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Burden of Group A Streptococcal Pharyngitis, Rheumatic Fever, and Rheumatic Heart Disease in India: A Systematic Review and Meta-Analysis

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Abstract

Objective

To estimate the burden of group A streptococcal pharyngitis (GAS) pharyngitis, rheumatic fever (RF), and rheumatic heart disease (RHD) in India using existing data sources, as well as to recognize the most serious gaps in GAS disease burden data.

Methods

Four electronic databases—PubMed, Scopus, Embase, and Web of Science were searched using a comprehensive search strategy. Data were identified primarily from observational studies including school surveys, community-based and hospital-based studies. The standard methodological procedures as per Cochrane guidelines were used. Eligible studies were pooled for estimating prevalence, incidence, and case fatality rate using R software version 3.3.3. The protocol was registered with PROSPERO; registration number CRD42018075742.

Results

The pooled prevalence of GAS pharyngitis among asymptomatic children and pharyngitis cases aged 5 to 15 y was estimated as 2.79 percent [95% Confidence interval (CI): 1.58–4.89] and 13 percent (95% CI: 3.18–41.97), respectively. The prevalence rate of rheumatic fever was found to be 0.04% (95% CI: 0.01–0.17). The pooled prevalence rate of RHD among children aged 5–15 y using clinical auscultation and echocardiography was estimated as 0.36 percent (95% CI: 0.02–7.52) and 0.28 percent (95% CI: 0.08–1.03), respectively.

Conclusion

The study emphasizes the importance of developing a population-based surveillance framework to track patterns, management strategies, and outcomes in order to develop informed recommendations for launching contextual measures to regulate RF and RHD.

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Authors and Affiliations

  1. Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India

    Jyoti Dixit, Sehr Brar & Shankar Prinja

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  1. Jyoti Dixit
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  2. Sehr Brar
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Contributions

SP: Conceptualization of the study, methodology, supervision, validation, writing–review and editing; JD: Conceptualization of the study, data curation, formal analysis, investigation, methodology, validation, writing–original draft preparation, writing–review and editing; SB: Investigation, writing–review and editing; All authors reviewed and approved the final study draft. SP is guarantor for this paper.

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Correspondence to Shankar Prinja.

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The study was approved by the Institute Ethics Committee of the Post Graduate Institute of Medical Education and Research, Chandigarh, India.

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Dixit, J., Brar, S. & Prinja, S. Burden of Group A Streptococcal Pharyngitis, Rheumatic Fever, and Rheumatic Heart Disease in India: A Systematic Review and Meta-Analysis. Indian J Pediatr 89, 642–650 (2022). https://doi.org/10.1007/s12098-021-03845-y

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