We undertook a 5-year retrospective study of group A streptococcal (GAS) bacteraemia in Fiji,
supplemented by a 9-month detailed retrospective study of b-haemolytic streptococcal (BHS)
infections. The all-age incidence of GAS bacteraemia over 5 years was 11.
6/100 000. Indigenous
Fijians were 4.
7 times more likely to present with invasive BHS disease than people of other
ethnicities, and 6.
4 times more likely than Indo-Fijians. The case-fatality rate for invasive BHS
infections was 28%. emm-typing was performed on 23 isolates: 17 different emm-types were
found, and the emm-type profile was different from that found in industrialized nations. These
data support the contentions that elevated rates of invasive BHS and GAS infections are
widespread in developing countries, and that the profile of invasive organisms in these settings
reflects a wide diversity of emm-types and a paucity of types typically found in industrialized
countrie