A Cluster of Pediatric Invasive Group A Streptococcus Disease in Melbourne, Australia, Coinciding with a High-Burden Influenza Season

Wong, Nicole X; Crawford, Nigel; Oliver, Jane; McMinn, Alissa; Ching, Natasha S; Baker, Ciara; Smeesters, Pierre; Daley, Andrew J; Steer, Andrew C.

doi:10.1055/s-0038-1677456

Cited by 7 publications

(7 citation statements)

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“…A concerning burden of disease was documented, concentrated among young children and infants, including a high proportion (12%) of Australian Aboriginal and Torres Strait Islander people, who comprise 3% of the national Australian population. As indicated by previous research in Victoria, Australia, the rate of paediatric iGAS disease among our cohort appeared to broadly correlate with national notifications for influenza, although on a greatly reduced scale [31]. Cases of influenza and iGAS co-infection have been frequently reported in the international literature [40].…”

Section: Discussionsupporting

confidence: 75%

“…Local Australian surveillance data indicates that the incidence rate of iGAS disease is increasing in Victoria, with a new high level reached in 2017, of 3.6/100,000 (95% confidence interval, CI: 3.2–4.1/100,000; i.e. 220 new cases that year) [30, 31]. A 2017 outbreak among Victorian children is especially concerning, and was associated with a high burden of seasonal influenza [31].…”

Section: Introductionmentioning

confidence: 99%

“…220 new cases that year) [30, 31]. A 2017 outbreak among Victorian children is especially concerning, and was associated with a high burden of seasonal influenza [31]. As iGAS disease is currently notifiable only in two Australian jurisdictions (Northern Territory & Queensland), it is difficult to accurately ascertain the burden of disease [10, 12].…”

Section: Introductionmentioning

confidence: 99%

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Invasive group A Streptococcus disease in Australian children: 2016 to 2018 – a descriptive cohort study

et al. 2019

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ObjectivesInvasive group A Streptococcus (iGAS) disease is serious and sometimes life-threatening. The Paediatric Active Enhanced Disease Surveillance (PAEDS) Network collects voluntary notifications from seven major Australian paediatric hospitals on patients with certain conditions, including iGAS disease. Our aims were to: 1) Describe the epidemiological distribution of paediatric iGAS disease in Australia and correlate this with influenza notifications, 2) Identify GAS strains commonly associated with invasive disease in children.MethodsIGAS and influenza notification data were obtained (from the PAEDS Network and the Australian Institute of Health and Welfare, respectively, for the period 1 July 2016 to 30 June 2018). Included iGAS patients had GAS isolated from a normally sterile body site. Data were described according to selected clinical and demographic characteristics, including by age group and Australian State, with proportions and minimum incidence rates estimated.ResultsA total of 181 patients were identified, with most (115, 63.5%) <5 years old. The mean annual minimum incidence rate was 1.6 (95% confidence interval: 1.1–2.3) per 100,000 children across the study period. An epidemiological correlation with the seasonal burden of influenza was noted. Contact prophylaxis was not consistently offered. Of 96 patients with emm-typing results available, 72.9% showed emm-1, −4 or − 12.ConclusionsRobust surveillance systems and cohesive patient management guidelines are needed. Making iGAS disease nationally notifiable would help facilitate this. Influenza vaccination may contribute to reducing seasonal increases in iGAS incidence. The burden of disease emphasises the need for ongoing progress in GAS vaccine development.

