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Multicenter Study
. 2025 Oct 1;44(10):925-930.
doi: 10.1097/INF.0000000000004855. Epub 2025 May 12.

National 10-year Cohort Study of Life-threatening Invasive Group A Streptococcal Infection in Children, 2013-2023

Victoria Holdstock  1 , Emily Heppenstall  2 , Donna Corrigan  3 , Andrew Eccleston  4 , Laura Jones  5 , Pota Kalima  6 , Christopher Lamb  1 , Eisin McDonald  7 , Catherine M McDougall  2 , Jillian McFadzean  2 , Kathryn McKenzie  8 , Dawn Penman  9 , Louisa Pollock  10 , Kevin J Scott  11 , Andrew Smith  11   12 , Alastair Turner  1 , Roisin Ure  11 , Margrethe van Dijke  2 , Sadia Zafreen  13 , Colin Begg  1 , Nic Robertson  14 , Thomas C Williams  15
Affiliations
Multicenter Study

National 10-year Cohort Study of Life-threatening Invasive Group A Streptococcal Infection in Children, 2013-2023

Victoria Holdstock et al. Pediatr Infect Dis J. .

Abstract

Background: Invasive group A streptococcal disease (iGAS) is an important cause of pediatric morbidity and mortality. We aimed to describe severe, life-threatening, iGAS cases to inform critical care services planning and identify potential opportunities for early intervention to prevent progression to death.

Methods: Retrospective, multicenter, national cohort study in Scotland investigating critically unwell iGAS cases ≤15 years old from October 01, 2013 to September 30, 2023. We included children and young people (CYP) who required advanced intensive care or died with iGAS as the primary cause of death. Information collected included demographics, Streptococcus pyogenes emm types, viral coinfections and clinical outcomes.

Results: Eighty-two cases of severe, life-threatening iGAS were identified, with 20 resulting in death. The annual iGAS pediatric intensive care unit (PICU) admission rate was 0.69/100,000 CYP, with a mean annual mortality rate of 0.22/100,000. iGAS PICU admissions dropped during 2020-2021, returned to baseline in 2021-2022, and then increased sharply in 2022-2023 without an increase in death rates. Across the cohort, the predominant emm type was type 1. In 9.8% of cases, GAS was identified using a nonculture molecular method (specific polymerase chain reaction or 16S rRNA sequencing). Prior primary or secondary care contact was sought by 9/20 (45%) of CYP who died; there was no significant association between time-to-care to PICU and illness severity or risk of death. Viral coinfections were common and associated with higher severity scores.

Conclusion: We demonstrate a significant annual burden of severe, life-threatening iGAS at the national level. High rates of viral coinfections and care-seeking before PICU admission or death, suggest potential opportunities for intervention.

Keywords: child deaths; invasive group a streptococcus; pediatric intensive care; vaccination.

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Conflict of interest statement

T.C.W. is Principal Investigator for the BronchStart project, which was funded by the Respiratory Syncytial Virus Consortium in Europe (RESCEU), with data collection supported by the National Institute for Health Research and the Wellcome Trust. C.B. is a local Principal Investigator for the GenOMICC study, which is funded by a consortium including the Wellcome Trust, the UK Medical Research Council, Sepsis Research—FEAT and supported by the Intensive Care Society and International Severe Acute Respiratory and Emerging Infection Consortium. He is a deputy local PI for the PRESSURE study, funded by the UK National Institute of Health & Care Research and supported by the Intensive Care National Audit & Research Centre and the UK Pediatric Critical Care Society. He is an unpaid medical Trustee of the charity Sepsis Research—FEAT. Other authors have no conflicts of interest to disclose.

Figures

FIGURE 1.
FIGURE 1.
Admissions to PICU in Scotland, and deaths, due to severe iGAS infection from October 1, 2013, to September 30, 2023. Deaths are shown in black, with PICU admissions for level 3 intensive care in bars, colored by presentation phenotype (“Respiratory,” “Sepsis” or “Skin, soft tissue and bone”). iGAS indicates Invasive group A streptococcal disease; PICU, pediatric intensive care units.
FIGURE 2.
FIGURE 2.
Virus positivity on rRT-PCR testing. Error bars are standard error, with P values derived from Fisher exact tests on odds ratios. iGAS indicates Invasive group A streptococcal disease; HMPV, human metapneumovirus; rRT-PCR, real-time reverse-transcriptase polymerase chain reaction.
See this image and copyright information in PMC

References

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