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Continued High Levels of Invasive Streptococcus pyogenes Infections in Belgian Children Under 5 Years: Exploring
Laura Cornelissen1, Frederik De Keersmaeker1, Sien De Koster2
1From the Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.
The Pediatric Infectious Disease Journal
|January 28, 2026
Summary
Invasive Group A Streptococcus (iGAS) infections in young Belgian children remained high post-pandemic. Varicella virus circulation, not other respiratory viruses, correlated with the iGAS increase, suggesting multifactorial causes.
Area of Science:
- Pediatric Infectious Diseases
- Epidemiology
- Microbiology
Background:
- An international rise in invasive Group A Streptococcus (iGAS) infections occurred in late 2022-early 2023.
- Previous reports focused narrowly on the post-pandemic period, leaving contributing factors unclear.
Purpose of the Study:
- To investigate the epidemiology of iGAS in Belgian children under five.
- To assess the impact of co-circulating viral infections on iGAS incidence.
Main Methods:
- Analysis of Belgian laboratory data from January 2014 to December 2024.
- Cointegration analysis to evaluate the relationship between iGAS cases and viral diseases (varicella, RSV, influenza) after seasonality adjustment.
Main Results:
- iGAS cases surged from June 2022, peaking in April 2023, and remained elevated into early 2024.
- Reduced population immunity alone did not explain the iGAS surge.
- Varicella incidence, but not RSV or influenza, showed a strong correlation with iGAS levels.
- Successive dominant iGAS genotypes (emm12, emm1, emm3) suggest complex transmission dynamics.
Conclusions:
- iGAS infections persisted at high levels for up to two years after non-pharmaceutical interventions ceased.
- The increase in iGAS is multifactorial, with varicella co-circulation being a significant factor.
- Ongoing, high-quality surveillance is crucial for monitoring iGAS trends.
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