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. 2024 Oct;29(40):2300739.
doi: 10.2807/1560-7917.ES.2024.29.40.2300739.

Attribution of invasive group A streptococcal infections (iGAS) to predisposing viral infections, the Netherlands, 2010 to 2023

Brechje de Gier  1 , Jan van de Kassteele  1 , Liselotte van Asten  1 , Annelot F Schoffelen  1 ; ISIS-AR study group  2 ; Mariette Hooiveld  3 , Margreet Jm Te Wierik  1 , Nina M van Sorge  4   5 , Hester E de Melker  1 ; Members of the ISIS-AR study group
Collaborators, Affiliations

Attribution of invasive group A streptococcal infections (iGAS) to predisposing viral infections, the Netherlands, 2010 to 2023

Brechje de Gier et al. Euro Surveill. 2024 Oct.

Abstract

BackgroundAfter most COVID-19 pandemic control measures were lifted in 2022, many infectious diseases re-emerged. An increase in invasive group A streptococcal (iGAS) infections among adults and young children was reported by several countries. Viral infections including influenza and varicella, known risk factors for iGAS infection, also increased.AimTo estimate the proportion of GAS skin and soft tissue infections (SSTI) and pneumonia/sepsis in children (≤ 5 years) attributable to varicella, and the proportion of GAS pneumonia/sepsis in children and adults attributable to potentially predisposing respiratory viruses influenza A and B, RSV, hMPV and SARS-CoV-2 in the Netherlands.MethodsWe performed time series regression using weekly data on respiratory viruses, varicella and non-invasive GAS infections and GAS isolates cultured from blood, lower airways, skin, pus and wounds, from January 2010 to March 2023.ResultsIn 2010-19, 50% (95% CI: 36-64) of GAS SSTI in children were attributable to varicella. Between January 2022 and March 2023, 34% (95% CI: 24-43) of GAS SSTI cases were attributable to varicella. Of iGAS pneumonia/sepsis between January 2022 and March 2023, 34% (95% CI: 20-49) and 25% (95% CI: 18-32) was attributable to respiratory virus infections in children and adults, respectively, with the largest contributor (17%) being influenza A.ConclusionsPredisposing viral infections likely contributed to, but cannot fully explain, the observed iGAS increase among children and adults in 2022-23 in the Netherlands. Public health measures to control viral infections, such as vaccination against varicella or influenza, might reduce the iGAS disease burden.

Keywords: Influenza; Streptococcus pyogenes; Varicella; timeseries analysis.

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Conflict of interest statement

Conflict of interest: NMvS declares fee for service and consultancy fees from MSD and GSK outside the submitted work directly paid to the institution. NMvS declares royalties related to a patent (WO 2013/020090 A3) on vaccine development against Streptococcus pyogenes (Vaxcyte; Licensee: University of California San Diego with NMvS as co-inventor). NMvS is a member of the science advisory board for the ItsME foundation (unpaid) and Rapua te me ngaro ka tau project (Protection of Whãnua against Strep A (POWAS); paid to institution). The other authors have nothing to declare.

Figures

Figure 1
Figure 1
Observed weekly numbers of GAS skin and soft tissue infections in children, GAS pneumonia or sepsis in children and adults, varicella and non-invasive GAS infection consultations for children, and detections of respiratory viruses, the Netherlands, January 2010–March 2023
Figure 2
Figure 2
Estimated weekly absolute and relative attributions of GAS skin and soft tissue infections in children aged 0–5 years to varicella, non-invasive GAS and a long-term time trend, the Netherlands, January 2010–March 2023 (n = 1,595)
Figure 3
Figure 3
Estimated weekly absolute and relative attributions of GAS pneumonia or sepsis in children aged 0–5 years to varicella, SARS-CoV-2, hMPV, RSV, influenza B, influenza A, non-invasive GAS and a long-term time trend, the Netherlands, January 2010–March 2023 (n = 446)
Figure 4
Figure 4
Estimated weekly absolute and relative attributions of GAS pneumonia or sepsis in adults to SARS-CoV-2, hMPV, RSV, influenza B, influenza A, non-invasive GAS and a long-term time trend, the Netherlands, January 2010–March 2023 (n = 4,643)
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