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National 10-year Cohort Study of Life-threatening Invasive Group A Streptococcal Infection in Children, 2013-2023
Victoria Holdstock1, Emily Heppenstall2, Donna Corrigan3
1From the Paediatric Intensive Care Unit, Royal Hospital for Children, Glasgow.
Insights
Severe invasive group A streptococcal disease (iGAS) significantly impacts pediatric health. Early intervention opportunities exist, particularly with common viral coinfections, to reduce mortality in critically ill children.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Epidemiology
Background:
- Invasive group A streptococcal disease (iGAS) is a major cause of severe illness and death in children.
- Understanding severe iGAS cases is crucial for planning pediatric critical care services and identifying early intervention strategies.
Purpose of the Study:
- To describe severe, life-threatening iGAS cases in children and young people (CYP) in Scotland.
- To inform critical care planning and identify potential interventions to prevent mortality.
Main Methods:
- A retrospective, multicenter, national cohort study was conducted in Scotland.
- Included critically unwell iGAS cases (≤15 years old) from 2013-2023 requiring advanced intensive care or resulting in death.
- Data collected included demographics, Streptococcus pyogenes emm types, viral coinfections, and clinical outcomes.
Main Results:
- Eighty-two severe iGAS cases were identified, with 20 deaths. The annual pediatric intensive care unit (PICU) admission rate was 0.69/100,000 CYP, with a mortality rate of 0.22/100,000.
- iGAS PICU admissions showed a dip during 2020-2021, returning to baseline before a sharp increase in 2022-2023.
- Viral coinfections were common and linked to higher severity scores; 45% of deceased CYP had prior care contact, but time-to-PICU was not significantly associated with severity or death risk.
Conclusions:
- A significant national burden of severe iGAS in children exists.
- High rates of viral coinfections and pre-PICU care-seeking suggest avenues for intervention.
- Further research into early detection and management of iGAS in pediatric populations is warranted.
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.
