Increase in invasive group A streptococcal (Streptococcus pyogenes) infections (iGAS) in young children in the Netherlands, 2022

Abstract

In 2022, a sevenfold increase in the number of notifiable invasive Streptococcus pyogenes (iGAS) infections among children aged 0–5 years was observed in the Netherlands compared with pre-COVID-19 pandemic years. Of 42 cases in this age group, seven had preceding or coinciding varicella zoster infections, nine were fatal. This increase is not attributable to a specific emm type. Vigilance for clinical deterioration as iGAS sign is warranted in young children, especially those with varicella zoster infection.

Increase in invasive group A streptococcal infection notifications, England, 2022

“…Nationwide alerts were issued to frontline clinicians on 2 December 2022, including a request for identification of routine surveillance reports relating to lower respiratory tract iGAS presentation in children younger than 15 years. Similar concerns about increases in paediatric iGAS cases are also being reported in the Netherlands, France, Ireland and the United States [10][11][12][13][14]. In the Netherlands, the increase seen earlier in 2022 was particularly apparent in children younger than 5 years, with emm types similar to the ones in England for all ages (emm 1, 12 and 4); high levels of chickenpox activity, also noted in England [1,2], were attributed to the rise in iGAS cases [10].…”

“…Similar concerns about increases in paediatric iGAS cases are also being reported in the Netherlands, France, Ireland and the United States [10][11][12][13][14]. In the Netherlands, the increase seen earlier in 2022 was particularly apparent in children younger than 5 years, with emm types similar to the ones in England for all ages (emm 1, 12 and 4); high levels of chickenpox activity, also noted in England [1,2], were attributed to the rise in iGAS cases [10]. The multinational nature of current signals suggests that this phenomenon may relate to decreased exposure to group A streptococci and other childhood infections during the coronavirus disease (COVID-19) pandemic.…”

Increase in Invasive Group a Streptococcal Infections in Children in the Netherlands, A Survey Among 7 Hospitals in 2022

“…Although our survey used a convenience sample of hospitals, we feel the observed increase in iGAS is representative of the national situation, as we used the same hospitals as historical controls and our findings are in line with an increase in notifiable pediatric iGAS cases on a national level. 3 This observation of iGAS surge in children in the Netherlands has implications for parents and clinicians and warrants increased vigilance for invasive disease. Early recognition and prompt initiation of therapy for children with iGAS infection may be life-saving.…”

“…1,2 This coincided with an increase in the number of notifiable iGAS cases in national surveillance. 3 However, this national surveillance only captures necrotizing fasciitis, toxic shock syndrome and puerperal fever/sepsis, whereas other clinical presentations of iGAS, such as (complicated) pneumonia or sepsis, are not systematically recorded. We performed a survey regarding pediatric iGAS cases in 7 Dutch hospitals to determine whether case numbers were indeed elevated compared with pre-COVID-19 and to gain more insight into the clinical presentation and severity of these cases.…”

Novelemm4 lineage associated with an upsurge in invasive group A streptococcal disease in the Netherlands, 2022

“…In conclusion, we identified an emerging emm4 lineage in the Netherlands, which descended from a predominantly carriage-associated type. Although iGAS cases in late 2022 and early 2023 in the Netherlands are dominated by emm1 (more specifically M1UK) 2 , emm4…”