{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T18:20:28Z","timestamp":1792002028298,"version":"4.4.0"},"reference-count":40,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2016,12,7]],"date-time":"2016-12-07T00:00:00Z","timestamp":1481068800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,1,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Worldwide, indigenous populations appear to be at increased risk for invasive group A streptococcal (iGAS) infections. Although there is empirical evidence that the burden of iGAS disease is significant among remote First Nations communities in Northwestern Ontario, Canada, the epidemiology of iGAS infections in the area remains poorly characterized.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Individuals that met case definition for iGAS disease and whose laboratory specimens were processed by Meno Ya Win Health Centre in Sioux Lookout, Canada or who were reported to Thunder Bay District Health Unit, Canada were identified for the period 2009 to 2014. Case demographics, clinical severity, comorbidities, and risk factors were collected through chart review. Strain typing and antibiotic susceptibility were determined when possible. Basic descriptive statistics were calculated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Sixty-five cases of iGAS disease were identified, for an annualized incidence of 56.2 per 100 000. Primary bacteremia was present in 26.2% of cases, and cellulitis was identified in 55.4% of cases. The most common comorbidities identified were diabetes (38.5%) and skin conditions (38.5%). Prevalent risk factors included alcohol dependence (25%). Fourteen different emm types were identified among 42 isolates, with the most common being emm114 (17.4%), emm11 (15.2%), and emm118 (13.0%). Resistance to erythromycin and clindamycin was found in 24.6% of isolates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Rural and remote First Nations communities in Northwestern Ontario experience iGAS infections at a rate 10 times the provincial and national average. Compared with other North American series, a lower proportion of isolates causing infection were of emm types included in candidate GAS vaccines.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ofid\/ofw243","type":"journal-article","created":{"date-parts":[[2016,12,8]],"date-time":"2016-12-08T02:50:32Z","timestamp":1481165432000},"source":"Crossref","is-referenced-by-count":53,"title":["High Incidence of Invasive Group A Streptococcal Infections in Remote Indigenous Communities in Northwestern Ontario, Canada"],"prefix":"10.1093","volume":"4","author":[{"given":"Natalie","family":"Bocking","sequence":"first","affiliation":[{"name":"Sioux Lookout First Nations Health Authority, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cai-lei","family":"Matsumoto","sequence":"additional","affiliation":[{"name":"Sioux Lookout First Nations Health Authority, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kassandra","family":"Loewen","sequence":"additional","affiliation":[{"name":"Anishinaabe Bimaadiziwin Research Program, Sioux Lookout, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Teatero","sequence":"additional","affiliation":[{"name":"Public Health Ontario, Toronto, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Marchand-Austin","sequence":"additional","affiliation":[{"name":"Public Health Ontario, Toronto, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet","family":"Gordon","sequence":"additional","affiliation":[{"name":"Sioux Lookout First Nations Health Authority, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nahuel","family":"Fittipaldi","sequence":"additional","affiliation":[{"name":"Public Health Ontario, Toronto, Canada"},{"name":"Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison","family":"McGeer","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2016,12,7]]},"reference":[{"key":"2020081004463625100_CIT0001","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1128\/CMR.13.3.470","article-title":"Pathogenesis of group A streptococcal infections","volume":"13","author":"Cunningham","year":"2000","journal-title":"Clin Microbiol Rev"},{"key":"2020081004463625100_CIT0002","doi-asserted-by":"crossref","first-page":"74","DOI":"10.14745\/ccdr.v42i04a01","article-title":"Invasive bacterial diseases in Northern Canada, 2006\u20132013","volume":"42","author":"Li","year":"2016","journal-title":"Can Commun Dis Rep"},{"key":"2020081004463625100_CIT0003","doi-asserted-by":"crossref","first-page":"1018","DOI":"10.1017\/S0950268815002010","article-title":"High burden of invasive group a streptococcal disease in the Northern Territory of Australia","volume":"144","author":"Boyd","year":"2016","journal-title":"Epidemiol Infect"},{"key":"2020081004463625100_CIT0004","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1017\/S0950268810001378","article-title":"Invasive group a streptococcal disease in children in Queensland","volume":"139","author":"Whitehead","year":"2011","journal-title":"Epidemiol Infect"},{"key":"2020081004463625100_CIT0005","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1128\/JCM.02122-15","article-title":"Epidemiology of invasive group A streptococcal disease in Alaska, 2001 to 2013","volume":"54","author":"Rudolph","year":"2016","journal-title":"J Clin Microbiol"},{"key":"2020081004463625100_CIT0006","first-page":"99","article-title":"Invasive CA-MRSA in northwestern Ontario: a 2-year prospective study","volume":"19","author":"Kirlew","year":"2014","journal-title":"Can J Rural Med"},{"key":"2020081004463625100_CIT0007","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1099\/jmm.0.026914-0","article-title":"Invasive disease caused by Haemophilus influenzae type A in Northern Ontario First Nations communities","volume":"60","author":"Kelly","year":"2011","journal-title":"J Med Microbiol"},{"key":"2020081004463625100_CIT0008","volume-title":"Infectious Diseases Protocol, 2013. 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