Invasive Group A Streptococcus infection: epidemiological update as of March 26, 2023

Epidemiological update following several pediatric cases of invasive Group A Streptococcus infections, primarily among children under the age of 10 in several regions of France.

During the second half of November 2022, clinicians and pediatric intensive care specialists reported to Santé publique France and the Regional Health Agencies (ARS) a higher-than-usual number of pediatric cases of invasive Group A Streptococcus (IGAS) infections in their departments, some of which were fatal. These reports came from various regions (Occitanie, Auvergne-Rhône-Alpes, Nouvelle-Aquitaine) and primarily involved children under the age of 10.

To objectively assess an increase in cases toward the end of 2022, an initial assessment was conducted on December 8 using nationally available data on Group A Streptococcus infections.

Santé publique France is releasing an update today on trends in key epidemiological indicators based on data as of March 26, 2023 (end of week 12).

Key Points

  • A trend toward stabilization in the number of pediatric cases of severe invasive group A streptococcal infections (IGASIs) hospitalized in critical care units has been observed since the week of January 9, 2023. (+49 cases compared to the 121 cases reported in the last epidemiological update on January 29, 2023).

  • Of the 170 cases recorded since September 2022, 13 have died. Six additional deaths from GAS-I before hospital admission have been reported. More than half of the cases occurred in the context of or following a viral infection such as influenza or RSV.

  • The number of outpatient visits and emergency department visits for non-invasive SGA infections (scarlet fever) remains at levels higher than those observed before the COVID epidemic.

  • The increase in the number of IISGA cases among adults, suggested by CNR data, will need to be confirmed by additional analyses based on data from the Epibac network (surveillance of invasive bacterial infections) and the PMSI (Program for the Medicalization of Information Systems).

  • The current epidemiological situation regarding IISGA is not linked to the emergence of a new bacterial strain but possibly to an increase in the frequency of the already known emm-1 genotype of sequence type (ST) 28.

  • A similar situation is observed in other European countries, notably in the United Kingdom, where a high incidence of IISGA affects all age groups and particularly children.

  • A resurgence of RSV infections was observed in late 2022 amid widespread circulation of respiratory viruses, particularly among children (a triple epidemic of influenza, COVID-19, and bronchiolitis) but can be explained, at least in part, by a resurgence of SGA infections following the lifting of public health measures, particularly among children whose immune systems have not been exposed to the strains that typically circulate.

Prevention Tips to Reduce the Risk of Invasive Group A Streptococcal Infections

Group A Streptococcal Invasive Infections in France and Prevention Tips
GAS is a strictly human pathogen transmitted through respiratory droplets and direct contact (nasal secretions, skin lesions, etc.). It most commonly causes mild, non-invasive infections, such as strep throat, impetigo, and scarlet fever. More rarely, it causes serious invasive infections (necrotizing skin infections, puerperal infections, pneumonia and pleuropneumonia, and meningitis) that may be associated with streptococcal toxic shock syndrome (STSS).

To limit the risk of transmission, it is recommended to follow the same preventive measures used against winter viruses:

  • handwashing,

  • wearing a mask for people with respiratory infections,

  • coughing or sneezing into the crook of the elbow.

As a reminder, the High Council for Public Health recommends that a child with scarlet fever or GAS tonsillitis be kept out of school or other group settings (for up to 2 days after starting antibiotic therapy) [8]. A suspected case of non-invasive GAS infection (e.g., strep throat, scarlet fever) should prompt an immediate consultation to confirm the cause so that appropriate treatment can be initiated.

Implementation of Enhanced Surveillance

Active surveillance is being implemented by Santé publique France and the GFRUP (Francophone Group for Pediatric Intensive Care and Emergency Medicine) to supplement the existing surveillance system, better assess the epidemiological situation, and characterize severe cases admitted to intensive care.

This data collection complements the microbiological surveillance of Group A streptococci conducted by the National Reference Center for Streptococci, as well as that of the EPIBAC network. The GAS strains submitted to the NRC by bacteriology laboratories are characterized there, particularly at the genotypic level.

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