Over the past two weeks, clinicians and pediatric intensivists have 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. Since the beginning of 2022, the CNR has also observed an increase in the proportion of pediatric strains, and since the summer of 2022, an increase in the number of pediatric invasive infection strains compared to previous years.

These invasive Group A Streptococcus infections (IISGA) have occurred in various regions (Occitanie, Auvergne-Rhône-Alpes, Nouvelle-Aquitaine) and primarily in children under 10 years of age. As part of its surveillance and alert missions, Santé publique France, in collaboration with its partners, is strengthening surveillance of these infections.

Group A Streptococcal Invasive Infections in France

Group A Streptococcus (GAS) is a strictly human pathogen transmitted via 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.

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. The protocol for this surveillance will be published shortly on our website.
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. Group A streptococcus (GAS) strains submitted to the National Reference Center by bacteriology laboratories are characterized there, particularly at the genotypic level.

As a reminder, the surveillance of invasive infections, including those related to Group A Streptococcus (Streptococcus pyogenes), conducted by Santé publique France relies on the EPIBAC network, whose objective is to estimate the incidence of invasive infections in France, track their trends over time, and describe the main epidemiological characteristics of hospitalized patients.

Data from the EPIBAC network show that invasive GAS infections were steadily increasing between 2003 and 2019. During this period, they affected approximately 1,500 to 2,500 people each year, nearly 10% of whom were children under the age of 10. In 2020, the incidence of these infections was declining, and this trend continued in 2021.

• See: EPIBAC Public Health Bulletin: Surveillance of Invasive Bacterial Infections in 2020

For more information:

• Opinion of the French High Council for Public Health