Update on the development of Group A Streptococcus vaccines

Abstract

Group A Streptococcus (GAS) is a ubiquitous pathogen that causes a wide spectrum of human diseases. These include mild conditions such as tonsillitis and impetigo (with over 600 million cases p.a .), to scarlet fever and more severe invasive GAS diseases such as sepsis, toxic shock, and necrotising fasciitis. Invasive GAS (iGAS) affects more than 600,000 patients globally p.a ., with a mortality rate of 25% 1 . Untreated or insufficiently treated, GAS infections can also trigger serious immune-related sequelae such as acute rheumatic fever, rheumatic heart disease (RHD), and inflammatory glomerulonephritis 2 . The IHME Global Burden of Disease estimates that globally there are more than 40 million cases of RHD 3 with the majority of cases occurring in low- and middle- income countries (LMIC). Rheumatic fever is most common in children aged 5 to 15 years, and approximately 460,000 new cases occur each year. RHD contributes significantly to morbidity and mortality in LMIC, with over 300,000 deaths annually and over 10 million disability-adjusted life years 4 . Globally, GAS continues to be among the top ten infectious diseases responsible for causing mortality, highlighting the need to develop a GAS vaccine 5 . The WHO has taken the lead in this effort by publishing in 2018 a roadmap for the development of the first GAS vaccine 6 .

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