Streptococcus pyogenes, commonly referred to as Group A Streptococcus (GAS), has theability to induce a diverse range of illnesses.In several European countries and the United States, a notable surge in invasive GAS(iGAS) infections has been documented since mid-2022. This sharp increase contrasts withthe gradual rise in iGAS incidence observed among children over the past three decades.As demonstrated for several viral infections, the recent upturn in iGAS infections ispotentially linked to the relaxation of mitigation measures implemented during theCOVID-19 pandemic, such as face mask usage and school closures.Since November 2022, concerns have been raised by French public health authoritiesregarding the rise in levels of iGAS infections, and an unexpected increase in pediatricsevere GAS infections was reported in a French single-center study. However, this studyended in December 2022 and could only explore short-term trends. The Necker - Enfantsmalades Hospital in Paris, France, represents an excellent opportunity to examine theimpact of the COVID-19 pandemic and the associated non-pharmaceutical interventions onthe incidence of severe GAS infections, during, and after the pandemic.This study aims to investigate trends of severe GAS infection incidence in children inthe Paris area over the course of the COVID-19 pandemic.
Streptococcus pyogenes, commonly referred to as Group A Streptococcus (GAS), has the
ability to induce a diverse range of illnesses. In primary care, acute pharyngitis,
commonly known as 'strep throat', is the predominant form of GAS infection. Other
commonly encountered non-invasive GAS infections encompass impetigo, scarlet fever,
perianal infections, and paronychia. GAS may also cause rarer yet severe conditions such
as streptococcal toxic shock syndrome, pneumonia with pleural empyema, and septic shock;
most severe GAS infections can even be life-threatening.
In several European countries and the United States, a notable surge in invasive GAS
(iGAS) infections has been documented since mid-2022. This sharp increase contrasts with
the gradual rise in iGAS incidence observed among children over the past three decades.
As demonstrated for several viral infections, the recent upturn in iGAS infections is
potentially linked to the relaxation of mitigation measures implemented during the
COVID-19 pandemic, such as face mask usage and school closures. Non-pharmaceutical
interventions and behavioral changes during the COVID-19 pandemic modified the spread of
SARS-CoV-2 and several respiratory pathogens, including GAS. Reduced exposure to endemic
infectious agents may have created an immunity gap, leading to unexpected epidemics of
viral and bacterial infections after non-pharmaceutical interventions were relaxed.
Since November 2022, concerns have been raised by French public health authorities
regarding the rise in levels of iGAS infections, and an unexpected increase in pediatric
severe GAS infections was reported in a French single-center study. However, this study
ended in December 2022 and could only explore short-term trends. The Necker - Enfants
malades Hospital in Paris, France, represents an excellent opportunity to examine the
impact of the COVID-19 pandemic and the associated non-pharmaceutical interventions on
the incidence of severe GAS infections, during, and after the pandemic. This tertiary
care university hospital is located in a densely populated region and has various
specialized departments involved in the management of severe infections, including
pediatric intensive care units (PICU), orthopedics, pulmonology, otolaryngology,
dermatology, infectious diseases, and microbiology.
This study aims to investigate trends of severe GAS infection incidence in children in
the Paris area over the course of the COVID-19 pandemic.
Other: Collection of data from the patient's medical file
Collection of data from the patient's medical file (electronic health record). The
identification of eligible cases will be conducted through an examination of the
hospital's electronic microbiology database. Subsequently, the complete hospital
record(s) of each patient will be used to extract a pre-defined set of variables required
for data analysis.
Inclusion Criteria:
- Children under the age of 18 years.
- Admitted to Necker-Enfants Malades hospital for community-acquired or
healthcare-associated severe Group A Streptococcus (GAS) infections between January
1, 2018, and December 31, 2023.
- Severe GAS infections comprises "invasive" and "probable invasive" GAS illnesses.
"Invasive" GAS infection will be defined as:
- isolation by culture or polymerase chain reaction (PCR) of GAS from a normally
sterile site (e.g., blood, pleural fluid, cerebrospinal fluid, joint fluid, bone,
bronchoalveolar lavage fluid); or
- isolation of GAS from a sterile or non-sterile site accompanied by necrotizing
fasciitis or streptococcal toxic shock syndrome.
"Probable invasive" GAS will be defined as acute infections with GAS isolated from a
non-sterile site, which includes sputum, otorhinolaryngology surgical specimens
(mastoiditis, ethmoiditis, pharyngeal abscess) accompanied with one or more of the
following severity criteria:
- intravenous (IV) antibiotics;
- surgery; and/or
- admission to the PICU.
Exclusion Criteria:
- Non-severe GAS infection, such as acute otitis media with otorrhea, pharyngitis,
scarlet fever, GAS skin carriage.
- GAS identified on minor/superficial skin lesions.
- Otolaryngology infections (e.g., parapharyngeal abscess) that do not require IV
antibiotics, surgery, or PICU admission.
- Opposition to the use of routine data.
Hôpital Necker-Enfants Malades
Paris 2988507, France