Faringitis

Prevalence of Streptococcal Pharyngitis and Streptococcal Carriage in Children: A Meta-analysis Nader Shaikh, Erica Leonard and Judith M. Martin Pediatrics 2010;126;e557; originally published online August 9, 2010; DOI: 10.1542/peds.2009-2648

The online version of this article, along with updated information and services, is located on the World Wide Web at:http://pediatrics.aappublications.org/content/126/3/e557.full.html

PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 2010 by the American Academy of Pediatrics. All rightsreserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.

Downloaded from pediatrics.aappublications.org by guest on May 23, 2012

ARTICLE

Prevalence of Streptococcal Pharyngitis and Streptococcal Carriage in Children: A Meta-analysis
AUTHORS: Nader Shaikh, MD, MPH,a Erica Leonard, MDb and Judith M. Martin, MDc
Divisions of aGeneral Academic Pediatrics and cPediatric InfectiousDiseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and bSwedish Family Medicine Residency Program, Seattle, Washington KEY WORDS Streptococcus, carriage, pediatrics, prevalence, meta-analysis ABBREVIATIONS GAS—group A Streptococcus CI—confidence interval www.pediatrics.org/cgi/doi/10.1542/peds.2009-2648 doi:10.1542/peds.2009-2648 Accepted for publication May 20, 2010 Addresscorrespondence to Nader Shaikh, MD, MPH, Children’s Hospital of Pittsburgh, General Academic Pediatrics, 3414 Fifth Ave, Pittsburgh, PA 15213-2583. E-mail: nader.shaikh@chp.edu PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). Copyright © 2010 by the American Academy of Pediatrics FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to thisarticle to disclose.

WHAT’S KNOWN ON THIS SUBJECT: The prevalence of group A streptococcal pharyngitis and carriage has not been systematically studied. WHAT THIS STUDY ADDS: In this meta-analysis the authors provide clinicians with quantitative estimates of the prevalence of GAS infection and carriage in children of various ages.

abstract
OBJECTIVES: Prevalence estimates can help cliniciansmake informed decisions regarding diagnostic testing of children who present with symptoms of pharyngitis. We conducted a meta-analysis to determine the (1) prevalence of streptococcal infection among children who presented with sore throat and (2) prevalence of streptococcal carriage among asymptomatic children. METHODS: We searched Medline for articles on pediatric streptococcal pharyngitis. Weincluded articles in our review when they contained data on the prevalence of group A Streptococcus (GAS) from pharyngeal specimens in children who were younger than 18 years. Two evaluators independently reviewed, rated, and abstracted data from each article. Prevalence estimates were pooled in a meta-analysis and stratified according to age group. RESULTS: Of the 266 articles retrieved, 29 met allinclusion criteria. Among children of all ages who present with sore throat, the pooled prevalence of GAS was 37% (95% confidence interval [CI]: 32%– 43%). Children who were younger than 5 years had a lower prevalence of GAS (24% [95% CI: 21%–26%]). The prevalence of GAS carriage among well children with no signs or symptoms of pharyngitis was 12% (95% CI: 9%–14%). CONCLUSIONS: Prevalence rates ofGAS disease and carriage varied by age; children who were younger than 5 years had lower rates of throat cultures that were positive for GAS. Pediatrics 2010;126: e557–e564

PEDIATRICS Volume 126, Number 3, September 2010

Downloaded from pediatrics.aappublications.org by guest on May 23, 2012

e557

Clinicians are frequently faced with the decision of whether to obtain a pharyngeal...