{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T14:16:48Z","timestamp":1784297808634,"version":"3.55.0"},"reference-count":23,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2024,2,19]],"date-time":"2024-02-19T00:00:00Z","timestamp":1708300800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000057","name":"National Institute of General Medical Sciences","doi-asserted-by":"publisher","award":["T32 AI 7535-21 A1"],"award-info":[{"award-number":["T32 AI 7535-21 A1"]}],"id":[{"id":"10.13039\/100000057","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["218669\/Z\/19\/Z"],"award-info":[{"award-number":["218669\/Z\/19\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["MR\/X020258\/1"],"award-info":[{"award-number":["MR\/X020258\/1"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"UK Medical Research Council","doi-asserted-by":"publisher","award":["200-2016-91779"],"award-info":[{"award-number":["200-2016-91779"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,5,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Group A Streptococcus (GAS) causes an estimated 5.2 million outpatient visits for pharyngitis annually in the United States, with incidence peaking in winter, but the annual spatiotemporal pattern of GAS pharyngitis across the United States is poorly characterized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We used outpatient claims data from individuals with private medical insurance between 2010 and 2018 to quantify GAS pharyngitis visit rates across U.S. census regions, subregions, and states. We evaluated seasonal and age-based patterns of geographic spread and the association between school start dates and the summertime upward inflection in GAS visits.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The South had the most visits per person (yearly average, 39.11 visits per 1000 people; 95% confidence interval, 36.21\u201342.01) and the West had the fewest (yearly average, 17.63 visits per 1000 people; 95% confidence interval, 16.76\u201318.49). Visits increased earliest in the South and in school-age children. Differences in visits between the South and other regions were most pronounced in the late summer through early winter. Visits peaked earliest in central southern states, in December to January, and latest on the coasts, in March. The onset of the rise in GAS pharyngitis visits correlated with, but preceded, average school start times.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The burden and timing of GAS pharyngitis varied across the continental United States, with the South experiencing the highest overall rates and earliest onset and peak in outpatient visits. Understanding the drivers of these regional differences in GAS pharyngitis will help in identifying and targeting prevention measures.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciae083","type":"journal-article","created":{"date-parts":[[2024,2,18]],"date-time":"2024-02-18T16:54:58Z","timestamp":1708275298000},"page":"1345-1351","source":"Crossref","is-referenced-by-count":8,"title":["Spatiotemporal Trends in Group A Streptococcal Pharyngitis in the United States"],"prefix":"10.1093","volume":"78","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1974-9276","authenticated-orcid":false,"given":"Madeleine C","family":"Kline","sequence":"first","affiliation":[{"name":"Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health , Boston, Massachusetts , USA"},{"name":"Center for Communicable Disease Dynamics, Harvard T.H. Chan School of Public Health , Boston, Massachusetts , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6000-8387","authenticated-orcid":false,"given":"Stephen M","family":"Kissler","sequence":"additional","affiliation":[{"name":"Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health , Boston, Massachusetts , USA"},{"name":"Center for Communicable Disease Dynamics, Harvard T.H. Chan School of Public Health , Boston, Massachusetts , USA"},{"name":"Department of Computer Science, University of Colorado Boulder , Boulder, Colorado , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lilith K","family":"Whittles","sequence":"additional","affiliation":[{"name":"MRC Centre for Global Infectious Disease Analysis and NIHR Health Protection Research Unit in Modelling and Health Economics, School of Public Health, Imperial College London , Norfolk Place, London , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael L","family":"Barnett","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, Harvard T.H. Chan School of Public Health , Boston, Massachusetts , USA"},{"name":"Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School , Boston, Massachusetts , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5646-1314","authenticated-orcid":false,"given":"Yonatan H","family":"Grad","sequence":"additional","affiliation":[{"name":"Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health , Boston, Massachusetts , USA"},{"name":"Center for Communicable Disease Dynamics, Harvard T.H. Chan School of Public Health , Boston, Massachusetts , USA"},{"name":"Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School , Boston, Massachusetts , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,2,19]]},"reference":[{"key":"2024051423565807100_ciae083-B1","doi-asserted-by":"crossref","first-page":"e47","DOI":"10.1093\/cid\/ciaa529","article-title":"Incidence of pharyngitis, sinusitis, acute otitis media, and outpatient antibiotic prescribing preventable by vaccination against group A streptococcus in the United States","volume":"73","author":"Lewnard","year":"2021","journal-title":"Clin Infect Dis"},{"key":"2024051423565807100_ciae083-B2","author":"Centers for Disease Control and Prevention"},{"key":"2024051423565807100_ciae083-B3","first-page":"204993612211321","article-title":"Seasonal variations and risk factors of Streptococcus pyogenes infection: a multicenter research network study","volume":"9","author":"Kennis","year":"2022","journal-title":"Ther Adv Infect Dis"},{"key":"2024051423565807100_ciae083-B4","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1097\/INF.0000000000004111","article-title":"A longitudinal study of group A streptococcal colonization and pharyngitis in US children","volume":"42","author":"Frenck","year":"2023","journal-title":"Pediatr Infect Dis J"},{"key":"2024051423565807100_ciae083-B5","doi-asserted-by":"crossref","first-page":"e1005382","DOI":"10.1371\/journal.pcbi.1005382","article-title":"Human mobility and the spatial transmission of influenza in the United States","volume":"13","author":"Charu","year":"2017","journal-title":"PLoS Comput Biol"},{"key":"2024051423565807100_ciae083-B6","doi-asserted-by":"crossref","first-page":"e1004591","DOI":"10.1371\/journal.ppat.1004591","article-title":"Environmental drivers of the spatiotemporal dynamics of respiratory syncytial virus in the United States","volume":"11","author":"Pitzer","year":"2015","journal-title":"PLoS Pathogens"},{"key":"2024051423565807100_ciae083-B7","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1001\/jama.2010.250","article-title":"Effect of influenza vaccination of children on infection rates in Hutterite communities: a randomized trial","volume":"303","author":"Loeb","year":"2010","journal-title":"JAMA"},{"key":"2024051423565807100_ciae083-B8","doi-asserted-by":"crossref","first-page":"1685","DOI":"10.1093\/infdis\/jit828","article-title":"The source of respiratory syncytial virus infection in infants: a household cohort study in rural Kenya","volume":"209","author":"Munywoki","year":"2014","journal-title":"J Infect Dis"},{"key":"2024051423565807100_ciae083-B9","author":"Merative"},{"key":"2024051423565807100_ciae083-B10"},{"key":"2024051423565807100_ciae083-B11","doi-asserted-by":"crossref","first-page":"e86","DOI":"10.1093\/cid\/cis629","article-title":"Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America","volume":"55","author":"Shulman","year":"2012","journal-title":"Clin Infect Dis"},{"key":"2024051423565807100_ciae083-B12"},{"key":"2024051423565807100_ciae083-B13","first-page":"Accessed May, 2023","author":"Walker"},{"key":"2024051423565807100_ciae083-B14","author":"Krieger"},{"key":"2024051423565807100_ciae083-B15","first-page":"Accessed May 2023","author":"United States Census Bureau"},{"key":"2024051423565807100_ciae083-B16","first-page":"Accessed June 2023","author":"DeSilver"},{"key":"2024051423565807100_ciae083-B17","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1542\/peds.2006-3368","article-title":"Burden of acute sore throat and group A streptococcal pharyngitis in school-aged children and their families in Australia","volume":"120","author":"Danchin","year":"2007","journal-title":"Pediatrics"},{"key":"2024051423565807100_ciae083-B18","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1089\/bsp.2014.0032","article-title":"Health inequalities and infectious disease epidemics: a challenge for global health security","volume":"12","author":"Quinn","year":"2014","journal-title":"Biosecur Bioterror"},{"key":"2024051423565807100_ciae083-B19","first-page":"195","article-title":"The effects of the COVID-19 pandemic on community respiratory virus activity","volume":"21","author":"Chow","year":"2023","journal-title":"Nat Rev Microbiol"},{"key":"2024051423565807100_ciae083-B20","first-page":". 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