First reported cluster of overwhelming group A streptococcal septicaemia and associated chickenpox infection in the UK

Abstract

We report the first reported cases of epidemiologically linked invasive group A streptococcal septicaemia, with one fatality, following primary chickenpox infection in previously fit and well children who attended the same preschool. Invasive group A streptococcal sepsis is a well documented complication of chickenpox, which requires prompt and aggressive treatment. Following the cluster, public health measures were put in place to prevent further disease. Varicella vaccination has been shown to significantly reduce hospital admissions as well as deaths related to chickenpox infection. This is the first reported cluster of two epidemiologically linked patients in the UK.

Varicella infection in a neonate with subsequent staphylococcal scalded skin syndrome and fatal shock

“…S aureus and group A streptococcus are very often responsible for skin and soft tissue infection and invasive infections, sometimes involving toxins production, mainly TSS—toxin 1 and superantigenic toxins, manifest as TSS, and exfoliative toxins A and B, manifest as bullous impetigo and SSSS 15–17. Streptococcal septicaemia following primary chickenpox infection has been reported in young children, with fatal outcome in one out of two children 4. Pollard et al ,5 in a series of 13 children aged between  1½ months and 84 months that had invasive bacterial infection following 2–14 days of varicella rash, have reported TSS in eight patients, one of which died; the isolates were S aureus and Streptococcus .…”

“…Indeed, a mild secondary bacterial infection of the skin, of little significance, is the most common varicella complication. There have been reports of severe bacterial infection during or following varicella 4 5. The occurrence of a varicella infection complicated by the development of the staphylococcal scalded skin syndrome (SSSS) is very rare 6 7.…”

Chickenpox In Ghana; Is It Time To Consider Universal Immunization?

“…While practicing in the UK, the corresponding author was involved with the management of two children who developed invasive streptococcal infection following VZV infection which has since been published 19 . Both children, whowere from the same daycare facility, presented within 14 days of each other.…”

“…In 2008, 77,790, cases of chickenpox representing 0.7% of total outpatient morbidity were reported by the Ghana Health Service 3 . In 2002, 2003 and 2004, it was 35,667 (0.5%) 19,614 (0.3%) and 45,512 (0.6%) respectively, suggesting a gradual rise in the contribution of chicken pox to outpatient morbidity 3 . Unfortunately, more recent facility-based or populationbased figures for Ghana are unavailable.…”