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Section: Discussionsupporting

confidence: 75%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Invasive group A Streptococcus disease in Australian children: 2016 to 2018 – a descriptive cohort study

et al. 2019

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“…The peak incidence of paediatric invasive Strep A disease in two tertiary hospitals in Melbourne, Victoria from 1 June 2017 to 31 October 2017 was 16.5 per 10 000 hospitalisations, an increase from 2.85 per 10 000 in the preceding 5 months 13 . This coincided with an increase in influenza.…”

Section: Introductionmentioning

confidence: 92%

The Australian burden of invasive group A streptococcal disease: a narrative review

Wright

Langworthy

Manning

2021

Internal Medicine Journal

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The Australian and New Zealand governments have allocated significant funding to advance efforts towards a group A Streptococcus (Strep A) vaccine. The argument for Strep A vaccine development has to date focussed on prevention of non‐invasive disease (e.g. pharyngitis) and immune‐mediated complications (especially rheumatic heart disease). Because of the poorer prognosis and theoretically more precisely known burden of invasive, compared to non‐invasive disease, exploration of the burden of invasive Strep A disease could lend further support to the vaccine business case. This narrative review critically assesses the Australian incidence of invasive Strep A disease. Case notification data were first assessed through government sources, expressing annual incidence as cases per 100 000 population. Published literature accessed through PubMed and MEDLINE was assessed to March 2020. Where estimates could be updated by replicating reported methods with publicly available data, this was performed. Invasive Strep A disease is currently notifiable in Queensland and the Northern Territory only. The magnitude, degree of certainty and recency of estimates vary by state/territory and between sub‐populations, including higher incidence among Indigenous Australians compared to non‐Indigenous Australians. According to inpatient records from 2017 to 2018, the Australian incidence of invasive Strep A disease was 8.3 per 100 000. However, this is likely to be an underestimate. Preventing invasive Strep A disease is an important use for a Strep A vaccine. This narrative review highlights deficiencies in our current understanding of the Australian disease burden. These difficulties would be overcome by nationally consistent mandatory case reporting.

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“…35,36 The high caseload and severity may be related to the 2017 winter influenza outbreak in Victoria. 37 Epidemiologic links between influenza and iGAS infection have been described previously. Mouse models have showed that influenza enhances the virulence of GAS in the alveoli.…”

Section: Discussionmentioning

confidence: 98%

Clinical Description and Outcomes of Australian Children With Invasive Group A Streptococcal Disease

Thielemans

Oliver

McMinn

et al. 2020

Pediatric Infectious Disease Journal

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Background: Invasive group A streptococcal disease is a severe infection with a high case fatality rate, estimated to cause more than 150,000 deaths per year worldwide. The clinical presentation of this infection is variable, and early diagnosis can be challenging. There are few data on its short-and longer-term outcomes, especially in children. The aim of this study was to assess the clinical presentation, management and short-and longer-term outcomes of invasive group A streptococcal disease in children in Australia. Methods: We undertook a prospective surveillance study of children with laboratory-confirmed invasive group A streptococcus disease admitted to 7 sentinel tertiary and quaternary pediatric hospitals in Australia between July 2016 and June 2018. We collected demographic and clinical data and contacted patients 6 months after discharge to assess longer-term outcomes. Results: We enrolled 181 children, 7 days to 16 years of age. The principal site of invasive infection was blood (126 children, 69.6%), and the most frequent clinical presentation was pneumonia in 46 children (25.4%). Twentysix children developed streptococcal toxic shock syndrome (14.4%), and 74 had severe disease (40.9%), including 71 admitted to the intensive care unit. Five children died (2.8%). At discharge and 6 months, 29.3% and 15.2% of the children had persisting health problems, respectively. Conclusions: Invasive group A streptococcal infection in Australian children is frequently severe and has a high long-term morbidity burden, highlighting the need for strengthened clinical care pathways, epidemiological surveillance and prevention strategies.

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A Cluster of Pediatric Invasive Group A Streptococcus Disease in Melbourne, Australia, Coinciding with a High-Burden Influenza Season

Cited by 7 publications

References 10 publications

Invasive group A Streptococcus disease in Australian children: 2016 to 2018 – a descriptive cohort study

Invasive group A Streptococcus disease in Australian children: 2016 to 2018 – a descriptive cohort study

The Australian burden of invasive group A streptococcal disease: a narrative review

Clinical Description and Outcomes of Australian Children With Invasive Group A Streptococcal Disease

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