A significant proportion of children in Western Australia’s Kimberley region are unknowingly carrying the potentially life-threatening strep A infection, new research reveals. A study conducted by the Kids Research Institute Australia found that one in six children in the area were carriers, with many infections remaining undiagnosed.

The four-year “Missing Piece Surveillance Study” involved weekly testing of 250 school students in Broome and Derby for Streptococcus pyogenes, commonly known as strep A. Researchers swabbed participants’ throats and any skin lesions, occasionally collecting blood samples to identify the bacterium’s presence.

Professor Asha Bowen of the Kids Research Institute Australia highlighted the critical link between strep A, sore throats, and skin sores, particularly in remote communities with high rates of chronic disease. Left untreated, strep A can progress to acute rheumatic fever (ARF) and, more severely, rheumatic heart disease (RHD).

Rheumatic heart disease is a fatal condition, with Indigenous Australian children facing a disproportionately high risk. Data indicates they are 55 times more likely to die from RHD compared to non-Indigenous children, underscoring the urgency of addressing strep A prevalence.

Analysis of over 1,000 throat swabs, 200 skin swabs, and 400 blood samples confirmed that strep A was circulating at much higher rates than previously understood. Professor Bowen stated that the high infection rate is “certainly concerning” and suggests many children at risk of rheumatic fever are not being identified through standard clinical practices.

Dr. Janessa Pickering, the study’s lead author, noted that some children experienced recurring strep A infections without displaying any noticeable symptoms. These asymptomatic cases are a key factor in the transmission of the bacteria and represent a crucial missing piece in the global effort to prevent RHD.

The research identified that some children could carry the same strep A strain for years, while others remained infection-free. This finding opens avenues for exploring the protective role of the throat’s natural microbiome, or beneficial bacteria, in guarding against infection.

Shelley Kneebone, CEO of Derby Aboriginal Health Service, acknowledged the concerning findings but emphasized the importance of increased knowledge in combating RHD. She expressed hope that the study’s revelations will highlight the need for greater attention to the social and environmental factors impacting children in the region.

In response to these findings, a new study is already underway to develop faster and more accessible testing methods. Professor Bowen explained they are trialling Point-of-Care tests that can provide results for throat swabs within approximately 20 minutes, allowing for same-day treatment.

These advancements aim to refine the delivery of care to the most vulnerable children as swiftly as possible. Professor Bowen hopes the research will inform clinical guidelines and secure further investment in RHD prevention strategies, ultimately improving health outcomes for children in affected communities.

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Keywords: strep A, Kimberley children, rheumatic heart disease, undiagnosed infections, asymptomatic strep A, acute rheumatic fever, West Australian study, RHD prevention