Prospective Surveillance of Pediatric Invasive Group A<i>Streptococcus</i>Infection

Ching, Natasha S; Crawford, Nigel; McMinn, Alissa; Baker, Ciara; Azzopardi, Kristy; Brownlee, Kate; Lee, Donna; Gibson, Margaret A.; Smeesters, Pierre; Gonis, Gena; Ojaimi, Samar; Buttery, Jim; Steer, Andrew C.

doi:10.1093/jpids/pix099

Cited by 13 publications

(12 citation statements)

References 33 publications

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“…Serotypes 1,3,4,11,12, and 28 are most frequently associated with invasive disease, with emm1 being the most frequently identified serotype in Victoria, accounting for up to 24% of cases. 5 In our cohort, a predominance of emm1 GAS was also seen. Thus, although this case series is relatively small, the distribution of emm types did not appear to change from that previously reported, and hence was not felt to be a likely cause in the increased number of IGAS cases.…”

Section: Discussionsupporting

confidence: 63%

“…The initial pilot was in the Australian state of Victoria, and we have previously published 2 years of all IGAS cases identified at the Royal Children's Hospital, Melbourne. 5 In 2017, our surveillance identified an increase in IGAS across the two tertiary pediatric hospitals in the state of Victoria: the Royal Children's Hospital and Monash Children's Hospital. Disease incidence was calculated as the percentage of cases per 10,000 hospital admissions.…”

Section: Identification Of An Increase In Invasive Group a Streptococmentioning

confidence: 92%

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A Cluster of Pediatric Invasive Group A Streptococcus Disease in Melbourne, Australia, Coinciding with a High-Burden Influenza Season

Wong

Crawford

Oliver

et al. 2019

J Pediatr Infect Dis

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Background Invasive group A streptococcal disease (IGAS) carries significant morbidity and mortality in children. Fluctuations in disease incidence are well documented. However, the modulating factors that contribute to these changes remain unclear. Prospective monitoring of IGAS cases in Victoria, Australia, showed an increased number of cases in 2017, coinciding with a peak of influenza illness. Methods Children identified to have IGAS are prospectively monitored in Melbourne through a disease surveillance network. Data on their presentation, investigations, and clinical course are collected. An increased number of cases identified between June 1, 2017, and October 31, 2017, have been retrospectively analyzed. Results We identified 22 cases of pediatric IGAS during the study period. Increased case detection occurred during a period of increased influenza disease. Of 11 children in our cohort who underwent respiratory viral testing, 4 were confirmed to have concurrent respiratory tract illnesses, and 2 were confirmed to have influenza.

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Section: Discussionsupporting

confidence: 63%

Section: Identification Of An Increase In Invasive Group a Streptococmentioning

confidence: 92%

A Cluster of Pediatric Invasive Group A Streptococcus Disease in Melbourne, Australia, Coinciding with a High-Burden Influenza Season

Wong

Crawford

Oliver

et al. 2019

J Pediatr Infect Dis

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“…Local Australian surveillance data indicates that the incidence rate of iGAS disease is increasing in Victoria, with a new high level reached in 2017, of 3.6/100,000 (95% confidence interval, CI: 3.2–4.1/100,000; i.e. 220 new cases that year) [30, 31]. A 2017 outbreak among Victorian children is especially concerning, and was associated with a high burden of seasonal influenza [31].…”

Section: Introductionmentioning

confidence: 99%

“…IGAS disease was included as a condition of interest in July 2016, however not all states commenced data collection at the same time and retrospective recruitment was frequent (Additional file 2: Figure S1). This national surveillance followed a pilot study at one of two participating PAEDS sites in Melbourne, Victoria over 2014–2016 (the Royal Children’s Hospital, RCH) [30]. A key goal of the PAEDS Network was to enhance the understanding the disease burden and provide data to support targeted control and prevention activities, including vaccination [34].…”

