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In the 1990s, research priorities have evolved as efforts to develop a more integrated approach to case management both in the home and within the health system have intensified. The success of case- management strategies depends only in part upon the availability of services provided by trained health care workers. Equally important, if not more so, are the behaviours of the carer in the home and in the community. Case management in the home, care- seeking practices (including the extent to which available health services are used), and compliance with counselling provided by health workers all have an important impact on children’s health. Research priorities have therefore focused increasingly on promoting and maintaining household. | doi 10.1111 j.1440-1754.2007.01051.x ANNOTATION Group A streptococcal infections in children Andrew C Steer 1 Margaret H Danchin1 and Jonathan R Carapetis1 2 Centre for International Child Health University of Melbourne Department of Paediatrics Murdoch Childrens Research Institute Royal Children s Hospital Melbourne Victoria and 2Menzies School of Health Research Darwin Northern Territory Australia Abstract The group A streptococcus causes the widest range of disease in humans of all bacterial pathogens. Group A streptococcal diseases are more common in children than adults with diseases ranging from pharyngitis and impetigo to invasive infections and the poststreptococcal sequelae - acute rheumatic fever and acute post-streptococcal glomerulonephritis. The global burden of severe group A streptococcal disease is concentrated largely in developing countries and Indigenous populations such as Aboriginal Australians. Control of group A streptococcal disease is poor in these settings and the need for a vaccine has been argued. With an ever-increasing understanding of the group A streptococcus at a molecular level new and sophisticated vaccines are currently in human trials and the next decade holds exciting prospects for curbing group A streptococcal diseases. Key words acute rheumatic fever epidemiology group A streptococcus impetigo pharyngitis post-streptococcal glomerulonephritis. The group A beta-haemolytic streptococcus GAS is a common infective agent in children that causes the widest range of clinical disease in humans of any bacterium. The spectrum of GAS diseases can be divided into superficial invasive toxin-mediated and post-infectious diseases Table 1 . The GAS has a large armamentarium of virulence factors responsible for this broad range of human disease. The most common infections caused by GAS are pharyngitis and pyoderma which occur particularly in children. Invasive disease is less common but has a high rate of mortality and long-term morbidity. .
