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Rationale and design of the African group A streptococcal infection registry: the AFROStrep study
  1. Dylan D Barth1,
  2. Mark E Engel1,
  3. Andrew Whitelaw2,
  4. Abdissa Alemseged3,
  5. Wilson E Sadoh4,
  6. Sulafa K M Ali5,
  7. Samba O Sow6,
  8. James Dale7,
  9. Bongani M Mayosi1
  1. 1Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
  2. 2Department of Microbiology, National Health Laboratory Service, Tygerberg Hospital and Stellenbosch University, Tygerberg, South Africa
  3. 3Department of Laboratory Sciences and Pathology, College of Health Sciences, Jimma University, Jimma, Ethiopia
  4. 4Department of Child Health, School of Medicine, University of Benin and University of Benin Teaching Hospital, Benin City, Nigeria
  5. 5Department of Pediatrics and Child Health, Faculty of Medicine, University of Khartoum and Sudan Heart Institute, Khartoum, Sudan
  6. 6Centre pour le Développement des Vaccins—Mali, Bamako, Mali
  7. 7Department of Medicine, Division of Infectious Diseases, University of Tennessee Health Science Center, Memphis, Tennessee, USA
  1. Correspondence to Associate Professor Mark E Engel; mark.engel{at}


Introduction Group A β-haemolytic Streptococcus (GAS), a Gram-positive bacterium, also known as Streptococcus pyogenes, causes pyoderma, pharyngitis and invasive disease. Repeated GAS infections may lead to autoimmune diseases such as acute post-streptococcal glomerulonephritis, acute rheumatic fever (ARF) and rheumatic heart disease (RHD). Invasive GAS (iGAS) disease is an important cause of mortality and morbidity worldwide. The burden of GAS infections is, however, unknown in Africa because of lack of surveillance systems.

Methods and analysis The African group A streptococcal infection registry (the AFROStrep study) is a collaborative multicentre study of clinical, microbiological, epidemiological and molecular characteristics for GAS infection in Africa. The AFROStrep registry comprises two components: (1) active surveillance of GAS pharyngitis cases from sentinel primary care centres (non-iGAS) and (2) passive surveillance of iGAS disease from microbiology laboratories. Isolates will also be subjected to DNA isolation to allow for characterisation by molecular methods and cryopreservation for long-term storage. The AFROStrep study seeks to collect comprehensive data on GAS isolates in Africa. The biorepository will serve as a platform for vaccine development in Africa.

Ethics and dissemination Ethics approval for the AFROStrep registry has been obtained from the Human Research Ethics Committee at the University of Cape Town (HREC/REF: R006/2015). Each recruiting site will seek ethics approval from their local ethics’ committee. All participants will be required to provide consent for inclusion into the registry as well as for the storage of isolates and molecular investigations to be conducted thereon. Strict confidentiality will be applied throughout. Findings and updates will be disseminated to collaborators, researchers, health planners and colleagues through peer-reviewed journal articles, conference publications and proceedings.

  • AFRO<i>Strep</i> Registry
  • Rheumatic Heart Disease
  • Group A β-haemolytic <i>streptococcus</i>

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