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Associations between common respiratory viruses and invasive group A streptococcal infection: A time-series analysis

Brechje de Gier1, Bart J M Vlaminckx2, Sjoukje H S Woudt1

  • 1Center for Epidemiology and Surveillance of Infectious Diseases, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.

Influenza and Other Respiratory Viruses
|June 26, 2019
PubMed
Abstract

Insights

Influenza A virus (IAV) circulation is linked to a severe group A Streptococcus (GAS) infection, streptococcal toxic shock syndrome (STSS). Up to 40% of STSS cases may be attributed to IAV, suggesting potential prevention through flu vaccination.

Area of Science:

  • Infectious Diseases
  • Epidemiology
  • Public Health

Background:

  • Invasive group A Streptococcus (iGAS) infections exhibit winter seasonality, coinciding with respiratory virus seasons.
  • Influenza superinfections with iGAS are known to cause severe illness and high mortality.
  • The contribution of specific respiratory viruses to iGAS incidence and severity requires further investigation.

Purpose of the Study:

  • To investigate the temporal association between the circulation of influenza A (IAV) and B (IBV) viruses, respiratory syncytial virus (RSV), and rhinovirus with iGAS incidence and severity.
  • To determine the extent to which these respiratory viruses contribute to iGAS infections.
  • To explore potential links between respiratory viral co-infections and severe iGAS manifestations like streptococcal toxic shock syndrome (STSS).

Main Methods:

  • Utilized time-series regression models to analyze weekly laboratory counts of IAV, IBV, RSV, and rhinovirus.
  • Correlated viral circulation data with weekly disease notifications and laboratory GAS cultures.
  • Focused on identifying temporal associations between specific respiratory viruses and iGAS outcomes.

Main Results:

  • A significant temporal association was observed between weekly IAV detections and notifications of STSS, a severe iGAS complication.
  • IAV circulation was found to account for up to 40% of all notified STSS cases during certain seasons.
  • No significant association was found between other iGAS manifestations and the studied respiratory viruses, except for STSS.

Conclusions:

  • An ecological temporal association exists between IAV and STSS, the most severe form of iGAS infection.
  • Further research is warranted to confirm this association and explore the potential preventability of STSS through influenza vaccination.
  • Influenza vaccination may be particularly important for individuals aged 60 years and older to prevent STSS.
Keywords:
Streptococcus pyogenesinfluenzaperiodicityrespiratory tract infectionsstatistical models

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