Burden of invasive group a streptococcus infection in Australia: a systematic review and meta-analysis

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Background: Invasive group A Streptococcal infection (iGAS) is a severe and life-threatening disease. In this study we aimed to estimate the burden of iGAS in Australia and describe the risk factors and outcomes across regions and populations.Methods: In this systematic review and meta-analysis, an extensive search across multiple databases including MEDLINE, CINAHL, Scopus, Web of Science, Emcare and Pubmed was conducted until 3 September 2024. Meta analysis and a meta regression were conducted to estimate the pooled incidence and risk factors. Studies were systematically reviewed for risk factors, adverse outcomes, and seasonal trends related to iGAS. The review was registered in PROSPERO (CRD42023493112).Findings: We identified 3036 studies out of which, 39 were included in the systematic review and 13 were included in the meta-analysis. The pooled incidence of iGAS was 5.08 per 100,000 person-years (95% CI 3.35-7.71). Adults had a higher incidence (7.62 per 100,000 person-years; 95% CI: 4.42-13.14) compared to children (3.19 per 100,000 person-years; 95% CI: 2.00-5.09). Indigenous Australians experienced a higher incidence (16.29 per 100,000 person-years; 95% CI: 9.15-29.01) than non-Indigenous (3.65 per 100,000 person-years; 95% CI 2.94-4.54). Tropical regions had the highest incidence (20.57 per 100,000 person-years; 95% CI: 14.69-28.80). 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 due to Streptococcal Toxic Shock Syndrome (STSS) while the rate of necrotising fascitis (NF) was 0.26-11%. Mortality ranged from 5.6-13.8%. The number of events reported increased in the third quarter, although not consistent.. Meta-regression showed that a 1% increase in the female population increased the incidence by 0.43 per 100,000 person-years, while a 1% increase in the proportion of population living in the tropics increased the incidence by 0.26 per 100,000 person-years.Interpretation: 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.Funding: None