Increasing Incidence of Invasive Group A <i>Streptococcus</i> Disease in First Nations Population, Alberta, Canada, 2003–2017
Bibliographic record
Abstract
G AS disease is caused by the gram-positive coccusbacterium Streptococcus pyogenes; invasive GAS (iGAS) disease is typically defined as identification of GAS from any sterile site, including blood, cerebrospinal fluid, brain, and deep tissues.GAS affects persons worldwide and causes a wide array of diseases including pharyngitis, skin infections (e.g., impetigo and cellulitis), bacteremia, pneumonia, septic arthritis, rheumatic fever, rheumatic heart disease, and the severe invasive diseases necrotizing fasciitis and streptococcal toxic shock syndrome (1,2).The epidemiology of many of these diseases varies by region; pharyngitis is more common in high-income countries, and diseases such as impetigo are more common in tropical climates and low-income countries (3,4).In 2005, the mortality rate associated with GAS disease (noninvasive and invasive) was ≈500,000 deaths/year (2).GAS bacteria can be typed by identifying variability in the DNA sequence at the tip of a coiled-coil protein on the bacteria's surface (the M protein), which is encoded by the emm gene.Worldwide, there are >240 emm types (5,6).Prevalence of emm types varies according to population and geography (7).In addition, the diversity of emm types is greater in developing countries and less in more developed countries (8-10).Previous studies have shown that rates of iGAS disease are higher for indigenous populations than for other populations (11)(12)(13)(14)(15). Examples include Native Americans in Arizona and Alaska and indigenous communities in parts of Australia and northwestern Ontario, Canada.For parts of the country such as western Canada, detailed descriptive data on iGAS in the indigenous population are lacking.We previously reported increased age-standardized rates of iGAS in Alberta's general population and increasing incidence from a low of 4.2 cases/100,000 persons in 2003 to a high of 10.2 cases/100,000 persons in 2017 ( 16).On the basis of that finding, we explored whether iGAS rates also increased for the First Nations population of Alberta during the same period. Methods Case and Population DataAll iGAS cases were identified by diagnostic microbiology laboratories in Alberta, where iGAS disease is listed as a Public Health Notifiable Disease (https:// open.alberta.ca/publications/streptococcal-disease- Increasing Incidence of Invasive Group A Streptococcus Disease in First Nations Population, Alberta, Canada, 2003-2017
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.004 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".