Natasha S Ching1,2, Nigel Crawford3,4,5, Alissa McMinn3, Ciara Baker1,4, Kristy Azzopardi1, Kate Brownlee3, Donna Lee3, Margaret Gibson3, Pierre Smeesters1,4,6,7, Gena Gonis8, Samar Ojaimi2,9, Jim Buttery3,2,10,9, Andrew C Steer1,4,5. 1. Group A Streptococcus Research Group, Murdoch Children's Research Institute, Melbourne, Australia. 2. SAEFVIC, Murdoch Children's Research Institute, Melbourne, Australia. 3. Department of Paediatrics, Monash University, Melbourne, Australia. 4. Department of General Medicine, Royal Children's Hospital, Melbourne, Australia. 5. Molecular Bacteriology Laboratory, Université Libre de Bruxelles, Brussels, Belgium. 6. Department of Microbiology, Royal Children's Hospital, Melbourne, Australia. 7. Department of Infection & Immunity, Monash Children's Hospital, Melbourne, Australia. 8. Department of Pediatrics, Academic Children Hospital Queen Fabiola, Université Libre de Bruxelles, Brussels, Belgium. 9. Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia. 10. Department of Paediatrics, University of Melbourne, Melbourne, Australia.
Abstract
BACKGROUND: Invasive group A Streptococcus (GAS) disease has an incidence in high-income countries of 3 to 5 per 100000 per annum and a case-fatality ratio of 10% to 15%. Although these rates are comparable to those of invasive meningococcal disease in Australia before vaccine introduction, invasive GAS disease currently requires reporting in only 2 jurisdictions. METHODS: Data were collected prospectively through active surveillance at the Royal Children's Hospital, Melbourne (October 2014 to September 2016). Isolation of GAS from a sterile site was required for inclusion. Comprehensive demographic and clinical data were collected, and emm typing was performed on all isolates. Disease was considered severe if the patient required inotropic support or mechanical ventilation. RESULTS: We recruited 28 patients. The median age of the patients was 3.5 years (range, 4 days to 11 years). Ten (36%) patients had severe disease. Fifteen (54%) children had presented to a medical practitioner for review in the 48 hours before their eventual admission, including 7 of the 10 patients with severe GAS infection. Complications 6 months after discharge persisted in 21% of the patients. emm1 was the most common emm type (29%). CONCLUSION: We found considerable short- and longer-term morbidity associated with pediatric invasive GAS disease in our study. Disease manifestations were frequently severe, and more than one-third of the patients required cardiorespiratory support. More than one-half of the patients attended a medical practitioner for assessment but were discharged in the 48-hour period before admission, which suggests that there might have been a window for earlier diagnosis. Our methodology was easy to implement as a surveillance system.
BACKGROUND: Invasive group A Streptococcus (GAS) disease has an incidence in high-income countries of 3 to 5 per 100000 per annum and a case-fatality ratio of 10% to 15%. Although these rates are comparable to those of invasive meningococcal disease in Australia before vaccine introduction, invasive GAS disease currently requires reporting in only 2 jurisdictions. METHODS: Data were collected prospectively through active surveillance at the Royal Children's Hospital, Melbourne (October 2014 to September 2016). Isolation of GAS from a sterile site was required for inclusion. Comprehensive demographic and clinical data were collected, and emm typing was performed on all isolates. Disease was considered severe if the patient required inotropic support or mechanical ventilation. RESULTS: We recruited 28 patients. The median age of the patients was 3.5 years (range, 4 days to 11 years). Ten (36%) patients had severe disease. Fifteen (54%) children had presented to a medical practitioner for review in the 48 hours before their eventual admission, including 7 of the 10 patients with severe GASinfection. Complications 6 months after discharge persisted in 21% of the patients. emm1 was the most common emm type (29%). CONCLUSION: We found considerable short- and longer-term morbidity associated with pediatric invasive GAS disease in our study. Disease manifestations were frequently severe, and more than one-third of the patients required cardiorespiratory support. More than one-half of the patients attended a medical practitioner for assessment but were discharged in the 48-hour period before admission, which suggests that there might have been a window for earlier diagnosis. Our methodology was easy to implement as a surveillance system.
Authors: Emma Sherwood; Stefania Vergnano; Isona Kakuchi; Michael G Bruce; Suman Chaurasia; Samara David; Angela Dramowski; Scarlett Georges; Rebecca Guy; Theresa Lamagni; Daniel Levy-Bruhl; Outi Lyytikäinen; Monika Naus; Jennifer Onukwube Okaro; Oddvar Oppegaard; Didrik F Vestrheim; Tammy Zulz; Andrew C Steer; Chris A Van Beneden; Anna C Seale Journal: Lancet Infect Dis Date: 2022-04-04 Impact factor: 71.421