Section: Introductionmentioning

confidence: 99%

Invasive group A Streptococcus disease in Australian children: 2016 to 2018 – a descriptive cohort study

et al. 2019

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ObjectivesInvasive group A Streptococcus (iGAS) disease is serious and sometimes life-threatening. The Paediatric Active Enhanced Disease Surveillance (PAEDS) Network collects voluntary notifications from seven major Australian paediatric hospitals on patients with certain conditions, including iGAS disease. Our aims were to: 1) Describe the epidemiological distribution of paediatric iGAS disease in Australia and correlate this with influenza notifications, 2) Identify GAS strains commonly associated with invasive disease in children.MethodsIGAS and influenza notification data were obtained (from the PAEDS Network and the Australian Institute of Health and Welfare, respectively, for the period 1 July 2016 to 30 June 2018). Included iGAS patients had GAS isolated from a normally sterile body site. Data were described according to selected clinical and demographic characteristics, including by age group and Australian State, with proportions and minimum incidence rates estimated.ResultsA total of 181 patients were identified, with most (115, 63.5%) <5 years old. The mean annual minimum incidence rate was 1.6 (95% confidence interval: 1.1–2.3) per 100,000 children across the study period. An epidemiological correlation with the seasonal burden of influenza was noted. Contact prophylaxis was not consistently offered. Of 96 patients with emm-typing results available, 72.9% showed emm-1, −4 or − 12.ConclusionsRobust surveillance systems and cohesive patient management guidelines are needed. Making iGAS disease nationally notifiable would help facilitate this. Influenza vaccination may contribute to reducing seasonal increases in iGAS incidence. The burden of disease emphasises the need for ongoing progress in GAS vaccine development.

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“…[38][39][40] Our study supports emerging data that describe a phenomenon of a nonspecific febrile prodrome lasting some days among pediatric patients with iGAS disease. 41 Almost half of our patients (47.5%) had consulted a doctor in the week before hospitalization, including 33.2% at an emergency department, but were sent home. In a previous study of 521 children with meningitis or sepsis in Ontario, Canada, 21.9% had repeated emergency department visits before admission to hospital.…”

Section: Discussionmentioning

confidence: 91%

Clinical Description and Outcomes of Australian Children With Invasive Group A Streptococcal Disease

Thielemans

Oliver

McMinn

et al. 2020

Pediatric Infectious Disease Journal

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Background: Invasive group A streptococcal disease is a severe infection with a high case fatality rate, estimated to cause more than 150,000 deaths per year worldwide. The clinical presentation of this infection is variable, and early diagnosis can be challenging. There are few data on its short-and longer-term outcomes, especially in children. The aim of this study was to assess the clinical presentation, management and short-and longer-term outcomes of invasive group A streptococcal disease in children in Australia. Methods: We undertook a prospective surveillance study of children with laboratory-confirmed invasive group A streptococcus disease admitted to 7 sentinel tertiary and quaternary pediatric hospitals in Australia between July 2016 and June 2018. We collected demographic and clinical data and contacted patients 6 months after discharge to assess longer-term outcomes. Results: We enrolled 181 children, 7 days to 16 years of age. The principal site of invasive infection was blood (126 children, 69.6%), and the most frequent clinical presentation was pneumonia in 46 children (25.4%). Twentysix children developed streptococcal toxic shock syndrome (14.4%), and 74 had severe disease (40.9%), including 71 admitted to the intensive care unit. Five children died (2.8%). At discharge and 6 months, 29.3% and 15.2% of the children had persisting health problems, respectively. Conclusions: Invasive group A streptococcal infection in Australian children is frequently severe and has a high long-term morbidity burden, highlighting the need for strengthened clinical care pathways, epidemiological surveillance and prevention strategies.

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Prospective Surveillance of Pediatric Invasive Group AStreptococcusInfection

Cited by 13 publications

References 33 publications

A Cluster of Pediatric Invasive Group A Streptococcus Disease in Melbourne, Australia, Coinciding with a High-Burden Influenza Season

A Cluster of Pediatric Invasive Group A Streptococcus Disease in Melbourne, Australia, Coinciding with a High-Burden Influenza Season

Invasive group A Streptococcus disease in Australian children: 2016 to 2018 – a descriptive cohort study

Clinical Description and Outcomes of Australian Children With Invasive Group A Streptococcal Disease

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