Unexpected Increase in Invasive Group A Streptococcal Infections in Children After Respiratory Viruses Outbreak in France: A 15-Year Time-Series Analysis

Abstract

In a 15-year pediatric time-series analysis, we showed a rise of invasive Group A streptococcal (iGAS) infections since October 2022, mainly involving pleural empyema, simultaneously to a respiratory virus outbreak. Physicians should be aware of this increased risk of pediatric iGAS infections, especially in settings with intense respiratory viruses' circulation.

Keywords: Streptococcus pyogenes; invasive Group A streptococcal infections; pediatrics; respiratory virus.

Figure 1.

Association of nonpharmaceutical intervention (NPI) implementation and relaxing with invasive Group A streptococcal (iGAS) infections and respiratory viruses. (A) Rate of iGAS infections per 1000 hospitalizations per 3 months in children <18 years between 2008 and 2022 at the Robert Debré Hospital (N = 135). The black line shows the observed data. The blue line shows the model estimates based on observed data using the quasi-Poisson regression model. The red dotted lines show the expected values without NPI implementation using the same quasi-Poisson model, with the 95% confidence interval. The dotted vertical lines indicate the NPI implementation in March 2020 and the NPI relaxing in April 2021. (B) Evolution of proportion of positive viral respiratory pathogens at the Robert Debré Hospital over the study period. COVID-19, coronavirus disease 2019; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2. Corresponding colors: navy blue line = respiratory syncytial virus; red line = influenza; green line = adenovirus; sky blue line = parainfluenza; yellow line = metapneumovirus; pink line = SARS-CoV2.