Increase in invasive group A streptococcal disease among Australian children coinciding with northern hemisphere surges

Yara-Natalie Abo^{1

2

3

4}, Jane Oliver^{1

5}, Alissa McMinn¹, Joshua Osowicki^{1

2

4}, Ciara Baker¹, Julia E Clark⁶, Christopher C Blyth⁷, Joshua R Francis^{8

9}, Jeremy Carr^{10

11

12}, Pierre R Smeesters^{13

14}, Nigel W Crawford¹, Andrew C Steer^{1

2

4}

Affiliations

¹ Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
² Infectious Diseases Unit, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.
³ Department of Microbiology, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.
⁴ Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
⁵ Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Victoria, Australia.
⁶ Queensland Children's Hospital, Queensland and School of Clinical Medicine, University of Queensland, Australia.
⁷ Telethon Kids Institute, University of Western Australia and Perth Children's Hospital, Western Australia, Australia.
⁸ Royal Darwin Hospital, Northern Territory, Australia.
⁹ Menzies School of Health Research, Charles Darwin University, Northern Territory, Australia.
¹⁰ Infection & Immunity, Monash Children's Hospital, Melbourne, Victoria, Australia.
¹¹ Monash University, Melbourne, Victoria, Australia.
¹² Department of Paediatrics, University of Oxford, Oxford, UK.
¹³ Department of Paediatrics, Brussels University Hospital, Academic Children Hospital Queen Fabiola, Université libre de Bruxelles, 1020 Brussels, Belgium.
¹⁴ Molecular Bacteriology Laboratory, Université Libre de Bruxelles, 1070 Brussels, Belgium.

PMID: 38223399
PMCID: PMC10786649
DOI: 10.1016/j.lanwpc.2023.100873

Increase in invasive group A streptococcal disease among Australian children coinciding with northern hemisphere surges

Yara-Natalie Abo et al. Lancet Reg Health West Pac. 2023.

. 2023 Aug 22:41:100873.

doi: 10.1016/j.lanwpc.2023.100873. eCollection 2023 Dec.

Authors

Affiliations

¹ Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
² Infectious Diseases Unit, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.
³ Department of Microbiology, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.
⁴ Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
⁵ Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Victoria, Australia.
⁶ Queensland Children's Hospital, Queensland and School of Clinical Medicine, University of Queensland, Australia.
⁷ Telethon Kids Institute, University of Western Australia and Perth Children's Hospital, Western Australia, Australia.
⁸ Royal Darwin Hospital, Northern Territory, Australia.
⁹ Menzies School of Health Research, Charles Darwin University, Northern Territory, Australia.
¹⁰ Infection & Immunity, Monash Children's Hospital, Melbourne, Victoria, Australia.
¹¹ Monash University, Melbourne, Victoria, Australia.
¹² Department of Paediatrics, University of Oxford, Oxford, UK.
¹³ Department of Paediatrics, Brussels University Hospital, Academic Children Hospital Queen Fabiola, Université libre de Bruxelles, 1020 Brussels, Belgium.
¹⁴ Molecular Bacteriology Laboratory, Université Libre de Bruxelles, 1070 Brussels, Belgium.

PMID: 38223399
PMCID: PMC10786649
DOI: 10.1016/j.lanwpc.2023.100873

Abstract

Background: Increases in invasive group A streptococcal disease (iGAS) have recently been reported in multiple countries in the northern hemisphere, occurring during, and outside of, typical spring peaks. We report the epidemiology of iGAS among children in Australia from 1 July 2018 to 31 December 2022.

Methods: The Paediatric Active Enhanced Disease Surveillance (PAEDS) Network prospectively collected iGAS patient notifications for children and young people aged less than 18 years admitted to five major Australian paediatric hospitals in Victoria, Queensland, Western Australia and the Northern Territory. Patients were eligible for inclusion if they had GAS isolated from a normally sterile body site, or met clinical criteria for streptococcal toxic shock syndrome or necrotising fasciitis with GAS isolated from a non-sterile site. We report patients' clinical and demographic characteristics, and estimate minimum incidence rates.

