Current epidemiological aspects of streptococcal and poststreptococcal diseases in the Russian Federation

Epidemiological situation related to the spread of streptococcal infection and post-streptococcal diseases in the world remains tense in recent decades. According to the World Health Organization, more than 616 million cases of streptococcal pharyngitis occur annually in the world. Group A Streptococcus (GAS) is the most common cause of morbidity and mortality in infectious diseases and one of the main human pathogens. The prevalence of severe cases of GAS infections amounted to 18.1 million people worldwide. At the same time, in recent years outbreaks of scarlet fever have been recorded in some countries. In 2011, scarlet fever rate was 10 times higher than the average rate of the previous decade. In the past 3 years, epidemics of scarlet fever have been registered in the UK, with an increased incidence every year. Although there are significant achievements in the fight against rheumatic fever (RF), it keeps reminding of itself in the form of new outbreaks. Currently, acute rheumatic fever (ARF) is not a mass disease, but it is a serious problem associated with heart damage. In the article, we analyzed incidence and prevalence of RF, rheumatic heart disease (RHD), chronic pharyngitis, nasopharyngitis, sinusitis and rhinitis. We present the comparative characteristic among children, adolescents and adults. We also describe high epidemiological and social significance of the problem and possible increase of RF and RHD, which cause significant social and economic damage, remaining the urgent problem of public health in Russia. It was revealed that the situation with ARF and RHD in Russia remains unstable. Between 1997 and 2016, epidemiological indicators of streptococcal infection tend to increase moderately. ARF incidence significantly increases with an average growth rate (AGR) of 2.5 %, while its prevalence has the opposite tendency to decrease. AGR was –29.2 %. RFD incidence showed a significant indicators increase with AGR of +1.1 %. At the same time, the prevalence tended to decrease and STP was –2 %. The situation makes it necessary to strengthen the epidemiological control of streptococcal infection and increase the alertness of doctors regarding the new cases of ARF and RHD.

group A streptococcus, Streptococcus pyogenes, streptococcal infection, streptococcal diseases, streptococcal pharyngitis, epidemiology, acute rheumatic fever, rheumatic heart disease, prevalence, incidence

1. Carapetis J.R., Steer A.C., Mulholland E.K., Weber M. The global burden of group A streptococcal diseases. Lancet Infect Dis 2005;5(11):685–94. DOI: 10.1016/S1473-3099(05)70267-X.

2. Pokrovsky V.I., Briko N.I., Rapis L.A. Streptococci and streptococcoses. Moscow: GEOTAR-Media, 2006. (In Russ.)

3. Russian national recommendations. Surgical infections of the skin and soft tissues. Russian Society of Surgeons, Russian Association of Specialists in Surgical Infections. Revision 2009. Available at: https://rumedo.ru/uploads/sites/2016/pdf/rekomendatcii%20po%20infektciiam%20kozhi.pdf. (In Russ.)

4. O’Loughlin R.E., Roberson A., Cieslak P.R. et al. The epidemiology of invasive group A streptococcal infection and potential vaccine implications: United States, 2000–2004. Clin Infect Dis 2007;45(7):853–62. DOI: 10.1086/521264.

5. Briko N.I., Pokrovsky N.I., Kleimenov D.A. The prevalence and clinical and epidemiological characteristics of diseases caused by group A streptococcus in Russia. Terapevticheskiy arkhiv = Therapeutic Archive 2009;11:5–9. (In Russ.)

6. Aksyonova A.V., Briko N.I., Kleimenov D.A. Dynamics of epidemiologic parameters of acute rheumatic fever in Moscow and Russian Federation during 1996–2007 periods. Vestnik Rossiyskogo gosudarstvennogo meditsinskogo universiteta = Bulletin of the Russian State Medical University 2009;7:10–5. (In Russ.)

7. Safar A., Lennon D., Stewart J. et al. Invasive group A streptococcal infection and vaccine implications, Auckland, New Zealand. Emerg Infect Dis 2011;17(6):983–9. DOI: 10.3201/eid/1706.100804.

8. Briko N.I., Glushkova E.V. Status and trends of the epidemic situation of group A streptococcal (GAS) infections in Russia in recent years. Zhurnal mikrobiologii, epidemiologii i immunobiologii = Journal of microbiology epidemiology immunobiology 2018;1:10–6. (In Russ.) DOI: 10.36233/0372-9311-2018-1-10-16.

9. Lau E.H., Nishiura H., Cowling B.J. et al. Scarlet fever outbreak, Hong Kong, 2011. Emerg Infect Dis 2012;18(10):1700–2. DOI: 10.3201/eid1810.120062.

10. Luk E.Y., Lo J.Y., Li A.Z. еt al. Scarlet fever epidemic, Hong Kong, 2011. Emerg Infect Dis 2012;18(10):1658–61. DOI: 10.3201/eid1810.111900.

11. Park D.W., Kim S.H., Park J.W. et al. Incidence and Characteristics of Scarlet Fever, South Korea, 2008–2015. Emerg Infect Dis 2017;23(4):658–61. DOI: 10.3201/eid2304.160773.

12. Lamagni T., Guy R., Chand M. et al. Resurgence of scarlet fever in England, 2014 16: a population-based surveillance study. Lancet Infect Dis 2018;18(2):180–7. DOI: 10.1016/S1473-3099(17)30693-X.

