Andrew Fox-Lewis: Capturing the complete clinical spectrum of severe acute Group A Streptococcus disease in Auckland

<p dir="ltr">Background: Development of an effective Group A Streptococcus (GAS) vaccine is global health priority. Severe acute GAS (saGAS) disease comprises hospitalised infections, toxin-mediated and immune-mediated disease (including acute rheumatic fever [ARF]). This population-based study characterised the burden and spectrum of saGAS in Auckland to inform future vaccine studies in this setting. Methods: Microbiology laboratory data and ARF notifications were used to capture all saGAS cases during 2023. Epidemiology, clinical features, incidence and hospitalisation costs are described. Results: The complete clinical spectrum of saGAS was observed, with 606 cases captured corresponding to 1:2000 people affected annually. The burden is inequitably distributed, greatest at the intersection of age, ethnicity and socioeconomic deprivation. Hospitalisation costs exceeded $13 million NZD. Conclusion: The health and economic burden of saGAS highlight the need for a vaccine, with the high incidence and entire range of saGAS disease present making Auckland an ideal location for future vaccine studies.</p>