title: Streptococcal pharyngitis in schoolchildren in Bamako, Mali.
abstract: BACKGROUND
  Group A streptococcus (GAS) pharyngitis is associated with high rates of rheumatic heart disease in developing countries. We sought to identify guidelines for empiric treatment of pharyngitis in low-resource settings. To inform the design of GAS vaccines, we determined the emm types associated with pharyngitis among African schoolchildren.
  
  
  METHODS
  Surveillance for pharyngitis was conducted among children 5-16 years of age attending schools in Bamako, Mali. Students were encouraged to visit a study clinician when they had a sore throat. Enrollees underwent evaluation and throat swab for isolation of GAS. Strains were emm typed by standard methods.
  
  
  RESULTS
  GAS was isolated from 449 (25.5%) of the 1,759 sore throat episodes. Painful cervical adenopathy was identified in 403 children (89.8%) with GAS infection and was absent in 369 uninfected children (28.2%). Emm type was determined in 396 (88.2%) of the 449 culture-positive children; 70 types were represented and 14 types accounted for 49% of isolates. Based on the proportion of the 449 isolates bearing emm types included in the 30-valent vaccine (31.0%) plus nonvaccine types previously shown to react to vaccine-induced bactericidal antibodies (44.1%), the vaccine could protect against almost 75% of GAS infections among Bamako schoolchildren.
  
  
  CONCLUSIONS
  Two promising strategies could reduce rheumatic heart disease in low-resource settings. Administering antibiotics to children with sore throat and tender cervical adenopathy could treat most GAS-positive children while reducing use of unnecessary antibiotics for uninfected children. Broad coverage against M types associated with pharyngitis in Bamako schoolchildren might be achieved with the 30-valent GAS vaccine under development.
authors.affiliation: From the *Division of Infectious Disease and Tropical Pediatrics, Department of Pediatrics and ¶Division of Geographic Medicine, Department of Medicine, Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland; †Centre pour le Développement des Vaccins-Mali, Bamako, Mali; ‡Department of Pediatrics, University of Virginia, Charlottesville, Virginia; and §University of Tennessee Health Science Center and Veterans Affairs Medical Center Research Service, Memphis, Tennessee.
authors.forename: Milagritos D
authors.initials: MD
authors.lastname: Tapia
authors.forename: Samba O
authors.initials: SO
authors.lastname: Sow
authors.forename: Boubou
authors.initials: B
authors.lastname: Tamboura
authors.forename: Mahamadou M
authors.initials: MM
authors.lastname: Keita
authors.forename: Abdoulaye
authors.initials: A
authors.lastname: Berthe
authors.forename: Mariam
authors.initials: M
authors.lastname: Samake
authors.forename: James P
authors.initials: JP
authors.lastname: Nataro
authors.forename: Uma O
authors.initials: UO
authors.lastname: Onwuchekwa
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Penfound
authors.forename: William
authors.initials: W
authors.lastname: Blackwelder
authors.forename: James B
authors.initials: JB
authors.lastname: Dale
authors.forename: Karen L
authors.initials: KL
authors.lastname: Kotloff
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008302:Mali / Q000453:epidemiology; D010612:Pharyngitis / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013290:Streptococcal Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology*; D013297:Streptococcus pyogenes / Q000302:isolation & purification*; D013334:Students / Q000706:statistics & numerical data