European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2026
Burden of invasive group a streptococcus infection in Australia: a systematic review and meta-analysis.
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Ratnayake Himali, Eisen Damon, Adegboye Oyelola, Pak Anton, Alahakoon Chanika, Teeluck Mohabeer, Otolorin Gbeminiyi Richard, McBryde Emma
Аннотация
PURPOSE: In this study, we aimed to estimate the burden of invasive Group A Streptococcus (iGAS) infection in Australia and describe the risk factors and outcomes across regions and populations.
METHODS: Studies published in six databases until October 2025 were included. The first study included in the systematic review was published in 1996. The review was registered in PROSPERO (CRD42023493112). The quality was assessed using The Joanna Briggs Institution checklist for prevalence studies. Common presentations, outcomes, risk factors, seasonality and emm types were systematically reviewed. A meta-analysis was conducted to estimate pooled incidence.
RESULTS: Forty-one articles were included in the systematic review and 10 were included in the meta-analysis. The pooled incidence of iGAS was 7.97 per 100,000 person-years (95% CI:4.21-15). Indigenous Australians experienced a higher incidence (26.31 per 100,000 person-years; 95% CI: 8.65–79.98) than non-Indigenous (4.58 per 100,000 person-years; 95% CI:2.67–7.85). Tropical regions also had a high incidence (29.22 per 100,000 person-years; 95% CI:18.04–47.34). Skin and Soft Tissue Infections (SSTIs) were the main primary focus of infection (35.6–71.3%). Around 6.6–16.5% of iGAS were Streptococcal Toxic Shock Syndrome (STSS). Mortality ranged from 5.6 to 13.8%. Old age, chronic diseases, IV drug use, Indigenous status and living in a tropical region were among the risk factors for iGAS while association with sex was mixed. The number of events reported increased in the third quarter, although not consistent. The predominant emm-types identified nationally were emm1, emm89, emm12, and emm4.
CONCLUSION: iGAS poses a significant burden in Australia. Larger studies with less heterogeneity are needed to better understand the disease’s true impact and associated risk factors.
SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10096-026-05480-x.
METHODS: Studies published in six databases until October 2025 were included. The first study included in the systematic review was published in 1996. The review was registered in PROSPERO (CRD42023493112). The quality was assessed using The Joanna Briggs Institution checklist for prevalence studies. Common presentations, outcomes, risk factors, seasonality and emm types were systematically reviewed. A meta-analysis was conducted to estimate pooled incidence.
RESULTS: Forty-one articles were included in the systematic review and 10 were included in the meta-analysis. The pooled incidence of iGAS was 7.97 per 100,000 person-years (95% CI:4.21-15). Indigenous Australians experienced a higher incidence (26.31 per 100,000 person-years; 95% CI: 8.65–79.98) than non-Indigenous (4.58 per 100,000 person-years; 95% CI:2.67–7.85). Tropical regions also had a high incidence (29.22 per 100,000 person-years; 95% CI:18.04–47.34). Skin and Soft Tissue Infections (SSTIs) were the main primary focus of infection (35.6–71.3%). Around 6.6–16.5% of iGAS were Streptococcal Toxic Shock Syndrome (STSS). Mortality ranged from 5.6 to 13.8%. Old age, chronic diseases, IV drug use, Indigenous status and living in a tropical region were among the risk factors for iGAS while association with sex was mixed. The number of events reported increased in the third quarter, although not consistent. The predominant emm-types identified nationally were emm1, emm89, emm12, and emm4.
CONCLUSION: iGAS poses a significant burden in Australia. Larger studies with less heterogeneity are needed to better understand the disease’s true impact and associated risk factors.
SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10096-026-05480-x.