Wrenn Katie, Blomquist Paula Bianca, Inzoungou-Massanga Carmellie, Olufon Oluwakemi, Guy Rebecca L, Hatziioanou Diane, Findlater Lucy, Smith Iona, Mirfenderesky Mariyam, Luyt Karen, Williams Tom, Stoianova Sylvia, Dickinson Michelle, Pietzsch Maaike, Jarvis Christopher I, Brown Colin, Lamagni Theresa, Kumar Deepti
Rapid Investigation Team, UK Health Security Agency, London, UK.
Rapid Investigation Team, UK Health Security Agency, London, UK.
Lancet. 2023 Nov;402 Suppl 1:S93. doi: 10.1016/S0140-6736(23)02095-0.
Following low incidence of invasive group A streptococcal (iGAS) infections during the COVID-19 pandemic, marked increases were noted in many countries during 2022, particularly in children. In November 2022, severe presentations of lower respiratory tract infections (LRTIs), including empyema, were notified by clinicians across the UK. UKHSA investigated this rise with the aim of informing clinical management and public health response.
We undertook a case-series analysis using multiple routine data sources, exempted from ethics approval or patient consent. We identified iGAS cases in England in children younger than 15 years with an LRTI reported between Oct 1 and Dec 21, 2022, using UKHSA laboratory surveillance data (GAS detected in LRT specimens) and notifications by clinicians and Health Protection Teams (HPTs). Symptoms, diagnoses, health-care interactions, and outcome (death or recovery) data were obtained from HPT case management notes, the National Child Mortality Database, and the NHS Digital Emergency Care Dataset.
We identified 147 cases of LRTI iGAS in children across England (77 [52%] male, 70 [48%] female; median age 4 years [IQR 2-6]). Predominant ethnicities were White (74 [65%] of 113 with known ethnicity) and Asian (18 [16%] of 113). Most reported symptoms were fever (90 [75%] of 120 children with ≥1 symptom) and cough (60 [50%] of 120), and 71 (48%) of all 147 children had a diagnosed respiratory viral coinfection (most commonly hMPV and RSV). 127 (86%) of children attended an emergency department, 31% (n=36/114 with onset date) at least twice within 21 days after symptom onset. 37 (25%) of 147 children died, with a median time from symptom onset to death of 4 days (IQR 3-7). Of 32 children with sample dates, 16 (84%) were tested for GAS on or after the day they died. Over half of deaths (21 [57%] of 37 deaths) occurred in the community after rapid deterioration, of whom 18 had previous contact with health-care services documented.
The UK saw an unusual rise in iGAS LRTIs in children in late 2022. One in four cases died, over half in the community. Non-specific symptoms, viral symptoms, or positive virology might have lowered suspicion of bacterial infection. Although the use of multiple available data sources expedited the analysis, varying data completeness limited interpretation. Our study highlights the need for earlier detection and identification of effective measures to prevent death.
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在新冠疫情期间侵袭性A组链球菌（iGAS）感染发病率较低之后，2022年许多国家出现了显著上升，尤其是在儿童中。2022年11月，英国各地的临床医生报告了包括脓胸在内的下呼吸道感染（LRTIs）的严重病例。英国卫生安全局（UKHSA）对这一上升情况进行了调查，目的是为临床管理和公共卫生应对提供信息。
我们使用多个常规数据源进行了病例系列分析，无需伦理批准或患者同意。我们利用UKHSA实验室监测数据（在LRT标本中检测到的GAS）以及临床医生和健康保护团队（HPTs）的通报，确定了2022年10月1日至12月21日期间报告患有LRTI的15岁以下英格兰儿童中的iGAS病例。症状、诊断、医疗保健互动及结局（死亡或康复）数据来自HPT病例管理记录、国家儿童死亡数据库和NHS数字急诊护理数据集。
我们在英格兰各地的儿童中确定了147例LRTI iGAS病例（77例[52%]为男性，70例[48%]为女性；中位年龄4岁[IQR 2 - 6]）。主要种族为白人（113例已知种族中有74例[65%]）和亚洲人（113例中有18例[16%]）。大多数报告的症状为发热（120例有≥1种症状的儿童中有90例[75%]）和咳嗽（120例中有60例[50%]），所有147例儿童中有71例（48%）被诊断为呼吸道病毒合并感染（最常见的是hMPV和RSV）。127例（86%）儿童前往了急诊科，31%（n = 36/有发病日期的114例）在症状出现后21天内至少去过两次。147例儿童中有37例（25%）死亡，从症状出现到死亡的中位时间为4天（IQR 3 - 7）。在有采样日期的32例儿童中，16例（84%）在死亡当天或之后接受了GAS检测。超过一半的死亡病例（37例死亡中的21例[57%]）在病情迅速恶化后发生在社区，其中18例有之前与医疗保健服务接触的记录。
2022年末英国儿童中iGAS LRTIs出现异常上升。四分之一的病例死亡，超过一半在社区死亡。非特异性症状、病毒症状或病毒学检测呈阳性可能降低了对细菌感染的怀疑。尽管使用多个可用数据源加快了分析速度，但不同的数据完整性限制了解读。我们的研究强调了早期检测和确定有效预防死亡措施的必要性。
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