Severe Group A Streptococcus Infection among Children, France, 2022-2024.

Area of Science:

• Pediatrics
• Infectious Diseases
• Epidemiology

Background:

• Group A Streptococcus (GAS) infections have seen a notable increase in Europe since September 2022.
• Severe GAS infections in children require urgent clinical attention and epidemiological monitoring.

Purpose of the Study:

• To investigate the characteristics and outcomes of severe pediatric Group A Streptococcus infections.
• To identify risk factors associated with severe disease and mortality in children.

Main Methods:

• A retrospective and prospective study involving 402 pediatric patients across 34 French hospitals from September 1, 2022, to April 1, 2024.
• Analysis included clinical presentation, treatment interventions, molecular typing of GAS strains, and patient outcomes (sequelae or death).

Main Results:

• The majority of severe GAS cases involved respiratory tract infections (55%), with a lower proportion of skin and soft tissue infections (16%).
• The overall case-fatality rate was 3.5%. Hydrocortisone, corticosteroid, and vasopressor therapies were significantly associated with major sequelae or death.
• Emm1 (73.0%) and emm12 (10.8%) were the predominant emm types, with the M1_UK clone accounting for 50% of emm1 strains.

Conclusions:

• Severe pediatric GAS infections present predominantly with respiratory symptoms and carry a significant risk of adverse outcomes.
• Specific therapeutic interventions, including corticosteroids and vasopressors, were associated with poorer prognoses, necessitating careful consideration in clinical management.
• Enhanced collaboration among clinicians, researchers, and public health authorities is crucial to effectively mitigate the impact of GAS on child health.