Streptococcus pyogenes (group A streptococci, or GAS) is a major cause of death and disability globally, particularly in low- and middle-income countries.^[1] The greatest burden is due to rheumatic heart disease which results from damage to heart valves caused by one or several episodes of rheumatic fever, an autoimmune inflammatory reaction to throat infection with GAS.^[2] In addition, there is significant burden due to invasive GAS diseases, acute rheumatic fever and post-streptococcal glomerulonephritis, and pharyngitis caused by GAS is a contributor to global antibiotic use.^[3] As of 8 December 2022, at least five Member States in the European Region, reported to WHO an increase in cases of invasive group A streptococcus (iGAS) disease and in some cases also scarlet fever. An increase in iGAS-related deaths has also been reported in some of these countries. Children under 10 years of age represent the most affected age group.

On 31 May 2017, the Executive Board of the WHO proposed a Resolution on ‘Rheumatic Fever and Rheumatic Heart Disease' for adoption at the Seventy-first World Health Assembly in May 2018. This resolution (WHA71.14) has led in 2018 to the development of a WHO Preferred Product Characteristics (PPC) and a R&D Roadmap on GAS vaccines, which provided guidance to the development of novel GAS vaccines. WHO PPCs aim to discuss and present preferences for key vaccine parameters that are important when considering the public health need and the pathway to policy decision and use. In parallel, WHO is developing guidelines on the prevention and diagnosis of rheumatic fever and rheumatic heart disease.

Vaccine development technology roadmaps aim to highlight priority activities for vaccine researchers, funders and product developers, with the goal to accelerate the pathway to availability. In parallel, the Strep A Vaccine Global Consortium (SAVAC) has developed a Full Value of Vaccine Assessment (FVVA) for GAS vaccines to better understand the health, social and economics value of having GAS vaccines being licensed and used in relevant target populations. The FVVA will be crossed referenced here in due course.

References