Flamant Alix, Faury Hélène, Luscan Romain, Couloigner Vincent, Pouletty Marie, Bustarret Olivier, Chappuy Hélène, Gaume Mathilde, Drummond David, Pinhas Yael, Toubiana Julie, Ferroni Agnès, Cohen Jérémie F
From the General Pediatrics and Pediatric Infectious Diseases.
Department of Clinical Microbiology.
Pediatr Infect Dis J. 2025 Jun 4. doi: 10.1097/INF.0000000000004872.
An unexpected surge in severe Group A Streptococcus (GAS) infections occurred during 2022-2023. We assessed changes in the epidemiology and clinical characteristics of severe GAS infections during and after the COVID-19 pandemic.
We analyzed severe GAS infections in children admitted to a university hospital in Paris, France (2018-2023). Proven and probable invasive GAS (iGAS and piGAS) cases were included. Using time-series analysis, we modeled the incidence of severe GAS infections across 4 periods: prepandemic, early pandemic, late pandemic and postpandemic. Infection characteristics were also compared between periods.
We included 269 children with severe GAS infections (mean age 4.0 ± 4.0 years), including 92 iGAS cases. Most cases were severe ear-nose-throat (ENT) infections (192/269, 71%), followed by bone and joint infections (10%) and pleural empyema (8%). In the early pandemic period, GAS infections decreased by 83% [incidence rate ratio (IRR) 0.17 (95% CI: 0.10-0.27)], but increased significantly in the late pandemic period [IRR 1.65 (95% CI: 1.22-2.24)]. Postpandemic incidence returned to prepandemic levels [IRR 0.97 (95% CI: 0.68-1.38)]. Compared to other periods, late pandemic cases were more severe, with longer hospital stays (9.4 vs. 6.4 days; P = 0.0007), more iGAS forms (47% vs. 28%; P = 0.001), increased proportions of pleural empyema (15% vs. 4%) and bone and joint infections (14% vs. 7%; P = 0.008), and more complicated ENT infections (22% vs. 7%; P = 0.003).
The late COVID-19 pandemic period was marked by a rise in both the incidence and severity of GAS infections. These findings may improve preparedness in future pandemics.
2022 - 2023年期间，A组链球菌（GAS）严重感染意外激增。我们评估了新冠疫情期间及之后严重GAS感染的流行病学和临床特征变化。
我们分析了法国巴黎一家大学医院收治的儿童严重GAS感染病例（2018 - 2023年）。纳入确诊和疑似侵袭性GAS（iGAS和piGAS）病例。采用时间序列分析，我们对4个时期的严重GAS感染发病率进行建模：疫情前、疫情早期、疫情后期和疫情后。还比较了各时期的感染特征。
我们纳入了269例严重GAS感染儿童（平均年龄4.0±4.0岁），其中包括92例iGAS病例。大多数病例为严重的耳鼻喉（ENT）感染（192/269，71%），其次是骨和关节感染（10%）和胸膜脓胸（8%）。在疫情早期，GAS感染减少了83%[发病率比（IRR）0.17（95%CI：0.10 - 0.27）]，但在疫情后期显著增加[IRR 1.65（95%CI：1.22 - 2.24）]。疫情后发病率恢复到疫情前水平[IRR 0.97（95%CI：0.68 - 1.38）]。与其他时期相比，疫情后期的病例更严重，住院时间更长（9.4天对6.4天；P = 0.0007），iGAS形式更多（47%对28%；P = 0.001），胸膜脓胸（15%对4%）和骨和关节感染（14%对7%；P = 0.008）的比例增加，复杂的耳鼻喉感染更多（22%对7%；P = 0.003）。
新冠疫情后期的特点是GAS感染的发病率和严重程度均有所上升。这些发现可能会提高未来大流行期间的应对准备。
