Systematic Review of Household Transmission of Strep A: A Potential Site for Prevention That Has Eluded Attention

Background Although Streptococcus pyogenes (Strep A) is the sixth-most common infectious disease globally, its transmission within the household remains an understudied driver of infection. We undertook a systematic review to better understand the transmission of Strep A among people within the home, while highlighting opportunities for prevention.Methods A search strategy was applied to 5 databases between September 2022 and March 2023. Results were limited to articles published between January 2000 and March 2023. Texts were reviewed by 2 authors and the following data extracted: article details (title, author, year), study type, transmission year, country, participant age, infection status, molecular testing, and transmission mode. Funding was provided by the Australian National Health and Medical Research Council (GNT2010716).Results The final analysis comprised 28 texts. Only 7 studies (25.0%) provided sufficient detail to identify the Strep A transmission mode: contact (n = 4), vehicle (bedding, clothing, other fabric, and medical equipment; n = 2), and contact with animals (n = 1). All others were classified as household (specific mode unascertainable). Most articles reported outbreaks involving invasive Strep A infections.Conclusions There is limited literature regarding household transmission of Strep A. Understanding transmission in this setting remains imperative to guide control methods. By taking a systematic approach, we attempted to describe the primary mechanisms of strep A person-to-person transmission within households. Household transmission of Strep A is poorly described in the literature with only 7 studies (25.0%) providing sufficient detail to appropriately infer the transmission mode.