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QUESTION 1: Are household contacts of patients with invasive group A streptococcal disease at higher risk of secondary infection?
  1. Jeremy P Carr1,
  2. Nigel Curtis1,2,3,
  3. Pierre R Smeesters2,3,4,
  4. Andrew Steer1,2,3
  1. 1 Infectious Diseases Unit, The Royal Children's Hospital, Parkville, Victoria, Australia
  2. 2 Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
  3. 3 Murdoch Children's Research Institute, Parkville, Victoria, Australia
  4. 4 Paediatric Department, Academic Children Hospital Queen Fabiola, Université Libre de Bruxelles, Brussels, Belgium
  1. Correspondence to Professor Andrew Steer, Department of Paediatrics, The University of Melbourne, Royal Children's Hospital Melbourne, Flemington Road, Parkville, VIC 3052, Australia; andrew.steer{at}rch.org.au

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Scenario

You are caring for a 7-year-old boy with group A streptococcal (GAS) toxic shock syndrome (TSS). You wonder whether his parents and siblings are at increased risk for invasive GAS disease and whether chemoprophylaxis should be considered.

Structured clinical question

Are close household contacts (population) of a patient with community-acquired invasive GAS disease at higher risk of invasive GAS disease (outcome) than the general population (comparator)?

Search strategy and outcome

PubMed, Medline (OVID, 1946–present) and EMBASE (OVID, 1974–present) databases were searched using the following structure: (group A streptococc* OR streptococcus pyogenes OR beta haemolytic streptococc* OR beta hemolytic streptococc*) AND (sepsis OR bacteraemia OR bacteremia OR septicaemia OR septicemia OR invasive OR necroti* OR toxic shock) AND (*prophylaxis OR prophylactic OR prevent* OR contact OR household OR family OR secondary OR subsequent). Limits set: human, English language. This produced 860 matches. After excluding studies related to outbreaks in nosocomial or institutional settings, and community clusters, we identified four prospective population-based studies that investigated the risk of secondary invasive GAS disease in household contacts (table 1).1–4 Additional data from surveillance by Davies et al were available in a secondary publication.5 The references of these manuscripts were hand-searched and no further relevant publications were identified.

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Table 1

Prospective population-based surveillance studies investigating the attack rate of invasive group A streptococcal (GAS) disease in household contacts of community-acquired index cases

Commentary

Invasive GAS disease is defined by the isolation of Streptococcus pyogenes from a sterile site and comprises TSS, necrotising fasciitis, bacteraemia and focal infections such as osteomyelitis.6 ,7 It causes significant morbidity, with overall mortality between 8% and 16% and …

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