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Pediatric invasive group A streptococcus (iGAS) cases significantly increased post-COVID-19, with higher severity and mortality. Risk factors for severe iGAS include pulmonary involvement, streptococcal toxic shock syndrome (STSS), and neurological symptoms.

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Area of Science:

  • Pediatric Infectious Diseases
  • Epidemiology
  • Public Health

Background:

  • An increase in pediatric invasive group A streptococcus (iGAS) disease was observed in the Netherlands starting in early 2022.
  • iGAS infections can range from mild to life-threatening, necessitating timely clinical data for public health decisions.

Purpose of the Study:

  • To identify risk factors for severe pediatric iGAS, defined as requiring intensive care unit admission and/or resulting in death.
  • To analyze pediatric iGAS incidence, clinical presentations, and outcomes across pre-pandemic, pandemic, and post-pandemic periods.

Main Methods:

  • An observational, retrospective and prospective cohort study involving 20 hospitals in the Netherlands from January 2015 to June 2024.
  • Included children aged 0 to 17 years diagnosed with iGAS.
  • Statistical analyses included logistic regression for risk factors and Poisson regression for incidence rate ratios.

Main Results:

  • iGAS cases decreased during the COVID-19 pandemic and significantly increased in the post-COVID-19 period (IRR, 2.93).
  • Factors associated with severe iGAS included post-COVID-19 diagnosis, pulmonary involvement, streptococcal toxic shock syndrome (STSS), and meningitis/encephalitis.
  • Disease severity increased post-pandemic, with higher mortality (4.4% vs 1.4%) and ICU admission rates (38.4% vs 15.6%) compared to pre-pandemic.

Conclusions:

  • Risk factors for complicated pediatric iGAS include pulmonary or central nervous system involvement, STSS, reduced consciousness, pulmonary clinical signs, elevated CRP, and decreased eGFR.
  • Awareness of these risk factors is crucial for timely recognition and improved clinical outcomes in at-risk pediatric iGAS cases.