{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T02:09:22Z","timestamp":1793844562955,"version":"4.6.1"},"reference-count":32,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T00:00:00Z","timestamp":1769731200000},"content-version":"unspecified","delay-in-days":29,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001674","name":"Leducq Foundation","doi-asserted-by":"crossref","award":["SAVAC 2.0: Paving a path for development of a Stre"],"award-info":[{"award-number":["SAVAC 2.0: Paving a path for development of a Stre"]}],"id":[{"id":"10.13039\/501100001674","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,1,7]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>\n                      Group A\n                      <jats:italic>Streptococcus<\/jats:italic>\n                      (Strep A) causes a wide spectrum of diseases, ranging from pharyngitis and impetigo to severe invasive infections and immune-mediated conditions such as acute rheumatic fever, rheumatic heart disease and acute post-streptococcal glomerulonephritis. Contemporary data on the global burden of Strep A diseases are lacking. The proposed study aims to use administrative data from numerous jurisdictions to estimate age-specific incidence or prevalence of Strep A diseases, with an emphasis on severe clinical endpoints. Depending on the availability of data, a secondary objective will be to estimate the economic burden of Strep A diseases.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>This population-based descriptive study will use routine health data obtained from different low-income and middle-income and high-income countries through international research collaborations to estimate the country-level and global burden of Strep A diseases. Data will be primarily obtained and collated from hospital or national health laboratory databases for individuals across all age groups, along with emergency department, primary care and microbiological datasets where available. Strep A disease endpoints will be identified using International Classification of Diseases 10th Revision or other relevant coding systems and microbiological diagnosis. Age-specific incidence and prevalence rates will be computed using population denominators, and country-level age-adjusted rates will be applied to standard global reference populations to estimate the number of cases globally.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethical approval to conduct this study was obtained from the Human Research Ethics Committee at the University of Western Australia (reference: #2024\/ET000401) and governance approval was obtained from The Kids Research Institute Australia. The findings from this study will be published in peer-reviewed journals and presented at Strep A Vaccine Global Consortium collaborative meetings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-107625","type":"journal-article","created":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T11:30:28Z","timestamp":1769772628000},"page":"e107625","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Country-level and global burden of diseases caused by group A\n                    <i>Streptococcus:<\/i>\n                    protocol for a multicountry epidemiological study"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2659-1059","authenticated-orcid":false,"given":"Belaynew Wasie","family":"Taye","sequence":"first","affiliation":[{"name":"Wesfarmers Centre of Vaccines and Infectious DIseases, The Kids Research Institute Australia, University of Western Australia, Perth, Western Australia, Australia"},{"name":"School of Population Health, Curtin University, Perth, Western Australia, Australia"},{"name":"Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Cannon","sequence":"additional","affiliation":[{"name":"Wesfarmers Centre of Vaccines and Infectious DIseases, The Kids Research Institute Australia, University of Western Australia, Perth, Western Australia, Australia"},{"name":"School of Medicine, University of Western Australia, Perth, Western Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Van Beneden","sequence":"additional","affiliation":[{"name":"Medical Epidemiologist, Consultant, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asha C","family":"Bowen","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Western Australia, Perth, Western Australia, Australia"},{"name":"Infectious Diseases Department, Perth Children's Hospital, Nedlands, Western Australia, Australia"},{"name":"The Kids Research Institute Australia, Nedlands, Western Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1334-8829","authenticated-orcid":false,"given":"Mark","family":"Engel","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael George","family":"Baker","sequence":"additional","affiliation":[{"name":"Department of Public Health, University of Otago, Wellington, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca L","family":"Guy","sequence":"additional","affiliation":[{"name":"National Infection Service, UK Health Security Agency, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theresa","family":"Lamagni","sequence":"additional","affiliation":[{"name":"National Infection Service, UK Health Security Agency, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Carapetis","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Western Australia, Perth, Western Australia, Australia"},{"name":"Infectious Diseases Department, Perth Children's Hospital, Nedlands, Western Australia, Australia"},{"name":"The Kids Research Institute Australia, Nedlands, Western Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah C","family":"Moore","sequence":"additional","affiliation":[{"name":"Wesfarmers Centre of Vaccines and Infectious DIseases, The Kids Research Institute Australia, University of Western Australia, Perth, Western Australia, Australia"},{"name":"School of Population Health, Curtin University, Perth, Western Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,1,30]]},"reference":[{"key":"2026013003302271000_16.1.e107625.1","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1016\/j.pop.2015.08.001","article-title":"Bacterial Skin Infections","volume":"42","author":"Ibrahim","year":"2015","journal-title":"Prim Care: Clin Off Pract"},{"key":"2026013003302271000_16.1.e107625.2","doi-asserted-by":"crossref","DOI":"10.1098\/rsos.201991","article-title":"A brief review on Group A Streptococcus pathogenesis and vaccine development","volume":"8","author":"Castro","year":"2021","journal-title":"R Soc Open Sci"},{"key":"2026013003302271000_16.1.e107625.3","doi-asserted-by":"crossref","unstructured":"Hand RM , Snelling TL , Carapetis JR . 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