Additional thoughts on group A streptococci
Authors: Dingle Yu, Yuejie Zheng, George Fu Gao, Yonghong Yang
Journal: The Lancet Microbe (2024)

We would like to express our gratitude to Theresa Lamagni and colleagues1Lamagni T McGregor C Guy RL Whitworth J Efstratiou A Seizing opportunities for prevention of group A streptococcal infection.Lancet Microbe. 2024; (published online Jan 23)https://doi.org/10.1016/S2666-5247(23)00404-4Google Scholar for recognising our Comment.2Yu D Liang Y Lu Q et al.Thoughts on group A streptococci.Lancet Microbe. 2023; 4: e484-e485Google Scholar Here, we would like to expand on our initial thoughts, published as a Comment on Group A Streptococcus (GAS) in The Lancet Microbe.2Yu D Liang Y Lu Q et al.Thoughts on group A streptococci.Lancet Microbe. 2023; 4: e484-e485Google Scholar GAS infectious diseases, such as scarlet fever, are indeed of immense clinical importance and their early diagnosis is especially important.3Venkatesan P Rise in group A streptococcal infections in England.Lancet Respir Med. 2023; 11: e16Google Scholar,4Kayima J Kaddumukasa M An urgent need for early diagnosis and treatment of acute rheumatic fever.Lancet Glob Health. 2024; 12: e362-e363Google Scholar We strongly agree with the point-of-care approach proposed by Lamagni and colleagues.1Lamagni T McGregor C Guy RL Whitworth J Efstratiou A Seizing opportunities for prevention of group A streptococcal infection.Lancet Microbe. 2024; (published online Jan 23)https://doi.org/10.1016/S2666-5247(23)00404-4Google Scholar GAS antigen detection is highly recommended for early diagnosis and treatment in individuals with suspected GAS infection. Furthermore, for individuals with negative GAS antigen detection results and high clinical suspicion of GAS infection, further refinement of GAS culture is recommended so that preserved GAS strains can also be isolated and studied, which will also be valuable for epidemiological studies. More importantly, GAS infectious diseases and post-infectious rheumatic diseases should be included as notifiable diseases globally. At least, scarlet fever, rheumatic fever, rheumatic heart disease, acute streptococcal glomerulonephritis, streptococcal toxic shock syndrome, and acute necrotising fasciitis should be classified as notifiable diseases. Notably, the terms notifiable disease and communicable disease are not interchangeable, although they intersect and overlap, which might lead to confusion in a global setting. Therefore, we propose that the definitions of notifiable disease and communicable disease should be standardised globally, preferably with a harmonised scope. Finally, vaccines are not yet available for GAS. Thus, antibiotics might play a preventive role in GAS infection epidemics.5The Lancet MicrobeStrep A treatment, working for now.Lancet Microbe. 2023; 4: e1Google Scholar Moreover, the rational use of antibiotics involves not only quantity (eg, in China, the number of defined daily dose of antimicrobials needs to be limited to some conditions) but also quality (eg, in China, gentamicin use is contraindicated in paediatric cases but azithromycin is overused, and the application of penicillin is still restricted owing to the need to perform skin tests before use).6Zhang J Zheng Y Yang Y Antibiotic prescription patterns in children and neonates in China.Lancet Glob Health. 2019; 7: e1496Google Scholar Antibiotics can even be used as prophylactic medications when necessary. We declare no competing interests. This research was funded by the Shenzhen Key Medical Discipline Construction Fund (SZXK032), Project of the Expert Committee on Clinical Application and Drug Resistance Evaluation of Antimicrobial Drugs of the National Health Commission (KJYWZWH-OT-02-2021-06), Shenzhen Fund for Guangdong Provincial High-level Clinical Key Specialties (SZGSP012), Guangdong High-level Hospital Construction Fund, and National Natural Science Foundation of China (82304198). DY and YZ contributed equally.