I
nvasive disease caused by group A streptococci (GAS)
occurs when the bacteria infect a normally sterile site.
Invasive GAS disease is often life threatening; mortality
rate is ˜10%–15% in industrialized countries, increasing
to up to 50% in the presence of streptococcal toxic shock
syndrome (1,2).
A review of the global effects of invasive GAS disease
in 2005 estimated that at least 663,000 new cases
and 163,000 deaths occur each year (3). Although >95%
of these cases and deaths occur in developing countries,
few data exist about the epidemiology of these infections
in developing countries. In addition, few data describe the
clinical signs and symptoms, case-fatality rate, and risk
factors associated with invasive GAS disease or the molecular
epidemiology of invasive GAS disease in developing
countries because most published reports originate from
industrialized countries (4–8).
We recently reported incidence of invasive GAS infection
in Fiji from a retrospective study in the years 2000–
2005 (9). This study indicated that potentially substantial
effects of invasive GAS disease occur in Fiji. We therefore
designed a prospective study with active surveillance to ensure
good case ascertainment and the acquisition of more
detailed clinical information.