13. Chen M., Yao W., Wang X. et al. Outbreak of scarlet fever associated with emm 12 type group A Streptococcus in 2011 in Shanghai, China. Pediatr Infect Dis J 2012;31(9):158–62. DOI: 10.1097/INF.0b013e31825874f3.

14. Guy R., Williams C., Irvine N. et al. Increase in scarlet fever notifications in the United Kingdom, 2013/2014. Euro Surveill 2014;19(12):20749. DOI: 10.2807/1560-7917.es2014.19.12.20749.

15. Lamagni T.L., Darenberg J., Luca-Harari B. et al. Epidemiology of severe Streptococcus pyogenes disease in Europe. J Clin Microbiol 2008;46(7):2359–67. DOI: 10.1128/JCM.00422-08.

16. Cole J.N., Barnett T.C., Nizet V., Walker M.J. Molecular insight into invasive group A streptococcal disease. Nat Rev Microbiol 2011;9(10):724–36. DOI: 10.1038/nrmicro2648.

17. Dale J.B., Penfound T.A., Chiang E.Y., Walton W.J. New 30-valent M proteinbased vaccine evokes cross-opsonic antibodies against non-vaccine serotypes of group A streptococci. Vaccine 2011;29(46):8175–8. DOI: 10.1016/j.vaccine.2011.09.005.

18. Walker M.J., Barnett T.C., McArthur J.D. et al. Disease manifestations and pathogenic mechanisms of Group A streptococcus. Clin Microbiol Rev 2014;27(2):264–301. DOI: 10.1128/CMR.00101-13.

19. Nelson G.E., Pondo T., Toews K.A. et al. Epidemiology of Invasive Group A streptococcal infections in the United States, 2005–2012. Clin Infect Dis 2016;63(4):478–86. DOI: 10.1093/cid/ciw248.

20. Hua C., Sbidian E., Hemery F. et al. Prognostic factors in necrotizing softtissue infections(NSTI): A cohort study. J Am Acad Dermatol 2015;73(6):1006–12. DOI: 10.1016/j.jaad.2015.08.054.

21. Parnaby M.G., Carapetis J.R. Rheumatic fever in indigenous Australian children. J Pediatr Child Health 2010;46(9):527–33. DOI: 10.1111/j.1440-1754.2010.01841.x.

22. Stollerman G.H. Current issues in the prevention of rheumatic fever. Minerva Med 2002;93(5):371–87.

23. Stollerman G.H. Global changes in group A streptococcal diseases and strategies for their prevention. Adv Intern Med 1982;27:373–406.

24. Centers for Disease Control (CDC). Acute rheumatic fever among Army trainees – Fort Leonard Wood, Missouri, 1987–1988. MMWR Morb Mortal Wkly Rep 1988;37(34):519–22.

25. Kaplan E.L., Bisno A.L. Antecedent streptococcal infection in acute rheumatic fever. Clin Infect Dis 2006;43(6):690–2. DOI: 10.1086/506944.

26. Kaplan E.L., Johnson D.R., Cleary P.P. Group A streptococcal serotypes isolated from patients and sibling contacts during the resurgence of rheumatic fever in the United States in the mid-1980s. J Infect Dis 1989;159(1):101–3. DOI: 10.1093/infdis/159.1.101.

27. Samorodskaya I.V. Cardiovascular morbidity and risk factors of cardiovascular events in the Russian Federation. Kardiovaskulyarnaya terapiya i profilaktika = Cardiovascular Therapy and Prevention 2005;4(3, part II): 94–100. (In Russ.)

28. Watkins D.A., Beaton A.Z., Carapetis J.R. et al. Rheumatic Heart Disease Worldwide: JACC scientific expert panel. J Am Coll Cardiol 2018;72(12):1397–416. DOI: 10.1016/j.jacc.2018.06.063.

29. State report on the state of health of the population of the Russian Federation in 2002. Zdravookhraneniye Rossiyskoy Federatsii = Health Care in the Russian Federation 2004;1:3–18. (In Russ.)

30. Belov B.S., Grishaeva T.P. Acute rheumatic fever: modern approaches to primary and secondary prevention. Lechashchiy vrach = Therapist 2007;6:99–101. (In Russ.)

31. Madden S., Kelly L. Update on acute rheumatic fever: it still exists in remote communities. Can Fam Physician 2009;55(5):475–8.

32. Vincent M.T., Celestin N., Hussain A.N. Pharyngitis. Am Fam Physician 2004;69(6):1465–70.

33. Aksyonova A.V., Briko N.I., Kleimenov D.A. Epidemiological significance of chronic pharyngitis, nasopharyngitis, sinusitis, and rhinitis in Moscow and the Russian Federation in 1996 to 2009. Rlinitsist = The Clinician 2012;6(3–4):38–43. (In Russ.)

34. Kleimenov D.A., Briko N.I., Aksyonova А.V. Streptococcal (Group A) Infection in the Russian Federation: Epidemiological Characteristics of the Determinants and Evaluation of Current Scope of the Problem. Epidemiologia i vakcinoprofilaktika = Epidemiology and Vaccinal Prevention. 2011;2(57):4–11. (In Russ.)

35. Watkins D.A., Zuhlke L.J., Engel M.E., Mayosi B.M. Rheumatic fever: neglected again. Science 2009;324(5923):37. DOI: 10.1126/science.324.5923.37b