Frequency of transmission, asymptomatic shedding, and airborne spread of Streptococcus pyogenes in schoolchildren exposed to scarlet fever: a prospective, longitudinal, multicohort, molecular epidemiological, contact-tracing study in England, UK

Cordery, Rebecca; Purba, Amrit Kaur; Begum, Lipi; Mills, Ewurabena; Mosavie, Mia; Vieira, Ana; Jauneikaite, Elita; Leung, Rhoda C. Y.; Siggins, Matthew K.; Ready, Derren; Hoffman, Peter; Lamagni, Theresa; Sriskandan, Shiranee

doi:10.1016/s2666-5247(21)00332-3

Cited by 38 publications

(43 citation statements)

References 27 publications

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“…For S. pneumoniae , studies have observed that progression from benign carriage to invasive infection often occurs only a few days after the acquisition of an upper airway infection [ 42 , 43 , 44 ]. Furthermore, airborne transmission of S. pyogenes has been postulated as being an outbreak of scarlet fever in school children [ 45 ], whereas airborne transmission of S. pneumoniae was only demonstrated among closely housed ferrets that were co-infected with the influenza A virus [ 46 ]. Some evidence of droplet transmission of S. pneumoniae was reported in outbreak settings [ 47 , 48 ].…”

Section: Discussionmentioning

confidence: 99%

Decreased Antibiotic Consumption Coincided with Reduction in Bacteremia Caused by Bacterial Species with Respiratory Transmission Potential during the COVID-19 Pandemic

Cheng

Wong

et al. 2022

Antibiotics

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Nonpharmaceutical interventions implemented during the COVID-19 pandemic (2020–2021) have provided a unique opportunity to understand their impact on the wholesale supply of antibiotics and incidences of infections represented by bacteremia due to common bacterial species in Hong Kong. The wholesale antibiotic supply data (surrogate indicator of antibiotic consumption) and notifications of scarlet fever, chickenpox, and tuberculosis collected by the Centre for Health Protection, and the data of blood cultures of patients admitted to public hospitals in Hong Kong collected by the Hospital Authority for the last 10 years, were tabulated and analyzed. A reduction in the wholesale supply of antibiotics was observed. This decrease coincided with a significant reduction in the incidence of community-onset bacteremia due to Streptococcus pyogenes, Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis, which are encapsulated bacteria with respiratory transmission potential. This reduction was sustained during two pandemic years (period 2: 2020–2021), compared with eight pre-pandemic years (period 1: 2012–2019). Although the mean number of patient admissions per year (1,704,079 vs. 1,702,484, p = 0.985) and blood culture requests per 1000 patient admissions (149.0 vs. 158.3, p = 0.132) were not significantly different between periods 1 and 2, a significant reduction in community-onset bacteremia due to encapsulated bacteria was observed in terms of the mean number of episodes per year (257 vs. 58, p < 0.001), episodes per 100,000 admissions (15.1 vs. 3.4, p < 0.001), and per 10,000 blood culture requests (10.1 vs. 2.1, p < 0.001), out of 17,037,598 episodes of patient admissions with 2,570,164 blood culture requests. Consistent with the findings of bacteremia, a reduction in case notification of scarlet fever and airborne infections, including tuberculosis and chickenpox, was also observed; however, there was no reduction in the incidence of hospital-onset bacteremia due to Staphylococcus aureus or Escherichia coli. Sustained implementation of non-pharmaceutical interventions against respiratory microbes may reduce the overall consumption of antibiotics, which may have a consequential impact on antimicrobial resistance. Rebound of conventional respiratory microbial infections is likely with the relaxation of these interventions.

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Section: Discussionmentioning

confidence: 99%

Decreased Antibiotic Consumption Coincided with Reduction in Bacteremia Caused by Bacterial Species with Respiratory Transmission Potential during the COVID-19 Pandemic

Cheng

Wong

et al. 2022

Antibiotics

View full text Add to dashboard Cite

show abstract

“…Transmission in schools might well alter when interventions relax, and when more transmissible variants arise, as occurred in late 2021. 31 Secondly, participation rates of contacts were very low, compared with participation rates of higher than 40% in our earlier contact tracing study 14 also involving throat swabs, lowering confidence in ruling out any bubble transmission. Low participation is reported in other studies in England that detect asymptomatic SARS-CoV-2 infections, 32 contrasting with high participation in Nordic countries.…”

Section: Discussionmentioning

confidence: 73%

“…The infrequency of transmission to other pupils contrasts with transmission frequency of other respiratory infections in schools, including group A streptococcus and influenza. 12 , 13 , 14 The result presumably reflects the multiple interventions in place during the pandemic period or the heterogeneity of infection in COVID-19, where most transmission is caused by a minority of infections. 24 , 25 …”

Section: Discussionmentioning

confidence: 99%

“…Forward contact tracing offers an opportunity to search actively for secondary infections in a controlled manner. Before the COVID-19 pandemic and the institution of several interventions to limit the spread of SARS-CoV-2, we did a scarlet fever forward contact tracing study 14 in schools and observed outbreak strains spread to over one quarter of classroom contacts, despite treatment and isolation of index cases, alongside evidence of pathogen dispersal into air. 14 We adapted our protocol to investigate transmission of SARS-CoV-2 by children in schools and households.…”

Section: Introductionmentioning

confidence: 99%

“…Before the COVID-19 pandemic and the institution of several interventions to limit the spread of SARS-CoV-2, we did a scarlet fever forward contact tracing study 14 in schools and observed outbreak strains spread to over one quarter of classroom contacts, despite treatment and isolation of index cases, alongside evidence of pathogen dispersal into air. 14 We adapted our protocol to investigate transmission of SARS-CoV-2 by children in schools and households. The Transmission of Coronavirus-19 in Kids (TraCK) study aimed to assess the risk posed by a SARS-CoV-2-infected child who attends school via longitudinal sampling of the child, school and household contacts, and associated environments (surfaces and air), to evaluate and inform interventions to limit the spread of COVID-19.…”

Section: Introductionmentioning

confidence: 99%

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