Findings: We identified 280 paediatric iGAS patients, median age 4.5 years (interquartile range 1.4-6.4). We observed a pre-pandemic peak annualised incidence of 3.7 per 100,000 (95% CI 3.1-4.4) in the 3rd quarter of 2018, followed by a decline to less than 1.0 per 100,000 per quarter from 2020 to mid-2021. The annualised incidence increased sharply from mid-2022, peaking at 5.2 per 100,000 (95% CI 4.4-6.0) in the 3rd quarter and persisting into the 4th quarter (4.9 per 100,000, 95% CI 4.2-5.7). There were 3 attributable deaths and 84 (32%) patients had severe disease (overall case fatality rate 1%, 95% CI 0.2-3.3). Respiratory virus co-infection, positive in 57 of 119 patients tested, was associated with severe disease (RR 1.9, 95% CI 1.2-3.0). The most common emm-type was emm-1 (60 of 163 isolates that underwent emm-typing, 37%), followed by emm-12 (18%).

Interpretation: Australia experienced an increase in the incidence of iGAS among children and young people in 2022 compared to pandemic years 2020-2021. This is similar to northern hemisphere observations, despite differences in seasons and circulating respiratory viruses. Outbreaks of iGAS continue to occur widely. This emphasises the unmet need for a vaccine to prevent significant morbidity associated with iGAS disease.

Funding: Murdoch Children's Research Institute funded open access publishing of this manuscript.

Keywords: Bacteraemia; Epidemiology; Invasive group A streptococcus; Sepsis; Streptococcus pyogenes; Viruses.

PubMed Disclaimer

Conflict of interest statement

AC Steer acts as Co-Director of Australian Strep A Vaccine Initiative and Co-Chair of Strep A Vaccine Global Consortium. The rest of the authors declare no competing interest.

Figures

**Fig. 1**
**Annualised minimum incidence of notified invasive group A streptococcal (iGAS) disease among children and young people aged less than 18 years, by yearly quarter, July 2018–December 2022ˆ**. ˆQ3 (July to September) includes 2 months of winter and one month of spring in Victoria, Western Australia and Queesnland, and the dry season in the Northern Territory.

**Fig. 2**
*emm*-type distribution among 163 paediatric iGAS cases notified to the PAEDS Network from 1 July 2018 to 31 December 2022. ∗‘Other’ indicates 19 different *emm-*types: *emm-*2, -6, -9, -11, -22, -28, -36, 41, -44, -49, -59, -71, -76, -77, -82, -87, -92, -110. 1 isolate was non-typeable.

See this image and copyright information in PMC

References

1. Tyrrell G.J., Fathima S., Kakulphimp J., et al. Increasing rates of invasive group A streptococcal disease in Alberta, Canada; 2003-2017. Open Forum Infect Dis. 2018;5(8) doi: 10.1093/ofid/ofy177. - DOI - PMC - PubMed
1. Oliver J., Wilmot M., Strachan J., et al. Recent trends in invasive group A Streptococcus disease in Victoria. Comm Dis Intell. 2019;43 doi: 10.33321/cdi.2019.43.8. - DOI - PubMed
1. Bronze M.S., Dale J.B. The reemergence of serious group A streptococcal infections and acute rheumatic fever. Am J Med Sci. 1996;311(1):41–54. doi: 10.1097/00000441-199601000-00008. - DOI - PubMed
1. Lamagni T.L., Darenberg J., Luca-Harari B., et al. Epidemiology of severe Streptococcus pyogenes disease in Europe. J Clin Microbiol. 2008;46(7):2359–2367. doi: 10.1128/jcm.00422-08. - DOI - PMC - PubMed
1. Lamagni T., Guy R., Chand M., et al. Resurgence of scarlet fever in England, 2014-16: a population-based surveillance study. Lancet Infect Dis. 2018;18(2):180–187. doi: 10.1016/s1473-3099(17)30693-x. - DOI - PubMed

LinkOut - more resources

Full Text Sources
Miscellaneous
- NCI CPTAC Assay Portal

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Increase in invasive group A streptococcal disease among Australian children coinciding with northern hemisphere surges

Affiliations

Increase in invasive group A streptococcal disease among Australian children coinciding with northern hemisphere surges

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources

Miscellaneous