Tropical Diseases Research Group, Murdoch Children's Research Institute.
Department of Infection and Immunity, Monash Children's Hospital.
Curr Opin Infect Dis. 2024 Dec 1;37(6):485-493. doi: 10.1097/QCO.0000000000001064. Epub 2024 Sep 7.
We describe the epidemiology of the recent global surge in invasive group A streptococcal (GAS) disease and consider its proximate and distal causes. We highlight important knowledge gaps regarding clinical management and discuss potential strategies for prevention.
Rates of invasive GAS (iGAS) disease were increasing globally prior to the COVID-19 pandemic. Since mid-2022, following the worst years of the pandemic in 2020 and 2021, many countries with systems to monitor GAS syndromes have reported surges in cases of iGAS concurrent with increased scarlet fever, pharyngitis, and viral co-infections. The emergence of the hypervirulent M1 UK strain as a cause of iGAS, particularly in high income countries, is concerning. New data are emerging on the transmission dynamics of GAS. GAS remains universally susceptible to penicillin but there are increasing reports of macrolide and lincosamide resistance, particularly in invasive isolates, with uncertain clinical consequences. Intravenous immunoglobulin is used widely for streptococcal toxic shock syndrome and necrotizing soft tissue infections, although there is limited clinical evidence, and none from a completed randomized controlled trial. Intensive and expensive efforts at population-level control of GAS infections and postinfectious autoimmune complications have been only partially successful. The great hope for control of GAS diseases remains vaccine development. However, all modern vaccine candidates remain in the early development stage.
In many countries, iGAS rates surged from mid-2022 in the aftermath of pandemic control measures and physical distancing. The emergence of a dominant hypervirulent strain is an important but incomplete explanation for this phenomenon. Clinical management of iGAS remains highly empirical and new data has not emerged. A vaccine remains the most likely means of achieving a sustainable reduction in the burden of iGAS.
我们描述了近期全球侵袭性 A 组链球菌（GAS）疾病的全球流行情况，并探讨了其近期和远期原因。我们强调了在临床管理方面的重要知识空白，并讨论了潜在的预防策略。
在 COVID-19 大流行之前，侵袭性 GAS（iGAS）疾病的发病率一直在全球范围内上升。自 2022 年年中以来，在 2020 年和 2021 年疫情最严重的几年之后，许多有监测 GAS 综合征系统的国家报告称，iGAS 病例激增，同时猩红热、咽炎和病毒合并感染增加。高毒力 M1 UK 株作为 iGAS 的一个原因出现，特别是在高收入国家，令人担忧。关于 GAS 传播动力学的新数据不断出现。GAS 仍然普遍对青霉素敏感，但越来越多的报告显示，特别是在侵袭性分离株中，大环内酯类和林可酰胺类耐药性增加，其临床后果尚不确定。静脉注射免疫球蛋白广泛用于链球菌中毒性休克综合征和坏死性软组织感染，尽管临床证据有限，且没有一项来自完成的随机对照试验。在人群层面上控制 GAS 感染和感染后自身免疫性并发症的密集和昂贵的努力只取得了部分成功。控制 GAS 疾病的最大希望仍然是疫苗的开发。然而，所有现代疫苗候选者仍处于早期开发阶段。
在许多国家，iGAS 发病率从 2022 年年中开始在大流行控制措施和保持社交距离之后飙升。一个占主导地位的高毒力菌株的出现是这一现象的一个重要但不完整的解释。iGAS 的临床管理仍然高度经验性，新的数据尚未出现。疫苗仍然是实现 iGAS 负担可持续减少的最有可能手段。
