Changes in Epidemiology in Pediatric Invasive Group A Streptococcal Infections in Ireland During the 2022-2023 Outbreak.

BACKGROUND

From October 2022 to June 2023, there was a 4-fold increase in pediatric invasive group A streptococcus cases (iGAS) in the Republic of Ireland. This project aimed to better understand the clinical characteristics and disease course of iGAS in children in Ireland to inform Public Health interventions and messaging for carers, clinicians and the public.

METHODS

All cases of iGAS notified to Public Health under 16 years from October 2022 to June 2023 inclusive were collated. A clinical case review of every death and hospitalization was performed under the auspices of the National Incident Management team using an online questionnaire. Analysis was performed using a 2-sided Fischer's exact test and 1-way analysis of variance.

RESULTS

Of 180 cases of iGAS in children, 167 had clinical data collected; 33 of 49 with skin and soft tissue infection had active varicella, and 69 of 167 had at least 1 respiratory viral coinfection. Seventy-four of 167 required therapeutic procedural intervention, and 34 of 167 required pediatric intensive care unit admission. Ten of 12 patients who died had necrotizing pneumonia, and 8 had an out-of-hospital cardiac arrest. Compared with historical data, significant changes in iGAS epidemiology in children were seen, with an increase in respiratory diagnoses, a decrease in musculoskeletal disease and an increased need for procedural intervention.

CONCLUSIONS

The rapidity and severity of secondary deterioration and death in children with iGAS highlight the importance of sepsis awareness in primary and secondary care. The high prevalence of viral coinfection emphasizes the importance of current vaccine uptake and expansion of the national schedule to include varicella zoster virus.