 8% 16% 2% GAS Poisson GAS / SESGAS GAS ( ) ( 5) GAS GAS 43% 1 (18 / 42) 1 (11 / 18) 2 ( )13% (95% CI 9 18)GAS81% (26 / 32) emm96% (25 / 26) emm emm 22emm emm 1 75 28 emm 12 28 1 emm 4 1 3.2 20 60 GAS 50 y GAS5 12 GAS (13%) 20 5060 [19, 20] 15%18% SES GAS 205060 GAS 23% [21] 26% [22] GAS 4 GAS GAS GAS / / 100 / /100 y y 95%CI y y 95%CI /y 5 10 97 10.3 4.919.0 6 97 6.2 2.313.5 512 50 392 12.8 9.516.8 41 392 10.5 7.514.2 1318 6 65 9.2 3.420.1 3 65 4.6 1.013.5 18 20 422 4.7 2.97.3 17 422 4.0 2.36.4 86 977 8.8 7.010.9 67 977 6.9 5.38.7 102 DANCHIN et al
5 GAS Poisson /IRR(95% CI) A / / IRR (95% CI) IRR (95% CI) 1 1.00 a 1.00 a 1.00 a 1 0.84 (0.621.16) 0.81 (0.511.28) 0.68 (0.381.20) 2 1.00 a 1.00 a 1.00 a 3 0.84 (0.451.53) 0.23 (0.110.46) 0.18 (0.080.41) 4 0.93 (0.501.70) 0.40 (0.200.79) 0.38 (0.170.83) 23 1.00 a 1.00 a 1.00 a 45 0.79 (0.531.18) 1.61 (0.763.43) 1.87 (0.685.10) 6 0.46 (0.230.87) 1.59 (0.643.93) 1.77 (0.545.85) 1.00 a 1.00 a 1.00 a 1.76 (0.744.23) 2.50 (0.768.15) 1.62 (0.485.49) 1.74 (0.773.91) 1.56 (0.504.83) 0.96 (0.303.05) 20 1.00 a 1.00 a 1.00 a 2030 1.50 (0.544.12) 1.12 (0.274.66) 0.50 (0.073.55) 3150 1.25 (0.811.93) 0.67 (0.401.13) 0.57 (0.301.08) IRR a 50% 95% 30% [3, 4, 23] GAS GAS GAS [23] GAS 1 /4 (1 / 3) 1 /3 GAS ( ) 2/3GAS GAS GAS GAS 24% 36% [2427] GAS GAS GAS GAS 1 1 8d GAS PEDIATRICS 2008 2 3 2 103
[13] GAS [2830] ( 1 7d ) ULN () 1 GAS 1 1 2 GAS 20% 5 GAS GAS 1999866 2 371 98 (26%) GAS [31] 1989 66 3.5 18 (27%) GAS [32] GASSES 20 60 [19, 25, 33, 34] [4] GAS [4] [3] GAS SES GAS () [4, 35, 36] GAS [37] GAS GAS 50 y GAS 1 GAS 1 Charles J, et al. Med J Aust 2004;180:216 219 2 Bisno AL, et al. Clin Infect Dis 2002;35:113 125 3 Lennon D. Rheumatic fever: a preventable disease? The New Zealand experience. In: Martin DR, et al, eds. Streptococci and Streptococcal Diseases: Entering the New Millennium Proceedings of the XIVth Lancefield International Symposium on Streptococci and Streptococcal Diseases. Auckland, New Zealand: ESR; 2000 4 Nandi S, et al. Bull World Health Organ 2001;79:528 533 5 Kaplan EL, et al. Lancet 2001;358:1334 1337 6 Zwart S, et al. BMJ 2003;327:1324 7 Martin JM, et al. Pediatrics 2004;114:1212 1219 8 Kotloff KL, et al. Pediatr Infect Dis J 2004;23:765 766 9 McNeil SA, et al. A double-blinded, randomized, controlled phase II trial of the safety and immunogenicity of a 26 valent 104 DANCHIN et al
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